Determinants of Maternal Death in a Pastoralist Area of Borena Zone, Oromia Region, Ethiopia: Unmatched Case-Control Study

Abstract

Background Globally, more than 830 maternal deaths happen daily, and nearly, all of these occur in developing countries. Similarly, in Ethiopia, maternal mortality is still very high. Studies done in pastoralist women are almost few. Therefore, the objective of this study was to assess the determinant factors of maternal death in the pastoralist area of Borena zone, Oromia region, Ethiopia. Methods Community-based unmatched case-control study was conducted on 236 mothers (59 maternal deaths (cases) and 177 controls). The sample included pregnant women aged 15–49 years from September 2014 to March 2017. Data were collected using a structured questionnaire adapted from Maternal Death Surveillance and Response Technical Guideline, entered into the EpiData, exported into SPSS for analyses. Odds ratios (ORs) and 95% confidence interval (CI) were computed to determine contributing factors of maternal death and control potential confounding variables. Results About 51 (86%) of all maternal deaths were due to direct obstetric causes. Of this, hemorrhage (45%), hypertensive disorders of pregnancy (23%), and obstructed labor (18%) were the leading direct causes of maternal deaths. Husbands who had no formal education were 5 times higher compared with their counterparts (AOR = 5.1, 95% CI: 1.6–16). Mothers who were not attending ANC were 5 times more at risk for death than those who attend (AOR 5.3, 95% CI 2.3–12.1). Mothers who gave birth at home/on transit were twice to die compared to health facility delivery (AOR 2.6, 95% CI 2.4–6) that were contributing factors of maternal deaths. Conclusions Husband's level of education, lack of antenatal care, and home delivery were the factors contributing to maternal deaths in the zone. Frequent and tailored antenatal care, skilled delivery, and access to education also need due attention.

Prevalence and predictors of primary postpartum hemorrhage: An implication for designing effective intervention at selected hospitals, Southern Ethiopia

“…Ethiopia has made significant progress in maternal health care services include the increases institutional births, avail skilled birth attendants at all births and practicing active management of the third stage of labor which reduces the incidence of PPH, the quantity of blood loss and the need for blood transfusions [30]. Despite this, PPH continues to remain the leading cause of maternal mortality in Ethiopia [31–34].…”

Maternal Mortality in the District of Uzumba in Zimbabwe

“…Age-old patriarchal traditions and existing gender role models based on male superiority weigh in heavily. This is supported by Thomsen et al (2012), Hagman (2013) Yamin, et al, (2015, Odekunle (2016) and Sara et al, (2019) who reiterate that gender inequalities and women's role in society are the root causes of the high levels of maternal mortality in the developing world. Gender inequalities exist in any society and contribute to the subordination of women relative to men in most contexts.…”

“…Cultural traditions and beliefs of having many children as a sign of motherhood can put woman's health at resulting in risks of maternal death. At some point in polygamous marriages due to family and societal pressure, a woman embarks on pregnancy as a form of competition and leaves her without enough time to recover (Hadley & Tuba 2011, Mnyani et al, 2017and Sara et al, 2019. In such a scenario of many pregnancies without receiving enough antenatal care, women are likely to be at high risk of pregnancy related problems in unfortunate circumstances it leads to maternal mortality.…”

“…In Zimbabwe and most developing countries, majority of maternal deaths go unregistered and underresearched (Hagman 2013 andNiehof 2014). Sara, et al (2019) further articulate that, barriers to safe motherhood persist, especially in socially and economically marginalized communities. Thus, sociocultural factors has been neglected too, as they contribute to women dying during and after pregnancy.…”

The Effect of Inter-Pregnancy Interval on Primary Postpartum Hemorrhage in Urban South Ethiopia: A Community-Based Matched Nested Case Control Study

“…Birth attendants are expected to monitor the duration and progress of labour and suggest appropriate intervention to reduce the risk of PPH and related burden from mothers and their families. More, early detection and appropriate management of prolonged labor saves the life of the mother, as it is one of the direct causes of maternal death (24), (22).…”