Maternal and Neonatal Mortality in South-West Ethiopia: Estimates and Socio-Economic Inequality

Abstract

IntroductionEthiopia has achieved the fourth Millennium Development Goal by reducing under 5 mortality. Nevertheless, there are challenges in reducing maternal and neonatal mortality. The aim of this study was to estimate maternal and neonatal mortality and the socio-economic inequalities of these mortalities in rural south-west Ethiopia.MethodsWe visited and enumerated all households but collected data from those that reported pregnancy and birth outcomes in the last five years in 15 of the 30 rural kebeles in Bonke woreda, Gamo Gofa, south-west Ethiopia. The primary outcomes were maternal and neonatal mortality and a secondary outcome was the rate of institutional delivery.ResultsWe found 11,762 births in 6572 households; 11,536 live and 226 stillbirths. There were 49 maternal deaths; yielding a maternal mortality ratio of 425 per 100,000 live births (95% CI:318–556). The poorest households had greater MMR compared to richest (550 vs 239 per 100,000 live births). However, the socio-economic factors examined did not have statistically significant association with maternal mortality. There were 308 neonatal deaths; resulting in a neonatal mortality ratio of 27 per 1000 live births (95% CI: 24–30). Neonatal mortality was greater in households in the poorest quartile compared to the richest; adjusted OR (AOR): 2.62 (95% CI: 1.65–4.15), headed by illiterates compared to better educated; AOR: 3.54 (95% CI: 1.11–11.30), far from road (≥6 km) compared to within 5 km; AOR: 2.40 (95% CI: 1.56–3.69), that had three or more births in five years compared to two or less; AOR: 3.22 (95% CI: 2.45–4.22). Households with maternal mortality had an increased risk of stillbirths; OR: 11.6 (95% CI: 6.00–22.7), and neonatal deaths; OR: 7.2 (95% CI: 3.6–14.3). Institutional delivery was only 3.7%.ConclusionHigh mortality with socio-economic inequality and low institutional delivery highlight the importance of strengthening obstetric interventions in rural south-west Ethiopia.

Childhood Mortality: Trends and Determinants in Ethiopia from 1990 to 2015—A Systematic Review

“…Analysis of the 1997 community and family survey data in Southern Ethiopia revealed that the risk of IM is significantly associated with short birth intervals of less than 18 months compared with an interval of 24-35 months [16]. In other records mortality among neonates [18,25,26] and infants [27] with a preceding birth interval of less than 24 months was found to be 2 times higher than those with a preceding birth interval of greater than 24 months. In epidemiological assessment of determinants of U5M in Jimma town, highest rate of death was observed in groups with short birth interval [22].…”

“…One of the pathways by which mothers' education affects child survival is through improved child care [17]. Records revealed that neonatal mortality [18] and U5M [19] were associated with parental illiteracy; particularly maternal education has a strong relation with CM [20]. Children born to mothers with secondary education had a significantly reduced IM [16,21].…”

“…The proper spacing of births allows more time for childcare to make more maternal resources available for the care of the child and mother [28]. In addition households with maternal mortality had an increased risk of stillbirths and neonatal deaths [18].…”

Causes and Timing of Maternal Death in Mizan – Tepi University Teaching and Bonga General Hospital from 2011 – 2015: A Case Control Study and Using Propensity Score Matching Analysis

“…However study from maternity hospital of Nigeria shows 61.9% of maternal deaths occurred in post-partum period which is lower than finding from this research (74.8%). This difference might be because of sample size difference, which is only 84 maternal deaths in two year study period were included but this research includes 120 deaths in 5 year period [11,14]. Higher number of maternal death in post-partum period implies that the management following delivery and during delivery might be poor.…”

“…Among the 49 maternal deaths, 6 (12%) occurred during pregnancy, 18 (37%) during labour, and 25 (51%) after birth within six weeks [11].…”