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Habte A, Bizuayehu HM, Lemma L, Sisay Y. Road to maternal death: the pooled estimate of maternal near-miss, its primary causes and determinants in Africa: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:144. [PMID: 38368373 PMCID: PMC10874058 DOI: 10.1186/s12884-024-06325-1] [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: 11/26/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Maternal near-miss (MNM) is defined by the World Health Organization (WHO) working group as a woman who nearly died but survived a life-threatening condition during pregnancy, childbirth, or within 42 days of termination of pregnancy due to getting quality of care or by chance. Despite the importance of the near-miss concept in enhancing quality of care and maternal health, evidence regarding the prevalence of MNM, its primary causes and its determinants in Africa is sparse; hence, this study aimed to address these gaps. METHODS A systematic review and meta-analysis of studies published up to October 31, 2023, was conducted. Electronic databases (PubMed/Medline, Scopus, Web of Science, and Directory of Open Access Journals), Google, and Google Scholar were used to search for relevant studies. Studies from any African country that reported the magnitude and/or determinants of MNM using WHO criteria were included. The data were extracted using a Microsoft Excel 2013 spreadsheet and analysed by STATA version 16. Pooled estimates were performed using a random-effects model with the DerSimonian Laired method. The I2 test was used to analyze the heterogeneity of the included studies. RESULTS Sixty-five studies with 968,555 participants were included. The weighted pooled prevalence of MNM in Africa was 73.64/1000 live births (95% CI: 69.17, 78.11). A high prevalence was found in the Eastern and Western African regions: 114.81/1000 live births (95% CI: 104.94, 123.59) and 78.34/1000 live births (95% CI: 67.23, 89.46), respectively. Severe postpartum hemorrhage and severe hypertension were the leading causes of MNM, accounting for 36.15% (95% CI: 31.32, 40.99) and 27.2% (95% CI: 23.95, 31.09), respectively. Being a rural resident, having a low monthly income, long distance to a health facility, not attending formal education, not receiving ANC, experiencing delays in health service, having a previous history of caesarean section, and having pre-existing medical conditions were found to increase the risk of MNM. CONCLUSION The pooled prevalence of MNM was high in Africa, especially in the eastern and western regions. There were significant variations in the prevalence of MNM across regions and study periods. Strengthening universal access to education and maternal health services, working together to tackle all three delays through community education and awareness campaigns, improving access to transportation and road infrastructure, and improving the quality of care provided at service delivery points are key to reducing MNM, ultimately improving and ensuring maternal health equity.
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Affiliation(s)
- Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
| | | | - Lire Lemma
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Yordanos Sisay
- Department of Epidemiology, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Negash A, Sertsu A, Mengistu DA, Tamire A, Birhanu Weldesenbet A, Dechasa M, Nigussie K, Bete T, Yadeta E, Balcha T, Debele GR, Dechasa DB, Fekredin H, Geremew H, Dereje J, Tolesa F, Lami M. Prevalence and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis, 2015-2023. BMC Womens Health 2023; 23:380. [PMID: 37468876 PMCID: PMC10357694 DOI: 10.1186/s12905-023-02523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/01/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND One of the most challenging problems in developing countries including Ethiopia is improving maternal health. About 303,000 mothers die globally, and one in every 180 is at risk from maternal causes. Developing regions account for 99% of maternal deaths. Maternal near miss (MNM) resulted in long-term consequences. A systematic review and meta-analysis was performed to assess the prevalence and predictors of maternal near miss in Ethiopia from January 2015 to March 2023. METHODS A systematic review and meta-analysis cover both published and unpublished studies from different databases (PubMed, CINHAL, Scopus, Science Direct, and the Cochrane Library) to search for published studies whilst searches for unpublished studies were conducted using Google Scholar and Google searches. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Duplicated studies were removed using Endnote X8. The paper quality was also assessed based on the JBI checklist. Finally, 21 studies were included in the study. Data synthesis and statistical analysis were conducted using STATA Version 17 software. Forest plots were used to present the pooled prevalence using the random effect model. Heterogeneity and publication bias was evaluated using Cochran's Q test, (Q) and I squared test (I2). Subgroup analysis based on study region and year of publication was performed. RESULT From a total of 705 obtained studies, twenty-one studies involving 701,997 pregnant or postpartum mothers were included in the final analysis. The national pooled prevalence of MNM in Ethiopia was 140/1000 [95% CI: 80, 190]. Lack of formal education [AOR = 2.10, 95% CI: 1.09, 3.10], Lack of antenatal care [AOR = 2.18, 95% CI: 1.33, 3.03], history of cesarean section [AOR = 4.07, 95% CI: 2.91, 5.24], anemia [AOR = 4.86, 95% CI: 3.24, 6.47], and having chronic medical disorder [AOR = 2.41, 95% CI: 1.53, 3.29] were among the predictors of maternal near misses from the pooled estimate. CONCLUSION The national prevalence of maternal near miss was still substantial. Antenatal care is found to be protective against maternal near miss. Emphasizing antenatal care to prevent anemia and modifying other chronic medical conditions is recommended as prevention strategies. Avoiding primary cesarean section is recommended unless a clear indication is present. Finally, the country should place more emphasis on strategies for reducing MNM and its consequences, with the hope of improving women's health.
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Affiliation(s)
- Abraham Negash
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Addisu Sertsu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dechasa Adare Mengistu
- School of Environmental Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Aklilu Tamire
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adisu Birhanu Weldesenbet
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mesay Dechasa
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Nigussie
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Bete
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Elias Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Taganu Balcha
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Deribe Bekele Dechasa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hamdi Fekredin
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Habtamu Geremew
- College of Health Sciences, Oda Bultum University, Chiro, Ethiopia
| | - Jerman Dereje
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fikadu Tolesa
- College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Magarsa Lami
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Mislu E, Seid A, Bililign N, Woyo T, Dulla D. Maternal Third Delay and Associated Factors among Women Admitted for Emergency Obstetric Care in Public Hospitals in Sidama Regional State, Ethiopia. J Pregnancy 2023; 2023:7767208. [PMID: 37091530 PMCID: PMC10118880 DOI: 10.1155/2023/7767208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Background Timing to get obstetric care is critical in preventing maternal death and disability. Maternal third delay, the delay in receiving care after reaching health facilities, involves factors related to organization, quality of care, patient referral, and availability of staff and equipment. However, data is limited on maternal third delay and its associated factors at higher health facilities in Ethiopia. Objective This study is aimed at assessing the magnitude of maternal third delay and associated factors among women admitted for emergency obstetric care in public hospitals in Sidama Regional State, Ethiopia, 2021. Methods An institution-based cross-sectional study was conducted from September to November 2021. Face-to-face interview with a structured questionnaire and data extraction from medical charts were carried out in selected 542 women (using systematic sampling method). The collected data were coded and entered using EpiData, and bivariable and multivariable logistic regression analyses were done using SPSS version 25. Statistical significances were declared at p value less than 0.05. Results Maternal third delay was identified among 29.3% (95%CI = 25.2 - 33.5) of the respondents. Additionally, women who arrived with a referral from other health facilities (AOR = 0.311, 95%CI = 0.181 - 0.534), well prepared for birth and its complications (AOR = 2.418, 95%CI = 1.51 - 3.869), self-employed (AOR = 0.223, 95%CI = 0.122 - 0.409), being a government employee (AOR = 0.157, 95%CI = 0.063 - 0.396), having ANC follow-up (AOR = 2.795, 95%CI = 1.318 - 5.928), and absence of health professional (AOR = 4.63, 95%CI = 2.857 - 7.50) were significantly associated with maternal third delay. Conclusion This study identified that maternal third delay was high, which indicates that women have not received emergency obstetric care in the recommended time range after they arrived at the health facilities.
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Affiliation(s)
- Esuyawkal Mislu
- Department of Midwifery, School of Midwifery, College of Health Science, Woldia University, Ethiopia
| | - Ali Seid
- Basic Health Science, Dessie Health Science College, Dessie, Ethiopia
| | - Nigus Bililign
- Department of Midwifery, School of Midwifery, College of Health Science, Woldia University, Ethiopia
| | - Terefe Woyo
- Department of Midwifery, College of Medicine and Health Science, Hawassa University, Ethiopia
| | - Dubale Dulla
- Department of Midwifery, College of Medicine and Health Science, Hawassa University, Ethiopia
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Yeshitila YG, Daniel B, Desta M, Kassa GM. Obstructed labor and its effect on adverse maternal and fetal outcomes in Ethiopia: A systematic review and meta-analysis. PLoS One 2022; 17:e0275400. [PMID: 36178921 PMCID: PMC9524671 DOI: 10.1371/journal.pone.0275400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/15/2022] [Indexed: 01/22/2023] Open
Abstract
Background Obstructed labor is one of the five major causes of maternal mortality and morbidity in developing countries. In Ethiopia, it accounts for 19.1% of maternal death. The current review aimed to assess maternal and perinatal outcomes of obstructed labor in Ethiopia. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. A literature search was made using PubMed/MEDLINE, CINAHL, Summon country-specific search, and Cochrane Libraries’ online databases. Search terms were adverse outcome, obstructed labor, maternal outcome, fetal outcome, and Ethiopia. The Newcastle-Ottawa scale (NOS), based on a star scoring system, was used to assess the quality of the included studies. The meta-analysis was conducted using STATA 16 software. The pooled prevalence of an adverse maternal outcome, fetal outcome, and association between adverse outcome and obstructed labor was calculated using a random-effects model. Egger’s test and funnel plot were used to evaluate publication bias. Result Eighty-seven studies were included in this review, with an overall sample size of 104259 women and 4952 newborns. The pooled incidence of maternal death was estimated to be 14.4% [14.14 (6.91–21.37). The pooled prevalence of uterine rupture and maternal near-miss was 41.18% (95% CI: 19.83, 62.54) and 30.5% [30.5 (11.40, 49.59) respectively. Other complications such as postpartum hemorrhage, sepsis, obstetric fistula, hysterectomy, bladder injury, cesarean section, and labor abnormalities were also reported. The pooled prevalence of perinatal death was 26.4% (26.4 (95% CI 15.18, 37.7). In addition, the association of obstructed labor with stillbirth, perinatal asphyxia, and meconium-stained amniotic fluid was also demonstrated. Conclusions In Ethiopia, the incidence of perinatal and maternal mortality among pregnant women with obstructed labor was high. The rate of maternal death and maternal near miss reported in this review was higher than incidences reported from high-income and most low and middle-income countries. Uterine rupture, postpartum hemorrhage, sepsis, fistula, hysterectomy, and bladder injury were also commonly reported. To improve the health outcomes of obstructed labor, it is recommended to address the three delay models: enhancing communities’ health-seeking behavior, enhancing transportation for an obstetric emergency with different stakeholders, and strengthening the capacity of health facilities to handle obstetric emergencies.
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Affiliation(s)
- Yordanos Gizachew Yeshitila
- School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
| | - Beniam Daniel
- School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Melaku Desta
- Department of Midwifery, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Getachew Mullu Kassa
- College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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Trends of and Factors Associated with Maternal Near-Miss in Selected Hospitals in North Shewa Zone, Central Ethiopia. J Pregnancy 2022; 2022:2023652. [PMID: 36120504 PMCID: PMC9481311 DOI: 10.1155/2022/2023652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/25/2022] [Indexed: 01/22/2023] Open
Abstract
Maternal near-miss (MNM) refers to a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Studies in Ethiopia showed an inconsistent proportion of MNM across time and in different setups. This study is aimed at assessing the magnitude, trends, and correlates of MNM at three selected hospitals in North Shewa Zone, Central Ethiopia. A hospital-based cross-sectional study was conducted among 905 mothers who gave birth from 2012 to 2017 in three hospitals using the WHO criteria for MNM. Medical records of the study subjects were selected using a systematic sampling technique. Data were retrieved using a pretested data extraction tool. Association between MNM and independent variables was assessed by using a binary logistic regression model. An odds ratio with a 95% confidence interval (CI) and p value of <0.05 were used to declare the level of significance. Of the 905 medical records reviewed, the prevalence of MNM was 14.3% (95%CI = 11.9 − 16.6) and similar over the last six years (2012-2017). The magnitude of life-threatening pregnancy complications was found to be 12.7%; severe preeclampsia (31%) and postpartum hemorrhage (26%) account for the highest proportion. Admission at a higher level of obstetric care like referral hospital (AOR = 4.85; 95% CI: 1.82-12.94) and general hospital (AOR = 3.76; 95% CI: 1.37-10.33), not using partograph for labor monitoring (AOR = 1.89; 95% CI: 1.17-3.04), history of abortion (AOR = 2.52; 95% CI: 1.18-5.37), and any other pregnancy complications (AOR = 6.91; 95% CI: 3.89-12.28) were factors significantly associated with higher MNM. Even though lower than the national figure, the proportion of MNM in the study area was very high, and there were no significant changes over the last six consecutive years. Giving special emphasis to women with prior history of pregnancy complications, hypertensive disorders of pregnancy, and obstetric hemorrhage with strict and quick management protocols and the use of partograph for labor monitoring are recommended to reduce the burden of severe maternal outcomes in the study area and Ethiopia.
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Dahie HA. Determinants of maternal near miss events among women admitted to tertiary hospitals in Mogadishu, Somalia: a facility-based case-control study. BMC Pregnancy Childbirth 2022; 22:658. [PMID: 35996082 PMCID: PMC9396757 DOI: 10.1186/s12884-022-04987-3] [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: 05/03/2022] [Accepted: 08/18/2022] [Indexed: 01/22/2023] Open
Abstract
Background A maternal near-miss is a situation in which a woman was on the verge of death but survived a life-threatening obstetric complication that happened during pregnancy, childbirth, or within 42 days after the pregnancy's termination. Survivors of near-miss events share several features with mothers who have died and identifying determinants of maternal near miss will aid in improving the capacity of the health system to reduce severe maternal morbidity and mortality. Therefore, this study was designed to identify determinants of maternal near miss incidents among women hospitalized to tertiary hospitals in Mogadishu, Somalia. Methods A facility-based unmatched case–control study was conducted in four tertiary hospitals in Mogadishu from May 1 to July 31, 2021. A total of five hundred thirty-three (178 cases and 355 controls) study participants were involved in the study. The discharge period, cases were recruited consecutively as they emerged, whereas controls were chosen using systematic sampling approach based on every fifth interval of those delivered through normal spontaneous vaginal delivery. Women who were hospitalized during pregnancy, delivery, or within 42 days of termination of pregnancy and met at least one of the maternal near-miss disease specific criteria were classified as cases, while women who were admitted and gave birth by normal vaginal delivery and resealed from the hospital without experiencing severe obstetric complications were considered controls. Participants were interviewed by well-trained research assistants using pre-tested structured questionnaire and the medical records were reviewed to identify maternal near-miss cases. Data were entered into and analyzed with SPSS 25.0. Logistic regression was used, and the significance level was set at p value ≤ 0.05. Results The most common maternal near-miss morbidities identified were severe anemia (32%), severe pre-eclampsia (19.6%), severe ante partum haemorrhage (15.0%), abortion complications (8.4%), eclampsia (6.1%), ICU admission (5.6%), severe PPH (2.8%) and severe systemic infections (2.8%). The main factors associated with maternal near-miss were rural residency [OR = 2.685, 95%CI: (1.702–4.235)], age below 20 years [OR = 2.728, 95%CI: (1.604–4.5640)], unmarried [OR = 2.18, 2.18, 95%CI (1.247–3.81)], lack of formal education [OR = 2.829, 95%CI: (1.262–6.341)], husband’s unemployment [OR = 2.992, 95%CI: (1.886–4.745)], low family income [OR = 3.333, 95%CI (1.055–10.530)], first pregnancy before 18 years of age [OR = 3.091, 95% CI: (2.044–4.674)], short birth interval [OR = 5.922, 95%CI: (3.891–9.014)], previous history of obstetric complication [OR = 6.568, 95%CI: (4.286–10.066)], never attended ANC services [OR = 2.687, 95%CI: (1.802–4.006)], lack of autonomy in seeking medical help [OR = 3.538, 95%CI: (1.468–8.524)], delivery at non-health facility setting [OR = 4.672, 95%CI: (3.105–7.029)], experiencing the second delay [OR = 1.773, 95% CI: (1.212–2.595)] and stillbirth of the last pregnancy [OR = 5.543, 95%CI: (2.880–10.668)]. Conclusion and recommendation. Lack of maternal education, lack of antenatal care, lack of autonomy to seek medical assistance, short birth interval, rural residence and delay in accessing obstetric services were identified as factors associated with maternal near-miss morbidity. As a result, the study suggests that those modifiable characteristics must be improved in order to avoid severe maternal complications and consequent maternal death.
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Affiliation(s)
- Hassan Abdullahi Dahie
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia. .,SOS Children's Villages, Mogadishu, Somalia.
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Teka H, Yemane A, Berhe Zelelow Y, Tadesse H, Hagos H. Maternal near-miss and mortality in a teaching hospital in Tigray region, Northern Ethiopia. WOMEN'S HEALTH 2022; 18:17455057221078739. [PMID: 35196926 PMCID: PMC8883400 DOI: 10.1177/17455057221078739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: This study seeks to examine the prevalence of maternal morbidities and deaths in Ayder Comprehensive Specialized Hospital from 1 July 2018 to 30 June 2019. Methods: This was a cross-sectional study. Total purposive sampling method was employed to collect data prospectively using modified World Health Organization criteria for baseline assessment of maternal near-miss and mortality. Pregnant women or those who are within 42 days postpartum/any form of pregnancy termination that satisfy the inclusion criteria were enrolled. Results: A total of 691 mothers were recorded as having severe maternal complications. Out of these, 170 women developed severe maternal outcome, ending with 146 maternal near-miss cases and 24 maternal deaths. The maternal near-miss ratio and maternal mortality ratio were 28.5 per 1000 live births and 469.1 per 100,000 live births, respectively. The overall mortality index was 14%. The top underlying causes of severe maternal complications were the infamous triads of preeclampsia (n = 303, 43.8%), obstetric hemorrhage (n = 166, 24.0%) and sepsis (n = 130, 18.8%). About 62.5% of mothers who died were not admitted to intensive care unit. Conclusion: This study found that the infamous triads of preeclampsia, obstetric hemorrhage and sepsis persist as the commonest causes of severe maternal complications in the study area. A significant number of women with severe maternal outcome were not admitted to intensive care unit. It also highlights that the severe maternal complications, severe maternal outcome, maternal near-miss ratio and mortality index in the study area are disproportionately higher than the global average. These staggering numbers call for a system re-thinking at multiple junctures.
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Affiliation(s)
- Hale Teka
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Awol Yemane
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Yibrah Berhe Zelelow
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Habtom Tadesse
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Hadgay Hagos
- Department of Epidemiology, School of Public Health, Mekelle University, Mekelle, Ethiopia
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