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Costs-effectiveness Analysis of Elective Cesarean Section Compared with Vaginal Delivery: a prospective cohort study in a hospital in León, Nicaragua
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
2016 (English)Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]


There is an increasing rate of cesarean section globally. Both low and high cesarean section rates are associated with maternal and neonatal mortality and morbidities. In Nicaragua, the rate of cesarean section is beyond the WHO recommendation of 10% to 15%.


The aim of this study was to evaluate the costs-effectiveness of elective caesarean section when compared with vaginal delivery in hospital in Nicaragua, a lower-middle income setting.


A 3 months prospective cohort study was conducted in a hospital in León, Nicaragua, from 1st May 2010 to 31st July 2010. Two questionnaires were used to obtain data, one on costs and maternal complications after delivery, and the other on postpartum complications. A descriptive analysis regarding maternal and neonatal outcomes, and a cost-effectiveness analysis were conducted comparing elective cesarean section with vaginal delivery, followed by a sensitivity analysis regarding change on rates of elective cesarean section.


The cesarean section rate was 37.9%, and the elective cesarean section rate was 21%. The percentage of live births was 99.6% in elective cesarean section group and 98.9% in vaginal delivery group. Cesarean section had both positive and negative influences on maternal complications and postpartum complications. The costs of elective cesarean section was higher than vaginal delivery ($66 compared to $39.36). For one more live birth, 3805.71 US dollars were needed.


The maternal outcomes of cesarean section need to be improved. With the increasing cesarean section rates, more medical resources are needed in the future.

Place, publisher, year, edition, pages
2016. , 49 p.
Keyword [en]
cesarean section, cost-effectiveness analysis, Nicaragua
National Category
Public Health, Global Health, Social Medicine and Epidemiology
URN: urn:nbn:se:uu:diva-296385OAI: oai:DiVA.org:uu-296385DiVA: diva2:941815
Educational program
Master Programme in International Health
Available from: 2016-09-02 Created: 2016-06-15 Last updated: 2016-09-02Bibliographically approved

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International Maternal and Child Health (IMCH)
Public Health, Global Health, Social Medicine and Epidemiology

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