Table 3. Multilevel logistic regression models for the association of caesarean delivery with socio-demographic characteristics and the interactions of the working status and wealth quintile with place of residence at five-time points (BDHS Surveys: 2004, 2007, 2011, 2014, 2017/18).
| Characteristics | BDHS 2004, OR (95% CI) | BDHS 2007, OR (95% CI) | BDHS 2011, OR (95% CI) | BDHS 2014, OR (95% CI) | BDHS 2017/18, OR (95% CI) |
|---|---|---|---|---|---|
| Maternal age at birth of the last child | |||||
| ≤19 (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 20–34 | 1.45 (0.97–2.16) | 1.53 (1.10–2.12)*** | 1.34 (1.09–1.66)*** | 1.28 (1.021.62)** | 1.35 (1.11–1.64)*** |
| ≥35 | 3.77 (1.65–8.63)*** | 2.87 (1.34–6.13)*** | 1.92 (1.13–3.26)*** | 2.18 (1.27–3.47)*** | 1.93 (1.28–2.91)*** |
| Maternal educational status | |||||
| Primary (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| No education | 1.18 (0.61–2.28) | 0.71 (0.35–1.43) | 0.98 (0.65–1.45) | 0.80 (0.52–1.23) | 1.18 (0.78–1.77) |
| Secondary | 1.43 (0.87–2.33) | 2.29 (1.47–3.58)*** | 1.20 (0.95–1.51) | 1.46 (1.06–2.03)** | 1.48 (1.19–1.84)*** |
| Higher | 2.28 (1.14–4.56)** | 2.86 (1.70–4.79)*** | 2.05 (1.44–2.92)*** | 1.73 (1.16–2.57)** | 2.04 (1.50–2.78)*** |
| Women’s working status | |||||
| Engaged in formal work (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Not engaged in formal work | 1.18 (0.72–1.93) | 1.25 (0.83–1.89) | 1.78 (1.25–2.53)*** | 1.56 (1.00–2.41)** | 1.07 (0.79–1.43) |
| Partner’s educational status | |||||
| Primary (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| No education | 0.64 (0.34–1.21) | 1.26 (0.73–2.16) | 0.72 (0.51–1.01) | 0.85 (0.52–1.37) | 1.04 (0.78–1.39) |
| Secondary | 1.06 (0.63–1.79) | 1.43 (0.97–2.10) | 1.11 (0.89–1.40) | 1.23 (0.93–1.63) | 1.16 (0.94–1.42) |
| Higher | 1.65 (0.90–3.02) | 1.82 (1.18–2.82)*** | 1.76 (1.29–2.41)*** | 1.73 (1.19–2.50)*** | 1.53 (1.14–2.06)*** |
| Partner’s occupation status | |||||
| Agricultural worker (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Physical worker | 1.24 (0.65–2.38) | 1.78 (1.02–3.12)** | 1.16 (0.90–1.49) | 1.07 (0.76–1.50) | 1.05 (0.83–1.34) |
| Services | 1.83 (0.87–3.88) | 2.22 (1.20–4.12)*** | 1.32 (0.92–1.88) | 1.83 (1.13–2.97)*** | 1.54 (1.02–2.32)** |
| Business | 1.07 (0.55–2.07) | 2.71 (1.61–4.54)*** | 1.20 (0.93–1.54) | 1.61 (1.16–2.22)*** | 1.08 (0.83–1.42) |
| Other | 2.28 (0.87–5.91) | 2.13 (1.01–4.50)*** | 0.64 (0.38–1.09) | 1.66 (0.94–2.92) | 0.93 (0.24–3.54) |
| Total children ever born | |||||
| 1–2 (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| >2 | 0.38 (0.24–0.60)*** | 0.44 (0.29–0.66)*** | 0.57 (0.45–0.72)*** | 0.62 (0.46–0.82)*** | 0.64 (0.52–0.78) |
| Exposure to mass media | |||||
| Little exposed | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Moderately exposed | 0.83 (0.37–1.88) | 0.82 (0.48–1.1.39) | 1.48 (1.14–1.93)*** | 0.97 (0.73–1.26) | 1.54 (1.26–1.89)*** |
| Highly exposed | 1.11 (0.51–2.42) | 1.03 (0.60–1.75) | 4.02 (3.02–5.35)*** | 1.09 (0.76–1.57) | 1.46 (1.06–2.02)** |
| Antenatal care use | |||||
| No use | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 1–3 visits | 4.40 (1.90–10.19)*** | 3.00 (1.69–5.32)*** | 2.32 (1.76–3.06)*** | 3.02 (1.91–4.78)*** | 3.06 (1.62–5.78)*** |
| ≥ 4 visits | 12.29 (5.15–29.33)*** | 8.47 (4.82–14.88)*** | 4.02 (3.02–5.35)*** | 4.79 (2.99–7.69)*** | 5.83 (3.10–10.98)*** |
| Household wealth status | |||||
| Middle (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Poorest | 0.25 (0.03–1.99) | 1.98 (0.31–12.63) | 2.13 (0.87–5.20) | 0.26 (0.11–0.62)*** | 0.44 (0.23–0.83)** |
| Poorer | 0.67 (0.15–2.90) | 1.62 (0.50–5.17) | 2.42 (0.98–5.99) | 1.36 (0.61–3.05) | 0.73 (0.36–1.47) |
| Richer | 0.51 (0.14–1.93) | 2.79 (0.95–8.22) | 2.09 (1.03–4.24)** | 1.10 (0.62–1.95) | 0.87 (0.57–1.33) |
| Richest | 1.44 (0.57–3.67) | 4.94 (2.00–12.19)*** | 4.08 (2.28–7.32)*** | 1.81 (1.04–3.14)** | 1.44 (0.89–2.31) |
| Place of residence | |||||
| Urban (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Rural | 0.17 (0.04–0.75) | 2.62 (0.88–7.87) | 4.04 (1.84–8.89)*** | 0.78 (0.35–1.73) | 0.62 (0.37–1.02) |
| Region of residence | |||||
| Dhaka (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Barishal | 0.61 (0.32–1.14) | 0.44 (0.24–0.78)*** | 0.66 (0.46–0.95)** | 0.64 (0.46–0.88)*** | 0.71 (0.52–0.98)** |
| Chattogram | 0.44 (0.27–0.73) | 0.47 (0.31–70.41)*** | 0.71 (0.55–0.97)** | 0.51 (0.38–0.69)*** | 0.54 (0.40–0.73)*** |
| Khulna | 0.79 (0.48–1.28) | 0.67 (0.43–1.02) | 1.49 (1.11–1.99)*** | 1.28 (0.95–1.72) | 1.25 (0.91–1.70) |
| Mymensingh | 0.77 (0.56–1.04) | ||||
| Rajshahi | 0.64 (0.36–1.10) | 0.55 (0.36–0.84)*** | 1.02 (0.76–1.38) | 0.92 (0.67–1.26) | 1.00 (0.73–1.37) |
| Rangpur | 0.66 (0.48–0.92)** | 0.58 (0.38–0.91)** | 0.78 (0.55–1.09) | ||
| Sylhet | 0.99 (0.58–1.71) | 0.57 (0.38–0.86)*** | 1.08 (0.79–1.48) | 0.48 (0.34–0.66)*** | 0.62 (0.46–0.82)*** |
| Interaction of working status and place of residence | |||||
| no#rural | 89 (0.71–99)** | 0.76 (0.40–0.93)*** | 0.51 (0.29–0.88)*** | 0.83 (0.49–0.99)*** | 0.49 (0.03–0.65)*** |
| Interaction of wealth quintile and place of residence | |||||
| poorest#rural | 0.88 (0.45–0.98)*** | 0.68 (0.29–0.89)*** | 0.17 (0.07–0.46)*** | 0.67 (0.52–0.74)*** | 0.44 (0.22–0.88)*** |
| poorer#rural | 0.90 (0.79–0.99)*** | 0.52 (0.13–0.86)*** | 0.32 (0.12–0.82)*** | 0.48 (0.19–0.79)*** | 0.52 (0.32–0.89)*** |
| richer#rural | 3.54 (0.77–16.32) | 0.52 (0.16–1.76) | 0.58 (0.27–1.24) | 1.31 (0.63–2.68) | 1.38 (0.83–2.30) |
| richest#rural | 1.23 (0.38–3.94) | 0.59 (0.21–1.68) | 0.37 (0.19–0.71)*** | 1.31 (0.65–2.63) | 1.47 (0.84–2.58) |
| Random effects (measure of variation for caesarean delivery) | |||||
| Cluster-level variance | 0.65 (0.04)*** | 0.59 (0.07)*** | 0.45 (0.04)*** | 0.31 (0.05)*** | 0.26 (0.06)*** |
| Intra-class correlation (ICC) | 27.04% | 24.36% | 19.12% | 15.26% | 11.08% |
| Log-likelihood for fixed effects to random effects model | 330.78*** | 325.28*** | 298.75*** | 347.15*** | 370.78*** |
Note
**p<0.05
***p<0.001.