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Debela DE, Aschalew Z, Bante A, Yihune M, Gomora D, Hussein F, Sahile A, Mersha A. Maternal delay for institutional delivery and associated factors among postnatal mothers at Southeastern Ethiopia: a cross sectional study. BMC Pregnancy Childbirth 2024; 24:206. [PMID: 38500066 PMCID: PMC10949752 DOI: 10.1186/s12884-024-06416-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Maternal delay in timely seeking health care, inadequate health care and the inability to access health facilities are the main causes of maternal mortality in low and middle income countries. The three-delay approach was used to pinpoint responsible factors for maternal death. There was little data on the delay in decision making to seek institutional delivery service in the study area. Therefore, the aim of this study was to assess the extent of the first maternal delay for institutional delivery and its associated factors among postpartum mothers in the Bale and east Bale zones. METHODS An institutional-based cross-sectional study was conducted among 407 postpartum mothers from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analysis was done by using binary logistic regression model to identify factors associated with maternal delay for institutional delivery services. Statistical significance was declared at P-value < 0.05. RESULTS In this study, the magnitude of the first maternal delay in making the decision to seek institutional delivery service was 29.2% (95% CI: 24.9, 33.9). Previous pregnancy problems (AOR = 1.8; 95% CI: 1.06, 3.08), knowing the danger signs of labor and childbirth (AOR = 1.78; 95% CI: 1.11, 2.85) and decision-making (AOR = 0.42; 95% CI: 0.20, 0.85) were significantly associated with the first maternal delay. CONCLUSION This study identified a significant number of postnatal mothers experienced delay in making decisions to seek institutional delivery service in the study area. Promoting women's empowerment and building on key danger signs should be emphasized.
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Affiliation(s)
- Derese Eshetu Debela
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia.
| | - Zeleke Aschalew
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Agegnehu Bante
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Manaye Yihune
- School of Public Health, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Feisal Hussein
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Shashamane, Ethiopia
| | - Ayele Sahile
- Department of Midwifery, College of Medicine & Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Abera Mersha
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Eshetu D, Aschalew Z, Bante A, Negesa B, Gomora D, Ejigu N, Geta G, Mersha A. Delay in reaching health facilities for emergency obstetric care and associated factors among postpartum mothers at Bale zones, Ethiopia. A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002964. [PMID: 38416745 PMCID: PMC10901325 DOI: 10.1371/journal.pgph.0002964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
Maternal mortality occurs in developing nations as a result of inadequate health care, delayed medical attention and the inability to access medical facilities. The three-delay model was employed to determine the causes of maternal death. There was limited data on maternal delay in reaching health facilities for emergency obstetric care services in the study area. Therefore, the aim of this study was to assess the prevalence of delay in reaching health facilities for emergency obstetric care and associated factors among postpartum mothers at Bale and east Bale zones. An institutional-based cross-sectional study was conducted among 407 postnatal women from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariable and multivariable analysis was done by using a binary logistic regression model to identify factors associated with delay in traveling for emergency obstetric care services. Statistical significance was declared at P-value < 0.05. In this study, the prevalence of delay in reaching health facilities during emergency obstetric care was 38.1% (95%CI: 33.3, 43). The following factors showed significant association with delay in reaching health facilities during emergency obstetric care: Average monthly income (AOR = 1.87; 95% CI: 1.12, 3.14), distance (AOR = 4.35; 95% CI: 2.65, 7.14), a referral from other health facilities (AOR = 1.77; 95% CI: 1.01, 3.11) and delay one (AOR = 2.9; 95% CI: 1.7, 4.93). This study showed that the prevalence of delay in reaching health facilities for emergency obstetric care services in the study area was high. Promoting road accessibility and transport mechanisms and strengthening referral mechanisms shall be emphasized.
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Affiliation(s)
- Derese Eshetu
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Zeleke Aschalew
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Agegnehu Bante
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Belda Negesa
- Department of Midwifery, Institute of Health Sciences, Bule Hora University, Bule Hora, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Neway Ejigu
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Girma Geta
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Abera Mersha
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Eshetu D, Aschalew Z, Bante A, Fikedu G, Abebe M, Gomora D, Silesh E, Belay R, Getachew T, Acha A, Mersha A. Delay in receiving emergency obstetric care and associated factors among mothers who gave birth in public hospitals of Bale and East Bale zones, Oromia region, South East Ethiopia: Facility based cross-sectional study. Heliyon 2023; 9:e18217. [PMID: 37501971 PMCID: PMC10368818 DOI: 10.1016/j.heliyon.2023.e18217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Delays in timely seeking care, failure to reach health institutions and receiving ineffective health care cause maternal mortality in developing countries. The three maternal delay was used to identify contributing factors to maternal death. There was limited data on the maternal delay in receiving emergency obstetric care services in the study area. Therefore, the aim of this study was to assess the magnitude of delay in receiving emergency obstetric care and associated factors among postnatal mothers in the Bale and east Bale zones. Methods A facility-based cross-sectional study was conducted among 407 postnatal women from April 6 to May 6, 2022. A systematic random sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analyses were done by using a binary logistic regression model to identify factors associated with delay in receiving emergency obstetric care services. Statistical significance was declared at P-value < 0.05. Results In this study, the magnitude of delay in receiving institutional delivery service utilization was 34.6% with [95% CI (30.0_39.5)]. Delay one was found to be statistically associated with maternal delay in receiving institutional delivery services (AOR = 2.07; 95% CI: 1.21, 3.53). Mothers with low monthly income had shown higher odds of delay (AOR = 1.79; 95% CI: 1.03, 3.10). Moreover, the delay in receiving emergency obstetric care was 89% less likely among mothers who had not been referred multiple times than among those who had been referred many times (AOR = 0.10; 95% CI: 0.06, 0.18). Conclusion This study showed that the magnitude of the delay in receiving the utilization of emergency obstetric care services in the study area was high. Factors such as delay one, average monthly income and multiple referrals of mothers were found significant factors for delay in receiving care. Therefore, it is important to reduce delay in receiving institutional delivery by working on promoting road accessibility, transport mechanisms and building health education on key danger signs.
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Affiliation(s)
- Derese Eshetu
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Zeleke Aschalew
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Agegnehu Bante
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Genet Fikedu
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Eden Silesh
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Rediet Belay
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Tewodros Getachew
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Aregash Acha
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Abera Mersha
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Tesfay N, Tariku R, Zenebe A, Habtetsion M, Woldeyohannes F. Place of death and associated factors among reviewed maternal deaths in Ethiopia: a generalised structural equation modelling. BMJ Open 2023; 13:e060933. [PMID: 36697051 PMCID: PMC9884926 DOI: 10.1136/bmjopen-2022-060933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The study aims to determine the magnitude and factors that affect maternal death in different settings. DESIGN, SETTING AND ANALYSIS A review of national maternal death surveillance data was conducted. The data were obtained through medical record review and verbal autopsies of each death. Generalised structural equation modelling was employed to simultaneously examine the relationships among exogenous, mediating (urban/rural residence) and endogenous variables. OUTCOME Magnitude and factors related to the location of maternal death. PARTICIPANTS A total of 4316 maternal deaths were reviewed from 2013 to 2020. RESULTS Facility death constitutes 69.0% of maternal deaths in the reporting period followed by home death and death while in transit, each contributing to 17.0% and 13.6% of maternal deaths, respectively. Educational status has a positive direct effect on death occurring at home (β=0.42, 95% CI 0.22 to 0.66), obstetric haemorrhage has a direct positive effect on deaths occurring at home (β=0.41, 95% CI 0.04 to 0.80) and death in transit (β=0.68, 95% CI 0.48 to 0.87), while it has a direct negative effect on death occurring at a health facility (β=-0.60, 95% CI -0.77 to -0.44). Moreover, unanticipated management of complication has a positive direct (β=0.99, 95% CI 0.34 to 1.63), indirect (β=0.05, 95% CI 0.04 to 0.07) and total (β=1.04, 95% CI 0.38 to 1.70) effect on facility death. Residence is a mediator variable and is associated with all places of death. It has a connection with facility death (β=-0.70, 95% CI -0.95 to -0.46), death during transit (β=0.51, 95% CI 0.20 to 0.83) and death at home (β=0.85, 95% CI 0.54 to 1.17). CONCLUSION Almost 7 in 10 maternal deaths occurred at the health facility. Sociodemographic factors, medical causes of death and non-medical causes of death mediated by residence were factors associated with the place of death. Thus, factors related to the place of death should be considered as an area of intervention to mitigate preventable maternal death that occurred in different settings.
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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Rozina Tariku
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Medhanye Habtetsion
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Department, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Tesfay N, Hailu G, Woldeyohannes F. Effect of optimal antenatal care on maternal and perinatal health in Ethiopia. Front Pediatr 2023; 11:1120979. [PMID: 36824654 PMCID: PMC9941639 DOI: 10.3389/fped.2023.1120979] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Receiving at least four antenatal care (ANC) visits have paramount importance on the health of mothers and perinates. In Ethiopia, several studies were conducted on ANC service utilization; however, limited studies quantified the effect of care on maternal and perinate health. In response to this gap, this study is conducted to quantify the effect of optimal ANC care (≥4 visits) on maternal and perinatal health among women who received optimal care in comparison to women who did not receive optimal care. METHODS The study utilized the Ethiopian perinatal death surveillance and response (PDSR) system dataset. A total of 3,814 reviewed perinatal deaths were included in the study. Considering the nature of the data, preferential within propensity score matching (PWPSM) was performed to determine the effect of optimal ANC care on maternal and perinatal health. The effect of optimal care was reported using average treatment effects of the treated [ATT]. RESULT The result revealed that optimal ANC care had a positive effect on reducing perinatal death, due to respiratory and cardiovascular disorders, [ATT = -0.015, 95%CI (-0.029 to -0.001)] and extending intrauterine life by one week [ATT = 1.277, 95%CI: (0.563-1.991)]. While it's effect on maternal health includes, avoiding the risk of having uterine rupture [ATT = -0.012, 95%CI: (-0.018 to -0.005)], improving the utilization of operative vaginal delivery (OVD) [ATT = 0.032, 95%CI: (0.001-0.062)] and avoiding delay to decide to seek care [ATT = -0.187, 95%CI: (-0.354 to -0.021)]. CONCLUSION Obtaining optimal ANC care has a positive effect on both maternal and perinatal health. Therefore, policies and interventions geared towards improving the coverage and quality of ANC services should be the top priority to maximize the benefit of the care.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Girmay Hailu
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Department, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Kea AZ, Lindtjorn B, Gebretsadik A, Hinderaker SG. Variation in maternal mortality in Sidama National Regional State, southern Ethiopia: A population based cross sectional household survey. PLoS One 2023; 18:e0272110. [PMID: 36881577 PMCID: PMC9990948 DOI: 10.1371/journal.pone.0272110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/24/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Maternal mortality studies conducted at national level do not provide information needed for planning and monitoring health programs at lower administrative levels. The aim of this study was to measure maternal mortality, identify risk factors and district level variations in Sidama National Regional State, southern Ethiopia. METHODS A cross sectional population-based survey was carried in households where women reported pregnancy and birth outcomes in the past five years. The study was conducted in the Sidama National Regional State, southern Ethiopia, from July 2019 to May 2020. Multi-stage cluster sampling technique was employed. The outcome variable of the study was maternal mortality. Complex sample logistic regression analysis was applied to assess variables independently associated with maternal mortality. RESULTS We registered 10602 live births (LB) and 48 maternal deaths yielding the overall maternal mortality ratio (MMR) of 419; 95% CI: 260-577 per 100,000 LB. Aroresa district had the highest MMR with 1142 (95% CI: 693-1591) per 100,000 LB. Leading causes of death were haemorrhage 21 (41%) and eclampsia 10 (27%). Thirty (59%) mothers died during labour or within 24 hours after delivery, 25 (47%) died at home and 17 (38%) at health facility. Mothers who did not have formal education had higher risk of maternal death (AOR: 4.4; 95% CI: 1.7-11.0). The risk of maternal death was higher in districts with low midwife to population ratio (AOR: 2.9; 95% CI: 1.0-8.9). CONCLUSION The high maternal mortality with district level variations in Sidama Region highlights the importance of improving obstetric care and employing targeted interventions in areas with high mortality rates. Due attention should be given to improving access to female education. Additional midwives have to be trained and deployed to improve maternal health services and consequently save the life of mothers.
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Affiliation(s)
- Aschenaki Zerihun Kea
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
- * E-mail:
| | - Bernt Lindtjorn
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Achamyelesh Gebretsadik
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Chou WK, Ullah N, Arjomandi Rad A, Vardanyan R, Shah V, Zubarevich A, Weymann A, Shah N, Miller G, Malawana J. Simulation training for obstetric emergencies in low- and lower-middle income countries: A systematic review. Eur J Obstet Gynecol Reprod Biol 2022; 276:74-81. [PMID: 35820293 DOI: 10.1016/j.ejogrb.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This review aims to systematically evaluate the currently available evidence investigating the effectiveness of simulation-based training (SBT) in emergency obstetrics care (EmOC) in Low- and Lower-Middle Income Countries (LMIC). Furthermore, based on the challenges identified we aim to provide a series of recommendations and a knowledge base for future research in the field. METHODS A systematic database search was conducted of original articles that explored the use of simulation-based training for EmOC in LMIC in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to January 2022. RESULTS The literature search identified 1,957 articles of which a total of 15 studies were included in this review, featuring 8,900 healthcare professionals from 18 countries. The SBT programmes varied in the reviewed studies. The most common training programme consisted of the PRONTO programme implemented by four studies, comprising of 970 participants across four different countries. In general, programmes consisted of lectures, workshops and simulations of emergency obstetric scenarios followed by a debrief of participants. There were thirteen studies, comprising of 8,332 participants, which tested for improvements in clinical knowledge in post-partum haemorrhage, neonatal resuscitation, pre-eclampsia, shoulder dystocia and sepsis. All the included studies reported improvements in clinical knowledge following the simulation of scenarios. Changes in teamwork, improvement in leadership and in communication skills were also widely reported. CONCLUSION The use of SBT programmes is not only sustainable, feasible and acceptable in LMIC, but could also improve clinical knowledge, communication, and teamwork among healthcare providers, thus directly addressing the UN Sustainable Development Goals.
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Affiliation(s)
- Wing Kiu Chou
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Nazifa Ullah
- Faculty of Medicine, University College London, London, United Kingdom
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom; Research Unit, The Healthcare Leadership Academy, London, United Kingdom.
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom; Research Unit, The Healthcare Leadership Academy, London, United Kingdom
| | - Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Nishel Shah
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - George Miller
- Research Unit, The Healthcare Leadership Academy, London, United Kingdom; Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, United Kingdom
| | - Johann Malawana
- Research Unit, The Healthcare Leadership Academy, London, United Kingdom; Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, United Kingdom
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Tesfay N, Tariku R, Zenebe A, Woldeyohannes F. Critical factors associated with postpartum maternal death in Ethiopia. PLoS One 2022; 17:e0270495. [PMID: 35749471 PMCID: PMC9231747 DOI: 10.1371/journal.pone.0270495] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Globally most maternal deaths occur during the postpartum period; however, the burden is disproportionately higher in some Sub-Saharan African countries including Ethiopia. According to Ethiopian Ministry of Health's annual report, in 2019 alone, nearly 70% of maternal deaths happen during the postpartum period. Although several studies have been conducted on postpartum maternal deaths in Ethiopia, most of the studies were focused either on individual-level or district-level determinants with limited emphasis on the timing of death and in relatively small and localized areas. Therefore, this study aimed at identifying the determinants of postpartum death both at an individual and districts level, which could shed light on designing pragmatic policies to reduce postpartum maternal death. METHODS The study utilized secondary data obtained from the Ethiopian maternal death surveillance system. A total of 4316 reviewed maternal death from 645 districts of Ethiopia were included in the analysis. A multilevel multinomial logistic regression model was applied to examine factors significantly associated with postpartum maternal death in Ethiopia. RESULT The findings revealed that 65.1% of maternal deaths occurred during the postpartum period. The factors associated with postpartum death included previous medical history (history of ANC follow up and party), medical causes (obstetrics haemorrhage, hypertensive disorder of pregnancy, pregnancy-related infection, and non-obstetrics complication), personal factors (poor knowledge of obstetrics complication), and facility-level barriers (shortage of life-saving maternal commodities and delay in receiving treatment). CONCLUSION Almost seven in ten maternal deaths happen during the postpartum period. The rate was even higher for some women based on their previous medical history, level of awareness about obstetrics complication, medical conditions, as well as the readiness of the health facility at which the women was served. Since the postpartum period is identified as a critical time for reducing maternal death, policies and actions must be directed towards improving health education, ANC service utilization, and facility-level readiness.
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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Rozina Tariku
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Abdisa DK, Jaleta DD, Feyisa JW, Kitila KM, Berhanu RD. Access to maternal health services during COVID-19 pandemic, re-examining the three delays among pregnant women in Ilubabor zone, southwest Ethiopia: A cross-sectional study. PLoS One 2022; 17:e0268196. [PMID: 35511923 PMCID: PMC9071126 DOI: 10.1371/journal.pone.0268196] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/24/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND All women require access to high-quality care during pregnancy, labor, and after childbirth. The occurrence of delay at any stage is one of the major causes of maternal mortality. There is, however, a scarcity of data on women's access to maternal health services during the COVID-19 pandemic. Therefore, the goal of this study was to assess the magnitude of delays in maternal health service utilization and its associated factors among pregnant women in the Ilubabor zone during the COVID-19 pandemic. METHODS A facility-based cross-sectional study was conducted among 402 pregnant women selected by systematic random sampling. Data were analyzed using IBM SPSS Statistics version 26. Descriptive and summary statistics were used to describe the study population. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with the outcome variables. Adjusted odds ratio with respective 95% CI was used to report significant covariates. RESULTS A total of 402 pregnant women participated in this study. The median age of the respondents was 25 years (IQR = 8). On average, a woman stays 1.76 hours (SD = 1.2) to make a decision to seek care. The prevalence of first, second and third delay were 51%, 48%, and 33.3%, respectively. Being unmarried [AOR (95% CI)], [0.145 (0.046-0.452)], being unemployed [AOR (95% CI)], [4.824 (1.685-13.814)], age [AOR (95% CI)], [0.227 (0.089-0.0579)], fear of COVID-19 [AOR (95% CI)], [1.112 (1.036-1.193)], urban residence [AOR (95% CI)], [0.517 (0.295-0.909)], and lack of birth preparedness [AOR (95% CI)], [6.526 (1.954-21.789)] were significantly associated with first delay. Being unmarried [AOR (95% CI)], [5.984 (2.930-12.223)], being unemployed [AOR (95% CI)], [26.978 (3.477-209.308)], and age [AOR (95% CI)], [0.438 (0.226-0.848)] were significantly associated with second delay. Having lengthy admission [AOR (95% CI)], [7.5 (4.053-13.878)] and non-spontaneous vaginal delivery [AOR (95% CI)], [1.471 (1.018-1.999)] were significantly associated with third delay. CONCLUSION This study identified a significant proportion of mothers experiencing delays, although there were no data to suggest exacerbated delays in utilizing maternal health services due to fear of the COVID-19 pandemic. The proportion of maternal delay varies with different factors. Improving the decision-making capacity of women is, therefore, essential.
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Affiliation(s)
- Diriba Kumara Abdisa
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Debela Dereje Jaleta
- Department of Nursing, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Jira Wakoya Feyisa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
| | - Keno Melkamu Kitila
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
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Tiruneh GA, Arega DT, Kassa BG, Bishaw KA. Delay in making decision to seek care on institutional delivery and associated factors among postpartum mothers in South Gondar zone hospitals, 2020: A cross-sectional study. Heliyon 2022; 8:e09056. [PMID: 35284676 PMCID: PMC8908018 DOI: 10.1016/j.heliyon.2022.e09056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/04/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Delay in seeking emergency obstetric care contributes to high maternal mortality and morbidity in developing countries. One of the major factors contributing to maternal death in developing countries is a delay in seeking emergency obstetric care. This study aimed to assess the proportion and associated factors of delay in deciding to seek emergency obstetric care on institutional delivery among postpartum mothers in the South Gondar zone hospitals, Ethiopia, 2020. Methods An institution-based cross-sectional study design was conducted from September to October 2020. A total of 650 postpartum mothers were recruited using a systematic random sampling technique. We collected the data through personal interviews with pretested semi-structured questionnaires. We used a logistic regression model to identify statistically significant independent variables, and entered the independent variables into multivariable logistic regression. The Adjusted Odds Ratio was used to identify associated variables with delay in deciding to seek emergency obstetric care, with a 95% confidence interval at P-value < 0.05. Results The proportion of delay in deciding to seek emergency obstetric care on institutional delivery was 36.3% (95% CI: 32.6–40.1). The mean age of the respondents was 27.23, with a standard deviation of 5.67. Mothers who reside in rural areas (AOR = 3.14,95%, CI:2.40–4.01), uneducated mothers (AOR = 3.62, 95%, CI:2.45–5.52), unplanned pregnancy (AOR: 2.01, 95% CI: 1.84–7.96), and no health facilities in Kebele (AOR: 1.62, 95% CI: 1.43–6.32) were significantly associated with delay in a decision to seek emergency obstetric care. Conclusion The proportion of delay in deciding to seek emergency obstetric care was 36.3% among postpartum mothers in the South Gondar zone hospitals. One of the factors contributing to maternal death is a delay in seeking emergency obstetric care in South Gondar zone. Pregnant mothers living in the rural area, unplanned pregnancy, uneducated mothers, no health facilities in Kebele were associated factors in the study area. Therefore, stakeholders must address them to reduce the proportion of delay in deciding to receive on-time obstetric care as per the standards.
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Affiliation(s)
| | - Dawit Tiruneh Arega
- Midwifery Department, College of Medicine and Health Sciences, Debre Tabor University, Ethiopia
| | - Bekalu Getnet Kassa
- Midwifery Department, College of Medicine and Health Sciences, Debre Tabor University, Ethiopia
| | - Keralem Anteneh Bishaw
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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