Magnitude and associated factors of postpartum morbidity in public health institutions of Debre Markos town, North West Ethiopia

Abstract

BackgroundPostpartum maternal morbidity is maternal illness that occurs after one hour of expulsion of placenta up to six weeks of childbirth. Though the true burden of this problem is not well known estimates of WHO, UNICEF and UNFPA showed that 1.4 million women experience acute obstetric morbidity annually. Knowledge of magnitude and predicting factors postpartum morbidity is central to understand the extent of the problem and will help as a cornerstone in designing and implementing better preventive strategies.ObjectivesTo assess the magnitude and factors associated with postpartum morbidity in public health institutions in Debre Markos town.MethodInstitutional based cross sectional study was conducted in Debre Markos town public health institutions by reviewing delivery charts, delivery records and reporting log books. Total deliveries in each health institution in the previous year were identified and number of records to be included from each institution was determined by probability proportion to size. Systematic sampling technique was employed to select 308 charts for review. Data was collected by trained midwifes using structured checklist; entered by epi info and analyzed using SPSS 20. To present findings descriptive statistics using frequencies, charts and figures were used accordingly. Finally binary and multiple logistic regressions were performed to identify predicting factors.ResultsThe magnitude of postpartum morbidity was found to be 101(32.8%). Divorced/widowed women [AOR = 10.920, 95% CI: (2.168, 54.998)], women who didn’t have ANC follow up [AOR = 3.710, 95% CI: (1.749, 7.870)], abnormal labour [AOR =3.496, 95% CI: (1.69, 7.22)], women delivered by doctor [AOR =0.111, 95% CI: (0.027, 0.454)] and women who were not attended postpartum visit [AOR =0.088, 95% CI: (0.040, 0.194)] were the factors associated with postpartum maternal morbidity.ConclusionMaternal morbidity in Debre Markos health institution was found to be major maternal health issue. Being divorced/widowed, absence of ANC visit, intrapartum abnormalities, delivery attended by skilled professionals and no post-partum visit were important predictors of maternal postpartum morbidity.

Postpartum Maternal Morbidity Requiring Hospital Admission in A Teaching Hospital: A Descriptive Cross-sectional Study

“…28.57% required blood transfusion. Postpartum haemorrhage was found in 22.8% of women in the study done byTalie A, et al 11 This was similar to the study done by Malla R, et al where women admitted with Postpartum Hemorrhage was 18.5%. 7 Increased morbidity was reported with secondary postpartum haemorrhage in the study done by Hoveyda F, et al where 63% required surgical evacuation and 17% blood transfusion.…”

Magnitude of postpartum hemorrhage and associated factors among women who gave birth in Ethiopia: a systematic review and meta-analysis

“…The smallest sample size was 144 from a study conducted in the Amhara region, Debretabor Hospital [ 27 ], and the largest sample size was 1060 in a study conducted in Amhara region [ 31 ]. All included studies were cross-sectional in study design with 4 prospective [ 26 – 28 , 30 ] and 5 retrospectives cross-sectional study design [ 13 , 14 , 29 , 31 , 32 ]. Regarding to study setting, five studies were conducted in the Amhara region [ 14 , 27 – 29 , 31 ], two studies in the Oromia region [ 30 , 32 ], and two studies were from Tigrayi region [ 13 ] and SNNP [ 26 ].…”

“…All included studies were cross-sectional in study design with 4 prospective [ 26 – 28 , 30 ] and 5 retrospectives cross-sectional study design [ 13 , 14 , 29 , 31 , 32 ]. Regarding to study setting, five studies were conducted in the Amhara region [ 14 , 27 – 29 , 31 ], two studies in the Oromia region [ 30 , 32 ], and two studies were from Tigrayi region [ 13 ] and SNNP [ 26 ]. The summary of the included articles is described in (Table 1 ).…”

“…The pooled magnitude of PPH was 11.14% (95% CI 7.21 , 15.07). The highest (32.79% (95% CI 27.55, 38.04)) magnitude of PPH was observed in Debre Markos referral hospital, Amhara region [ 14 ] and the lowest 3.06% (95% CI 1.83, 4.29) magnitude of PPH was reported in Tigrayi region [ 13 ] (Fig. 2 ).…”

“…Once an event of PPH has occurred, the recommended management follows a sequential scheme of treatments that become increasingly intensive and invasive as the duration of hemorrhage advances [ 12 ]. In Ethiopia, the magnitude range from 3.06% in the study conducted the in Tigray region [ 13 ] to 32.8% a [ 14 ] in study conducted in the Amhara region. Factors that lead to increased risk of PPH include grand multiparity [ 15 , 16 ], antepartum hemorrhage [ 16 ], cesarean section delivery [ 15 , 16 ], pregnancy-induced hypertension [ 15 – 17 ], hydramnios and big baby [ 15 , 17 ], prolonged and precipitate labor [ 18 ], mismanagement of third stage labor and previous PPH [ 19 , 20 ], and lack of antenatal care (ANC) follow up [ 1 , 3 ].…”