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Authors




Objectives:


To determine the general contextual effect of the department in the variation of Cesarean section in Colombia in 2016, and their individual and contextual related factors.




Methods:


A cross-sectional study based on a birth cohort. We used the birth certificate database from January 1 to December 31, 2016. Three multilevel logistic models were constructed. Pregnant women were set at the first level and department at the second level. We fitted a null multilevel model followed by two multiple models, including individual and individual and department variables, respectively.




Results:


The overall prevalence of C-sections was 45.5% (95% CI: 45.4-45.6), ranged from 5 to 76%. The variance partition coefficient was 15%. Individual factors did not explain the general contextual effect. However, the region to which these departments belong explained 71% of the variance. The Caribbean region was positively associated with C-section compared to the Andean region (OR:3.88, 95% CI: 2.65-5.67).




Conclusions:


Multilevel analysis of individual heterogeneity and discriminatory accuracy showed that the department plays an important role in the variation of C-sections in Colombia. Our results suggest that the proportional universalism approach should be applied to reduce the proportion of C-Section, focusing on departments with the highest risk and on the Caribbean and Insular region.




 

Merida Rodriguez-Lopez, Pontificia Universidad Javeriana. Facultad de Ciencias de la Salud. Departamento de Salud Pública y Epidemiología. Centro Interdisciplinario de Estudios en Salud. Cali, Colombia

orcid_id14.png https://orcid.org/0000-0001-8245-0811

Elsa Lorena Correa-Avendaño, Pontificia Universidad Javeriana. Facultad de Ciencias de la Salud. Departamento de Salud Pública y Epidemiología. Centro Interdisciplinario de Estudios en Salud. Cali, Colombia

orcid_id14.png  https://orcid.org/0000-0002-3972-0174

Ana Maria Martinez-Avila, Pontificia Universidad Javeriana. Facultad de Ciencias de la Salud. Departamento de Salud Pública y Epidemiología. Centro Interdisciplinario de Estudios en Salud. Cali, Colombiai

orcid_id14.png https://orcid.org/0000-0001-7998-3668

Juan Merlo, Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden. Center for Primary Health Care Research, Region Skåne, Malmö, Sweden

orcid_id14.png https://orcid.org/0000-0001-8379-9708

Rodriguez-Lopez, M., Correa-Avendaño, E. L., Martinez-Avila, A. M., & Merlo, J. (2021). Multilevel analysis of birthplace effect on the proportion of C-Section in Colombia. Colombia Medica, 52(3), e2044411. https://doi.org/10.25100/cm.v52i3.4411

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Received 2020-06-25
Accepted 2021-12-13
Published 2021-11-10