Caesareansection (C-section) considered as a public health problem, is one of the mostcommon surgeries in the world 1. The procedure is often performed without medicalneed, hence putting women and their babies at risk of short- and long-termhealth problems. Recently, it has been reported that the rates of C-section continueto skyrocket, particularly in high- and middle-income countries 12.

The international healthcare community consideredthe ideal rate for cesarean sections tobe between 10% and 15% 12 3. On the hand, Malawifollows the United Nations (UN) process indicators, which recommend that aminimum of 5% and a maximum of 15% of all births should be delivered byC-section 4. However, the World Health Organization (WHO)underscores the importance of focusing on the needs of the patient and discouragesthe practice of aiming for target rates 2. C-section may be necessary when vaginal deliverymight pose a risk to the mother or baby especially due to prolonged labor,fetal distress, or because the baby is presenting in an abnormal position 13. Unfortunately, the procedure can cause significant problems,disability or death, predominantly in settings that lack the facilities toconduct safe surgeries or treat potential complications 23.Previousstudies in many settings have reported that the causes of an increase in C-sections are multifactorial and poorlyunderstood 5.

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Notably, changes in maternal characteristics (i.e.higher educational education, rise in maternal age, prior cesarean section, prolongedlabor, and increasing maternal Body Mass Index) 56, infant characteristics (i.e. baby weight – suspectedlow infant birthweight or macrosomia, length of the baby) 67 and professional practice styles, increasingmalpractice pressure – private hospital status, as well as economic,organizational, social and cultural factors have all been implicated in an increase in C-sections 5. Cesarean section is one of the most important risk factors for postpartum maternal infection whichaccount for approximately 10% of pregnancy-related mortality and it carries a risk of infection 5 to 20 times that of vaginaldelivery 8910. It.

In Malawi, since1992, the rates of C-sections have been on the riseas it was reported that only 3% of births occurred with C-section in 1992-2000compared with 5% in 2010 and 6% in 2015-16 11. To the best of ourknowledge, few studies have until now been conducted to address the factorsthat affect C-section in Malawi. For better results on C-sections, it isnecessary to contextualize the sociocultural determinants in addition to thecurrent healthcare model. Thus, the present study aimed to investigate theassociated factors of C-sections from2004 to 2015 using the population-baseddata.