The rate and perioperative mortality of caesarean section in Sierra Leone

Research output: Contribution to journalArticle


Introduction Sierra Leone has the world's highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country. Methods We conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality. Results In 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population rate of 2.9% of all live births, a 35% increase from 2012, with district rates ranging from 0.4% to 5.2%. The most common indications for surgery were obstructed labour (42%), hypertensive disorders (25%) and haemorrhage (22%). Ninety-nine deaths occurred during or after caesarean section, and the in-facility perioperative caesarean section mortality rate was 1.5% (median 0.7%, IQR 0-2.2). Haemorrhage was the leading cause of death (73%), and of those who died during or after surgery, 80% had general anaesthesia, 75% received blood transfusion and 22% had a uterine rupture diagnosed. Conclusions The caesarean section rate has increased rapidly in Sierra Leone, but the distribution remains uneven. Caesarean section mortality is high, but there is wide variation. More access to caesarean sections for maternal and neonatal complications is needed in underserved areas, and expansion should be coupled with efforts to limit late presentation, to offer assisted vaginal delivery when indicated and to ensure optimal perioperative care.


  • Hampus Holmer
  • Michael M. Kamara
  • Håkon Angell Bolkan
  • Alex Van Duinen
  • Sulaiman Conteh
  • Fatu Forna
  • Binyam Hailu
  • Stefan R. Hansson
  • Alimamy P. Koroma
  • Michael M. Koroma
  • Jerker Liljestrand
  • Herman Lonnee
  • Santigie Sesay
  • Lars Hagander
External organisations
  • Karolinska Institutet
  • Karolinska University Hospital
  • Norwegian University of Science and Technology
  • St. Olav’s University Hospital
  • Ministry of Health and Sanitation, Sierra Leone
  • Skåne University Hospital
  • University of Sierra Leone
  • World Health Organization, Sierra Leone
  • Princess Christian Maternity Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Obstetrics, Gynecology and Reproductive Medicine
  • Public Health, Global Health, Social Medicine and Epidemiology


  • maternal health, obstetrics, surgery
Original languageEnglish
Article numbere001605
JournalBMJ Global Health
Issue number5
Publication statusPublished - 2019
Publication categoryResearch