Area of focus to handle delays related to maternal death in Ethiopia

Abstract

Background Maternal delay factors, together with medical factors, have a substantial role in determining maternity outcomes. Although several studies were conducted on delay factors that contribute to maternal death in Ethiopia, the studies were mostly focused either on an individual or at a provincial level factor with a limited number of study participants. In response to this gap, this study is aimed at exploring the magnitude and factors related to delay factors that contribute to maternal death in Ethiopia. Methods The study used maternal death surveillance data collected from different regions of Ethiopia, compiled between 2013 and 2021. A total of 4530 maternal deaths were reviewed during the study period. A Multilevel multinomial logistic regression model was applied to examine factors associated with delays related to maternal death. An adjusted relative risk ratio with a 95% confidence interval was stated and variables with p-values less than 0.05 were declared as significant predictors of maternal delay. Result Delay three (delay in receiving adequate and appropriate care once reached a health facility) has contributed to 36.3% of maternal deaths followed by delay one (delay in deciding to seek care when experiencing an obstetric emergency) and delay two (delay in reaching to an appropriate obstetric facility) where each of them contributed to 36.1% and 27.6% of maternal deaths respectively. In the multivariate multilevel multinomial model, maternal age, education status, and place of death were among the individual level factors associated with both delay two and delay three. Conversely, marital status and ANC follow-up were associated with delay two alone, while the timing of maternal death was associated with delay three. Residence and type of facility were provincial-level factors linked with both delay two and delay three, while the type of region was related to delay three of maternal death. Conclusion Both delay one and three have a major contribution to maternal death in Ethiopia. Individual and provincial level factors played an important role in determining delays related to maternal death. Therefore, it is crucial to account for measures that provide emphasis on the area of raising awareness on the utilization of Antenatal care (ANC) service, improving facility readiness to handle obstetrics emergencies, and narrowing down inequality among regions in service provision.

Maternal Mortality in Africa: Regional Trends (2000–2017)

“…Another problem in South and East Africa is the delay in accessing healthcare. Delays in receiving adequate care once reaching a health facility, deciding to seek care in an obstetric emergency, and reaching an appropriate obstetric facility are responsible for 32–36.3%, 33–36%, and 27.6–29% of maternal deaths, respectively [ 113 , 114 ].…”

Maternal Mortality in Africa, Regional Trends (2000-2017)

“…Delays in receiving adequate care once reaching a health facility, deciding to seek care in an obstetric emergency, and reaching an appropriate obstetric facility are responsible for 32%-36.3%, 33%-36%, and 27.6%-29% of maternal deaths, respectively. [115,116].…”

Determinants of stillbirth among reviewed perinatal deaths in Ethiopia

“…Moreover, maternal health conditions were assigned per the guidance of ICD-PM. The score of delay one, which is a delay in deciding to seek care ( 42 ), was computed using the row sum of seven variables included under this domain; namely (1) family poverty, (2) bad experience with previous health care, (3) failure to recognize the danger signs of pregnancy, (4) lack of awareness on where to seek care, (5) lack of person to take care of other children, (6) reliant on traditional practice and (7) lack of decision to go to a health facility. All of them were binary variables with “Yes” and “No” responses; and after summation of the score, to keep the normality of the data a square root transformation was carried out ( 43 ).…”

“…Furthermore, the type of facility was codified into classes (primary, secondary, and tertiary facilities) according to their manpower, medical equipment, and service provision ( 46 ). Moreover, the score of delay two(a delay to reach the facility that provides emergency obstetric care (EmONC) and delay three(a delay that occurs in receiving care after arrival at the health facility) ( 42 ), were computed similarly to the score of delay one. The score of delay two was computed using four questions: namely (1) absence of transportation, (2) expensive cost of transportation, (3) no facility within a reasonable distance and (4) poor road condition.…”