Spatial distribution of C-sections within the state of Sao Paulo

Objective: to identify spacial patterns for cesarean deliveries per microregion in the state of Sao Paulo. Methods: this is an ecological and exploratory study with data on live births occurred between 2003 and 2007 in 63 microregions in the state of Sao Paulo. Variables analyzed included cesarean delivery rates, teenage mothers, mothers with high levels of education and who had at least seven prenatal consultations. Moran's index (I), a measure of spatial autocorrelation of rates related to the variables described above and which identifies the presence of spatial clusters, was calculated. The distributions of the variables' rates in this study were visualized using thematic maps. The Moran map was used to identify microregions with high priority need for attention. Pearson correlation coefficients among the variables were also obtained. Results: there were 3,045,293 births, being 1,636,009 (53.7 %) cesarean deliveries. It was possible to identify spatial clusters of C-sections (I = 0.58 and p < 0.01) in the microregions located on the north and northwest of the state of Sao Paulo, as well as in Guaratingueta; the values found for Moran index were, I = 0.32, I = 0.30 and I = 0.24, for the rates of teenage mothers, schooling and number of consultations, respectively, being all significant results (p <0.01). Micro-regions with high-priority need for attention were identified. Cesarean rates were significantly correlated with high rates of maternal education and number of prenatal consultations. Conclusion: the identification of these microregion clusters with high rates of cesarean delivery allows health managers to implement policies in order to minimize these rates.