Assessing the Factors Affecting Cesarean Section Selection in Iranian Women Using Multilevel Count Models with Excess Zeros

Eghbal Zandkarimi; Abbas Moghimbeigi; Hossein Mahjub

doi:10.18502/ijph.v50i4.6008

Eghbal Zandkarimi Departement of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
Abbas Moghimbeigi Department of Biostatistics and Epidemiology, School of Health & Research Center for Health, Safety and Environment, Alborz University of Medical Sciences, Karaj, Iran
Hossein Mahjub Research Center for Health Sciences, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

DOI: https://doi.org/10.18502/ijph.v50i4.6008

Keywords: Cesarean delivery; Vaginal delivery; Multilevel models; Zero-inflated

Abstract

Background: Iran has ranked second in the frequency of cesarean delivery (CD) and this rate in 2014 has increased by 56 percent. The CD has multiple complications for the woman and newborn, and due to the women's readmission after surgery impose additional costs to the countries. Although CD has many complications and is not recommended by obstetrician and midwives; some factors affect the choice of this method of delivery.

Methods: We used data from the Iranian Institute for Health Sciences Research (IIHSR) in 2015. We studied the effects of factors such as socioeconomic and demographic factors and supplemental insurance status in the choice of CD. We used multilevel Zero-Inflated models for the modeling of data.

Results: The employed women resident in urban areas with the high-income and age greater than 34-yr old and supplemental insurance more likely chose CD. On the other hand, women with high education level, women who use at least one media (e.g. Radio, television, etc.) and women that use contraceptive methods have chosen the less CD.

Conclusion: Our findings highlighted the importance of supplemental insurance and socio-economic status in choosing a CD by women. However, in some cases especially in the rich class of society, the high cost of this type of delivery does not affect the choice decrease of it, and governments should adopt rigorous policies in using this method.