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

Chojenta, Catherine; Taddele, Tefera; Loxton, Deborah

doi:10.1186/s12884-020-03276-1

Cited by 20 publications

(15 citation statements)

References 36 publications

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“…Our results are lower than those found by Ntoimo (2,085 per 100,000 live births) (31), Ousmane (1962 per 100,000 live births in the Labé Regional Hospital in Guinea) (32), and Kamga (1,538.9/100,000 live births in three university hospitals in Yaoundé) (33). However, our results are higher than those found by Sissoko (201.87 per 100,000 live births) (34) and Geleto (149 per 100,000 live births in Ethiopian hospitals) (35). This diversity of results con rms that maternal mortality in hospitals varies according to the context (36).…”

Section: Maternal Mortality Rate In the Reference Hospital Settingcontrasting

confidence: 66%

Maternal Mortality Study in the Eastern Democratic Republic of the Congo

Ramazani¹,

Ntela

Ahouah

et al. 2022

Preprint

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Background: Affordable, quality health care for pregnant women can improve their health. Thus, performance-based financing (PBF) remains one of the outcomes for improving the health system and increasing the accessibility of the poorest pregnant women to health care and reducing the maternal mortality rate. However, there is no up-to-date data on maternal mortality in the health structures using PBF in the Democratic Republic of the Congo (DRC). This study measures the mortality rate among pregnant women in health facilities by applying the PBF approach and identifies the associated risk factors.Methods: This analytical epidemiological study was based on rétrospective data materna deaths recorded in 59 health facilities, using the PBF approach in three health zones in the southern part of Maniema province in east DRC. The study was conducted from July 1, 2015 to June 30, 2020. Descriptive, bi and multivariate analyses were used.Results: The maternal mortality rate was estimated at 620 deaths per 100,000 live births, of which 46% of maternal deaths were related to a parturients’ delayed decision in seeking healthcare in time (first delay). Maternal deaths were significantly associated with extreme ages (≤19 years and ≥40 years: p = <0.001), patient parity (in primigravidas and in large multiparas: p = 0.001), complications such as hemorrhagic, (p = <0.001), uterine ruptures:(p = <0.001), infections, (p = <0.001), and dystocia (p = <0.001).Conclusion: Despite the establishment of the PBF approach in this part of eastern DRC, women continue to lose their lives when they decide to give birth. The results imply that it is imperative to strengthen both women and health professionals’ knowledge about pregnancy and maternal health and their power to reduce instances of first delay by supporting women in formulating their birth plans

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Section: Maternal Mortality Rate In the Reference Hospital Settingcontrasting

confidence: 66%

Maternal Mortality Study in the Eastern Democratic Republic of the Congo

Ramazani¹,

Ntela

Ahouah

et al. 2022

Preprint

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“…The country has made tangible strides in reducing maternal mortality in the last two decades. The MMR has declined from around 871 deaths in 2000 to 401 deaths in 2017; despite this achievement, there is noticeable variation among regional states [5][6][7]. Due to these regional variations the country has failed to achieve one of the MDGs goals, which had a target of dropping MMR to 267 in 2015 [4].…”

Section: Introductionmentioning

confidence: 99%

Critical factors associated with postpartum maternal death in Ethiopia

et al. 2022

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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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“…Facility delivery and caesarian sections were not disrupted (except in Oromia were facility deliveries declined by 7%). It is well known that facility delivery and caesarian sections are key services to reduce maternal complications and deaths and maintaining these services is crucial [30]. Similarly, child vaccinations were generally maintained except in Dire Dawa and Harari regions.…”

Section: Discussionmentioning

confidence: 99%

“…In April 2020, there were about 18% reduction in antenatal care visit in Nigeria and a 17% decline in postnatal care use in Mali [2]. A study conducted in urban Ethiopia found a significant reduction in child vaccination services in urban area especially in Addis Ababa and Harari [30]. However, these reductions occurred only for a few months after the pandemic was declared.…”

Section: Discussionmentioning

confidence: 99%

Effect of the COVID-19 pandemic on health service utilization across regions of Ethiopia: An interrupted time series analysis of health information system data from 2019–2020

Mebratie

Nega

Gage

et al. 2022

PLOS Glob Public Health

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The spread of COVID-19 and associated deaths have remained low in Ethiopia. However, the pandemic could pose a public health crisis indirectly through disruptions in essential health services. The aim of this study was to examine disruptions in health service utilization during the first nine months of the COVID-19 pandemic across 10 regions in Ethiopia. We analyzed utilization of 21 different health services across all of Ethiopia (except the Tigray region) for the period of January 2019 to December 2020. Data were extracted from the Ethiopian district health information system (DHIS2). Monthly visits in 2020 were graphed relative to the same months in 2019. Interrupted time series analysis was used to estimate the effect of the pandemic on service utilization in each region. We found that disruptions in health services were generally higher in urban regions which were most affected by COVID. Outpatient visits declined by 52%, 54%, and 58%, specifically in Dire Dawa, Addis Ababa and Harari, the three urban regions. Similarly, there was a 47% reduction in inpatient admissions in Addis Ababa. In agrarian regions, the pandemic caused an 11% to 17% reduction in outpatient visits and a 10% to 27% decline in inpatient admissions. Visits for children with diarrhea, pneumonia and malnutrition also declined substantially while maternal health services were less affected. Our study indicates that disruptions in health services were more pronounced in areas that were relatively harder hit by the pandemic. Our results show that the Ethiopian health system has a limited capacity to absorb shocks. During future waves of COVID or future pandemics, the Ethiopian health system must be better prepared to maintain essential services and mitigate the indirect impact of the pandemic on public health, particularly in urban areas.

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

Cited by 20 publications

References 36 publications

Maternal Mortality Study in the Eastern Democratic Republic of the Congo

Maternal Mortality Study in the Eastern Democratic Republic of the Congo

Critical factors associated with postpartum maternal death in Ethiopia

Effect of the COVID-19 pandemic on health service utilization across regions of Ethiopia: An interrupted time series analysis of health information system data from 2019–2020

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