Background: The World Health Organization sets a cesarean delivery rate of 5–15% which is assumed to be a range that can decrease neonatal morbidity and mortality. This study aimed to assess the prevalence of cesarean section deliveries and identify determinants of neonatal outcomes at Orotta National Referral Maternity Hospital.

Methods: This was a medical record and register review study. Data about neonates born via cesarean section between January 1, 2021, and December 31, 2022, were extracted from the hospital's operation book. Data were gathered, recorded in an Excel spreadsheet, and subsequently analyzed using SPSS version 25. Descriptive statistics were used to summarize the data. Odds ratios, 95% confidence intervals, and both univariable and multivariable analyses were employed to assess the association between determinants and outcomes, with significance set at p < 0.05.

Results: The prevalence of cesarean section at Orotta National Referral Maternity Hospital was 20.1%. Previous cesarean section (30.9%), cephalo-pelvic disproportion (20.1%), and malpresentation and position (19.8%) were the most common indications. The stillbirth rate among neonates delivered by cesarean section was 2.9%. Patients referred from other Zoba’s (AOR: 2.63; 95%CI: 1.58- 4.40, p<0.001), antepartum hemorrhage as an indication for cesarean section (AOR: 12.18; 95%CI: 1.75-106.96, p=0.02), newborns delivered by emergency cesarean section (AOR: 3.36; 95%CI: 1.16-9.74, p=0.03), mothers delivered under general anesthesia (AOR: 6.61; 95%CI: 2.43-17.98, p<0.001), neonatal birth weight < 1.5kg (AOR: 8.23; 95%CI: 2.80-24.23, p<0.001) and neonatal birth weight of greater than 4kg (AOR: 15.59; 95%CI: 3.13-77.77, p<0.001) were the predictors of neonatal outcome in mothers delivered by cesarean section.

Conclusions: The prevalence of cesarean section deliveries was higher than the World Health Organization and national levels. Patients referred from other Zoba’s, antepartum hemorrhage, emergency cesarean section, type of anesthesia, and neonatal birth weight were identified as key determinants of neonatal outcomes. Enhancing healthcare professionals' awareness of antepartum and intrapartum management is crucial to reducing neonatal morbidity and mortality.