Determinants of maternal length of stay following childbirth in a rural health facility in Eritrea

Abstract

Background: The lack of hospital based data limits understanding of potential leading indicators to formulate evidence based intervention efforts. This study explores maternal length of hospital stay (LOS) following child birth and associated factors in a rural health facility in Eritrea. Methodology: A retrospective study of all mothers that delivered in Nakfa hospital between 2020 and 2022 was conducted. Factors associated with postpartum LOS were evaluated for both vaginal delivery (VD) and cesarean delivery (CD). Determinants of LOS following vaginal delivery were explored using negative binomial regression. Results: A total of 2025 mothers [1975 (97.5%) VD and 50 (2.5%) CD] with a median age 26 (IQR: 22-30) years were included in the study. The median LOS following childbirth was 1 (IQR: 0-1) day for VD and 6 (IQR: 4-8) days for CD. Substantial mothers were found to have inadequate stay following VD [29% (95% CI: 27-31)] whereas [68 % (95% CI: 54%-81%)] stayed for > 4 days following CD. Following CD, LOS > 4 days was significantly associated with emergency CD (90.6% Vs 9.4% respectively, p- value< 0.001) as compared to elective CD. Meanwhile in VD; 5 minute Apgar score < 4 was significantly associated with prolonged LOS as compared to score of 4-6 and > 6 (24.1% Vs 9.1% and 8.2% respectively, p-value= 0.001). Moreover, VD that were attended by physicians had no inadequate stay whereas 27.4 % of deliveries attended by midwives and 31.3% by associate nurse resulted in inadequate stay (P-value <0.001). Determinants of LOS following VD were: presence of maternal complication (IRR=2.8, 95% CI: 1.6-5, p-value < 0.001), delivery year 2020 and 2021 (IRR= 1.5, 95% CI: 1.2-1.8, p-value <0.001 and IRR= 1.4 95% CI: 1.2-1.7, p-value <0.001 respectively) and delivery hour interval 23:00-7:00 (IRR= 0.8, 95% CI: 0.7-0.9, p-value=0.03). Conclusion: Substantial proportion of mothers stay too short post VD to allow adequate postnatal care whereas LOS post CD was high, particularly following emergency operation. Going forward, focus should be placed on enforcing adherence to guidelines on LOS, investment in hospital infrastructure, and personnel through provision of in-service training and upscale coverage antenatal care for early diagnosis of maternal complication in pregnancy.