Trends and causes of maternal mortality in Jimma University Specialized Hospital, southwest Ethiopia: a matched case–control study

Abstract

IntroductionMeasures of maternal death are fundamental to a country’s health and development status. In developing countries, it remains a daunting and largely unmet public health challenge. There were two studies completed over 10 years ago in Jimma University Specialized Hospital to identify trends, but recently there have been many changes in Ethiopia to reduce maternal death. Therefore, it is important to track the achievements made in Ethiopia in the context of Jimma University Specialized Hospital. No study undertaken in the country has quantified deaths of women from specific causes after controlling confounders.ObjectiveTo assess trends and causes of maternal death in Jimma University Specialized Hospital, southwest Ethiopia.MethodsA time-matched case–control study was conducted on 600 (120 cases and 480 controls) females who utilized obstetrics and gynecology services from January 2010 to December 2014. To observe trends in maternal death, maternal mortality ratio was calculated for each year. Stata version 13 was used to analyze causal inference using propensity score matching method.ResultsMaternal mortality ratio was 857/100,000 and had a decreasing trend from it’s highest in 2010 of 1,873/100,000 to it’s lowest of 350/100,000 in 2014. The leading cause of maternal death was hemorrhage (54%) (β=0.477, 95% confidence interval [CI]: 0.307, 0.647), followed by pregnancy-induced hypertension (20%) (β=0.232, 95% CI: 0.046, 0.419), and anemia (12%) (β=0.110, 95% CI: 0.017, 0.204).ConclusionThere is a decreasing trend of maternal death. Hemorrhage was the major cause of death identified in each year of study.

Association between maternal mortality and caesarean section in Ethiopia: A national cross-sectional study

“…Our ndings showed a substantially lower MMRs as compared to the Ethiopian Demographic and Health Survey in 2016 18 . Although there are no similar studies in the country, current ndings are also lower than that found in a small scale study in a specialized 19 , general 26 and rural (for directly admitted women) hospital 27 in Ethiopia. Our estimate is much lower compared to ndings of a systematic review of hospital-based studies in other sub-Saharan Africa, where the pooled MMR was 957 per 100,000 live births 28 .…”

“…Consistent with an Eritrean study, hypertensive disorders of pregnancy were the leading cause of maternal mortality 33 . Similarly, this study revealed that postpartum haemorrhage, prolonged labour and postpartum sepsis were the predominant causes of maternal mortality, supported by several small-scale studies in Ethiopia 19,34 and ndings of a systematic review of literature 35 .…”

“…Therefore, this study aimed to assess the association between MMRs and CS rates in all hospitals in Ethiopia in order to generate evidence for policy and practice for maternal health improvement. This is crucial for Ethiopia, where population-based MMR was 412/100,000 live births in 2016 18 and hospital-based MMR was 350/100,000 live births in 2014 19 .…”

Magnitude, Characteristics, Maternal and Feto-Neonatal Outcomes of Obstetric Emergencies in Western Ethiopia, Nekemte, Ethiopia

“…The main contributing factors for maternal underlying in this studies were death were obstetric hemorrhage (31.9%) followed pregnancy related infections (21.27%). These are nearly similar with findings of study done to assess causes of maternal death in Ethiopia (23).…”

Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 Demographic and Health Survey

“…Obstetric hemorrhage, hypertension, abortion, sepsis, HIV, preexisting medical disorders, and other indirect causes like anemia are the main causes of maternal mortality both globally and in Ethiopia [2,[4][5][6][7][8][9][10][11]. These causes of death are preventable with proven cost-effective interventions.…”