Magnitude of Postpartum Hemorrhage and Its Associated Factors in Ethiopia: Systematic Review and Meta-analysis.

Abstract

Background: Postpartum hemorrhage or postpartum bleeding (PPH) is often defined as loss of > 500 ml of blood after vaginal delivery or > 1,000 ml after cesarean delivery within 24 hrs. Postpartum hemorrhage is a leading direct cause of maternal morbidity and mortality in Ethiopia. Therefore, the main objective of this systematic review and meta-analysis was to estimate the pooled magnitude of postpartum hemorrhage and the pooled effect size of the associated factors in Ethiopia.Methods: Primary studies were searched in PubMed / MEDLINE online, Science Direct and Hinari Cochrane Library, CINAHL, African Journals Online databases, Google and Google Scholars. The search for studies was not limited by time and all articles up to October 10/2021 were included. The data extraction format was prepared in Microsoft Excel. The data extracted from the Microsoft Excel format was exported to Stata Version 16.0 statistical software for analysis. A random effect meta-analysis model was used. Statistical heterogeneity was evaluated by the I2 test and Egger's weighted regression test was used to assess publication bias.Result: A total of 165 records from the electronic databases were excluded, but 145 records were excluded for different reasons, and finally 20 studies were included in this final analysis. The pooled magnitude of postpartum hemorrhage in Ethiopia was 8.18% [(95% CI; 6.996 - 9.363]. Older age [OR= 5.038 (95% CI; 2.774 - 9.151)], prolonged labor [OR = 4.054 (95% CI; 1.484 - 11.074)], absence of ANC visit [OR = 13.84 (95% CI; 5.57 - 34.346)] grand-multiparty, [OR = 6.584 (95% CI; 1.902 - 22.795)], and history of postpartum hemorrhage [OR = 4.355 (95% CI; 2.347 - 8.079)] were identified as factors for the occurrence of postpartum hemorrhage.Conclusions: This study concludes that the magnitude of postpartum hemorrhage in Ethiopia was moderately high. The finding was strongly help different stakeholder working in maternal and child health to focus on the main contributors factors to reduce PPH. Health professionals attending delivery should emphasize high-risk groups of mothers. Encouraging ANC visit and prevent prolonged labor should be recommended to reduce the occurrence of postpartum hemorrhage.