Epidemiologic trends in caesarean section delivery in Hamadan province during 1998-2019 using join point regression analysis

Due to the growing trend of caesarean section rate in Iran in the past years, natural childbirth promotion program was implemented as one of the health system transformation plan in 2014. In this research, the trend of changes in the percentage of cesarean deliveries following the implementation of this program in Hamadan province has been evaluated.

The current research was conducted using secondary data as a longitudinal study with the aim of investigating the changes in the rate of cesarean delivery in the 22 years of period. The data required for this study included deliveries from April 1998 to March 2019 by delivery type. The statistical analysis of this study was done by joining point regression method using joinpoint version 3.4 software.

The percentage of cesarean deliveries in the whole province during the studied time period has always been increasing and has reached from about 32% in 2017 to about 48% in 2019. The results of the joinpoint regression showed that, in Hamadan province, an annual increase of 1.9% (95% CI: 0.7, 3) in the trend of caesarean section was observed (p<0.05). The trend has some joinpoints that none of them corresponds to the timing of the implementation of the health evolution plan.

Based on the obtained results, although the transformation plan has been able to reduce the increasing percentage of cesarean births, but this amount of changes was not high and could not achieve the predetermined goals of health transformation plan.