Magnitude and determinants of obstetric case fatality rate among women with the direct causes of maternal deaths in Ethiopia: a national cross sectional study

Abstract

Background: In sub-Saharan Africa, maternal death due to direct obstetric complications remains an important health threat for women. A high direct obstetric case fatality rate indicates a poor quality of obstetric care. Therefore, this study was aimed at assessing the magnitude and determinants of the direct obstetric case fatality rate among women admitted to hospitals with direct maternal complications. Methods: In 2015, the Ethiopian Public Health Institute conducted a national survey about emergency obstetric and newborn care in which data about maternal and neonatal health indicators were collected. Maternal health data from these large national dataset were analysed to address the objective of this study. Descriptive statistics were used to present hospital specific characteristics and the magnitude of direct obstetric case fatality rate. Logistic regression analysis was performed to examine determinants of the magnitude of direct obstetric case fatality rate and the degree of association was measured using an adjusted odds ratio with 95% confidence interval at p < 0.05. Results: Overall, 335,054 deliveries were conducted at hospitals and 68,002 (20.3%) of these women experienced direct obstetric complications. Prolonged labour (23.4%) and hypertensive disorders (11.6%) were the two leading causes of obstetric complications. Among women who experienced direct obstetric complications, 435 died, resulting in the crude direct obstetric case fatality rate of 0.64% (95% CI: 0.58-0.70%). Hypertensive disorders (27.8%) and maternal haemorrhage (23.9%) were the two leading causes of maternal deaths. The direct obstetric case fatality rate varied considerably with the complications that occurred; highest in postpartum haemorrhage (2.88%) followed by ruptured uterus (2.71%). Considerable regional variations observed in the direct obstetric case fatality rate; ranged from 0.27% (95% CI: 0.20-0.37%) at Addis Ababa city to 3.82% (95% CI: 1.42-8.13%) at the Gambella region. Type of hospitals, managing authority and payment required for the service were significantly associated with the magnitude of direct obstetric case fatality rate.

The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study

“…The purpose of this study was to investigate the clinical effect of internal iliac artery balloon occlusion in patients with PAS and placenta previa. Postpartum haemorrhage is one of the main causes of maternal death [24,25]. PAS often causes uncontrollable bleeding.…”

Assessment of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: A Cross-Sectional Study

“…Proportion of PPH in Ethiopia ranges from 5.8-16.6% based on the study settings, study design or nature of study [10][11][12][13] In a national cross-section study, PPH was found to have the highest case fatality rate among all the direct obstetric complications in Ethiopia. 14 PPH is more likely among women with macrosomia, those who had histroy of PPH, previous cesarean, abnormal placentation, prolonged third stage of labor, hypertensive disorders of pregnancy, soft tissue lacerations or induction of labor. [15][16][17] Active management of the third stage of labor is the most effective strategy for prevention of PPH.…”

Magnitude of postpartum hemorrhage and its associated factors in Ethiopia: a systematic review and meta-analysis

“…The current systematic review and meta-analysis included 21 primary studies with a total of 93,898 study participants. Of the total of 21 studies; 7 studies were conducted in Amhara region [11,[36][37][38][39][40][41], 6 studies in South nation nationality and people (SNNP) region [30,[42][43][44][45][46], 2 studies in Oromia region [10,47], 2 studies in Addis Ababa City administration [29,48], 1 study in Tigray region [49], 1 study in Dire Dawa City administration [50], 1 study in Harar region [51] and 1 study was conducted national-wide [52] (Table 1). Only 4 studies were conducted in rural area, the rest 17 were conducted in urban area.…”

“…Three studies from 21 studies were case-control, and the rest were a cross-sectional in study design. The sample size of the primary studies included in this systematic review and meta-analysis ranged from 144 to 68,437 as reported in debre tabor Amhara region and nationalwide studies respectively [39,52]. The highest magnitude of post-partum hemorrhage was 16.6% reported in SNNP region [30], and the lowest report was 1.4% in Addis Ababa [29].…”