Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

Open Access 01-12-2020 | Research article

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

Authors: Ayele Geleto, Catherine Chojenta, Tefera Taddele, Deborah Loxton

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

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.

Conclusions

The high direct obstetric case fatality rate is an indication for poor quality of obstetric care. Considerable regional differences occurred with regard to the direct obstetric case fatality rate. Interventions should focus on quality improvement initiatives and equitable resource distribution to tackle the regional disparities.
Literature
1.
WHO. Trends in maternal mortality: 1990 to 2010. 2012.
2.
Sikder SS, Labrique AB, Ullah B, Ali H, Rashid M, Mehra S, et al. Accounts of severe acute obstetric complications in rural Bangladesh. BMC Pregnancy Childbirth. 2011;11(1):76.CrossRef
3.
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–e33.CrossRef
4.
5.
Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet. 2016;387(10017):462–74.CrossRef
6.
World Health Organization. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. 2019.
7.
Ethiopian Demographic and Health Survey, key indicators. Rockville: CSA, ICF; 2016.
8.
WHO. Maternal mortality fact sheet. Geneva: World Health Organization; 2016.
9.
World Health Organization. A hand book: Monitoring emergency obstetric care: a handbook. New York: World Health Organization; 2009.
10.
United Nations Population Fund. Monitoring emergency obstetric care: a handbook. New York: World Health Organization; 2009.
11.
Abegunde D, Kabo IA, Sambisa W, Akomolafe T, Orobaton N, Abdulkarim M, et al. Availability, utilization, and quality of emergency obstetric care services in Bauchi state, Nigeria. Int J Gynaecol Obstet. 2015;128(3):251–5.CrossRef
12.
Kongnyuy EJ, Hofman J, Mlava G, Mhango C, van den Broek N. Availability, utilisation and quality of basic and comprehensive emergency obstetric care services in Malawi. Matern Child Health J. 2009;13(5):687–94.CrossRef
13.
Admasu K, Haile-Mariam A, Bailey P. Indicators for availability, utilization, and quality of emergency obstetric care in Ethiopia, 2008. Int J Gynaecol Obstet. 2011;115(1):101–5.CrossRef
14.
Federal Ministry of Health Ethiopia. Health Sector Transformation Plan, HSTP 2015/16–2019/20, (2008–2012 EFY). 2015.
15.
16.
Ethiopian Mini Demographic and Health Survey 2019. Rockville: Ethiopian Public Health Institute, FMo, ICF; 2019.
17.
Prual A, Bouvier-Colle M-H, Bernis L, Breart G. Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates. Bull World Health Organ. 2000;78:593–602.PubMedPubMedCentral
18.
Ghebrehiwet M, Sharan M, Rogo K, Gebreamlak O, Haile B, Gaim M, et al. Magnitude and causes of maternal deaths at health facilities in Eritrea in 2007. J Eritrean Med Assoc. 2009;4(1):22–5.
19.
Esteves-Pereira AP, Deneux-Tharaux C, Nakamura-Pereira M, Saucedo M, Bouvier-Colle MH, Leal MC. Caesarean delivery and postpartum maternal mortality: a population-based case control study in Brazil. PLoS One. 2016;11(4):e0153396.CrossRef
20.
Liambila WN, Kuria SN. Birth attendance and magnitude of obstetric complications in Western Kenya: a retrospective case–control study. BMC Pregnancy Childbirth. 2014;14(1):311.CrossRef
21.
Berhan Y, Berhan A. Causes of maternal mortality in Ethiopia: a significant decline in abortion related death. Ethiop. 2014;24:15–28.
22.
Legesse T, Misra Abdulahi AD. Trends and causes of maternal mortality in Jimma University specialized hospital, Southwest Ethiopia: a matched case–control study. Int J Womens Health. 2017;9:307.CrossRef
23.
Tessema GA, Laurence CO, Melaku YA, Misganaw A, Woldie SA, Hiruye A, et al. Trends and causes of maternal mortality in Ethiopia during 1990–2013: findings from the global burden of diseases study 2013. BMC Public Health. 2017;17(1):160.CrossRef
24.
Ahmed S, Tholandi M, Pedrana A, Zazri A, Parmawaty N, Rahmanto A, et al. Changes in obstetric case fatality and early newborn mortality rates in hospitals after the implementation of the expanding maternal and neonatal survival program in Indonesia: results from a health information system. Int J Gynecol Obstet. 2019;144:13–20.CrossRef
25.
Kaye DK, Kakaire O, Osinde MO. Systematic review of the magnitude and case fatality ratio for severe maternal morbidity in sub-Saharan Africa between 1995 and 2010. BMC Pregnancy Childbirth. 2011;11(1):65.CrossRef
26.
Yesuf EA, Calderon-Margalit R. Disparities in the use of antenatal care service in Ethiopia over a period of fifteen years. BMC Pregnancy Childbirth. 2013;13(1):131.CrossRef
27.
Muchie KF. Quality of antenatal care services and completion of four or more antenatal care visits in Ethiopia: a finding based on a demographic and health survey. BMC Pregnancy Childbirth. 2017;17(1):300.CrossRef
28.
Lakew Y, Reda AA, Tamene H, Benedict S, Deribe K. Geographical variation and factors influencing modern contraceptive use among married women in Ethiopia: evidence from a national population based survey. Reprod Health. 2013;10(1):52.CrossRef
29.
Federal Ministry of Health Ethiopia. Health Sector Transformation Plan 2015/16–2019/20. 2015.
30.
WHO. Time to respond: A report on the global implementation of Maternal Death Surveillance and Response 2016.
31.
Smith H, Ameh C, Roos N, Mathai M, van den Broek N. Implementing maternal death surveillance and response: a review of lessons from country case studies. BMC Pregnancy Childbirth. 2017;17(1):233.CrossRef
32.
Abebe B, Busza J, Hadush A, Usmael A, Zeleke AB, Sita S, et al. 'We identify, discuss, act and promise to prevent similar deaths': a qualitative study of Ethiopia's Maternal Death Surveillance and Response system. BMJ Glob Health. 2017;2(2):e000199.CrossRef
33.
Boller C, Wyss K, Mtasiwa D, Tanner M. Quality and comparison of antenatal care in public and private providers in the United Republic of Tanzania. Bull World Health Organ. 2003;81:116–22.PubMedPubMedCentral
34.
Chen L, Dai Y, Zhang Y, Wu Q, Rudan D, Saftić V, et al. A comparison between antenatal care quality in public and private sector in rural Hebei, China. Croatian Med J. 2013;54(2):146–56.CrossRef
35.
Tabatabai P, Henke S, Sušac K, Kisanga OM, Baumgarten I, Kynast-Wolf G, et al. Public and private maternal health service capacity and patient flows in southern Tanzania: using a geographic information system to link hospital and national census data. Glob Health Action. 2014;7(1):22883.CrossRef
36.
Danilovich N, Yessaliyeva E. Effects of out-of-pocket payments on access to maternal health services in Almaty, Kazakhstan: a qualitative study. Eur Asia Stud. 2014;66(4):578–89.CrossRef
37.
Sumankuuro J, Crockett J, Wang S. Perceived barriers to maternal and newborn health services delivery: a qualitative study of health workers and community members in low and middle-income settings. BMJ Open. 2018;8(11):e021223.CrossRef
38.
Hatt LE, Makinen M, Madhavan S, Conlon CM. Effects of user fee exemptions on the provision and use of maternal health services: a review of literature. J Health Popul Nutr. 2013;31(4 Suppl 2):S67.PubMedCentral
39.
Lindtjørn B, Mitiku D, Zidda Z, Yaya Y. Reducing maternal deaths in Ethiopia: results of an intervention Programme in Southwest Ethiopia. PLoS One. 2017;12(1):e0169304.CrossRef
Metadata
Title
Magnitude and determinants of obstetric case fatality rate among women with the direct causes of maternal deaths in Ethiopia: a national cross sectional study
Authors
Ayele Geleto
Catherine Chojenta
Tefera Taddele
Deborah Loxton
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-2830-5

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue

Research article

Pre-conception blood pressure and evidence of placental malperfusion

Research article

Weighing as part of your care: a feasibility study exploring the re-introduction of weight measurements during pregnancy as part of routine antenatal care

Case report

Sudden onset of syncope and disseminated intravascular coagulation at 14 weeks of pregnancy: a case report

Research article

Maternal exposure to Wenchuan earthquake and prolonged risk of offspring birth outcomes: a natural experiment study

Research article

Identifying fear of childbirth in a UK population: qualitative examination of the clarity and acceptability of existing measurement tools in a small UK sample

Research article

Perinatal and neonatal outcomes of pregnancies after early rescue intracytoplasmic sperm injection in women with primary infertility compared with conventional intracytoplasmic sperm injection: a retrospective 6-year study