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Saffa G, Keimbe C, Bangalie A, Sheriff AA, Jalloh B, Bah D, Bangura F, Tamba F, Bangura H, Sesay I, Kamara K, Gborie S, Teka H, Ikoona E, Elduma AH, Gebru GN. Factors contributing to delays in accessing health facility-based maternal delivery services in Sierra Leone, 2018: A community-based cluster survey. PLoS One 2024; 19:e0307179. [PMID: 39288131 PMCID: PMC11407616 DOI: 10.1371/journal.pone.0307179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/01/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND With a Maternal Mortality Ratio (MMR) of 516 deaths per 100,000 live-births, Sierra Leone hosts one of the highest maternal mortalities in globally. National data indicates that over 98% of maternal deaths are related to delays in accessing obstetric services. This study sought to examine factors contributing to delays in accessing maternal delivery services as perceived by women in Sierra Leone. METHODS We conducted a community-based survey among women who delivered from May 1, 2017 to June 30, 2018, in four districts of Sierra Leone. Delay one was defined as perceived delays in deciding to seek facility-based delivery. Delay two was defined as perceived delays reaching the health facility for delivery services. Data on participants' socio-demographics, delay one, delay two, three and determinants of delays one and two and three were collected using questionnaires. We calculated frequencies and proportions for factors contributing to delays as well as Prevalence Odds Ratios (POR) to identify risk factors for the delays. RESULTS A total of 614 mothers were interviewed, median age 28 years (range, 14-52 years). The prevalence of Delay One was 23.3% (143/614), and Delay Two was 26.9% (165/614). Mother with secondary education were associaited with delay one (aPOR = 2.3; 95% CI:1.14, 4.46). These was an association between perceived delay-two and previous pregnancy-related complications (aPOR = 1.6; 95% CI:1.071, 2.538) and poor condition of roads (POR = 2.34; 95%CI, 1.15, 4.77). Additinally, there was an association between delay-three and previous-related complication during last pregnancy (aPOR = 1.9; 95% CI: 1.055, 3.67). CONCLUSIONS This study revealed a high prevalence of perceived delays one and two for mothers to access obstetric services. Delays were mainly related to transport difficulties, low knowledge of pregnancy-related complications, and costly obstetric services. A practical strategy for birth preparedness and readiness to reduce delays is urgently needed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Hale Teka
- Mekelle University, College of Health Sciences, Mekelle, Ethiopia
- Track Trust, SCIO, Scotland, United Kindom
| | - Eric Ikoona
- ICAP at Columbia University in Sierra Leone, Sierra Leone
| | - Adel Hussein Elduma
- African Field Epidemiology Network, Field Epidemiology Training Program, Sierra Leone
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Anteneh TA, Endale ZM, Aragaw GM, Mamo HY, Ketema B, Gashaw T, Misaw R, Tiruye TM. Delay in Seeking Institutional Delivery Services and Associated Factors Among Immediate Postpartum Mothers in Public Health Facilities in Gondar Town, Northwest Ethiopia, 2022. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:404-411. [PMID: 39035136 PMCID: PMC11257110 DOI: 10.1089/whr.2024.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 07/23/2024]
Abstract
Background Maternal and neonatal mortality is a global problem that is highly prevalent in low- and middle-income countries, including Ethiopia. Maternal delay in seeking institutional delivery services utilization plays a significant role in determining maternal and neonatal health outcomes. Although studies have been conducted on institutional delivery service utilization in Ethiopia, little is known about factors for delays in seeking care for institutional delivery services. Objective This study aimed to assess the delay in seeking institutional delivery services and associated factors among immediate postpartum mothers in public health facilities in Gondar, northwest Ethiopia. Methods A facility-based cross-sectional study was conducted from July 15 to September 10, 2022. A total of 391 participants were selected using systematic random sampling. Data were collected through face-to-face interviews using structured, pretested, and interviewer-administered questionnaires. Data were entered into EpiData version 4.6, and the analysis was conducted using Statistical Package for Social Science version 26. The multivariable logistic regression model was fitted and the level of significance was set at p ≤ 0.05. Result The prevalence of delay in seeking institutional delivery was 49.10% (95% confidence interval [CI]: 44.13, 54.08). Rural residence (adjusted odds ratio [AOR] = 2.51; 95% CI: 1.43-4.41), no antenatal care visits (AOR: 2.87; 95% CI: 1.34-6.13), unplanned pregnancy (AOR: 2.98; 95% CI: 1.78-5.01), poor decision-making autonomy in maternity care services (AOR: 1.98; 95% CI: 1.15-3.40), and poor birth preparedness plan (AOR: 4.88; 95% CI: 2.79-8.53) were significantly associated with delays in seeking institutional delivery. Conclusion Delays in seeking institutional delivery services were high. It is better to promote women's decision-making power in their own health care. In addition, it is better to arrange programs that will improve maternal and child health service utilization.
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Affiliation(s)
- Tazeb Alemu Anteneh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zerfu Mulaw Endale
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getie Mihret Aragaw
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hana Yohanes Mamo
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Betelhem Ketema
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Gashaw
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rahel Misaw
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tiringo Molla Tiruye
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Morka W, Megersa G, Bekele E, Deksisa A. Incidence of Adverse Perinatal Outcomes among Women Exposed to Maternal Near-Misses in Arsi Zone in Ethiopia: Prospective Cohort Study in 2022. J Pregnancy 2024; 2024:6560652. [PMID: 38550878 PMCID: PMC10978081 DOI: 10.1155/2024/6560652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/30/2023] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
Background Exposure to maternal near-misses has a massive effect on adverse perinatal outcomes. Hence, investigating the effect of maternal near-misses on perinatal outcomes can aid in the reduction of perinatal morbidity and mortality. The study is aimed at assessing the incidence of adverse perinatal outcomes among women exposed to maternal near-misses at Arsi Zone public hospitals in Ethiopia in 2022. Method The study included a prospective cohort of 335 women at Arsi Zone public hospitals from December 2021 to June 2022. Women who were admitted for management of pregnancy were followed. The exposed group was women with maternal near-misses screened based on disease-validated criteria. The nonexposed group was made up of women who delivered without complications. Trained data collectors used pretested, structured questionnaires to collect data from women. Pertinent data was also extracted from the clients' logbooks. Data was transferred from EpiData version 3.1 to SPSS version 25 for analysis, logistic regression was computed, and 95% confidence intervals were declared at a p value of 5% significance level. Result The incidence of adverse perinatal outcomes was higher in the exposed women than in the nonexposed women (56% versus 16%). Contrasted with the nonexposed, women exposed to maternal near-misses had a higher incidence of stillbirth (22% vs. 0.5%), low birth weight (13% vs. 3%), and preterm birth (12% vs. 2%). After adjusting for confounders, exposed women had a twofold increased risk of adverse perinatal outcomes compared to nonexposed women. Delivery mode, delay in seeking care, transport mode, and delay in receiving treatment were the risk factors for negative pregnancy outcomes. Conclusion In exposed women, a higher incidence of adverse perinatal outcomes was linked to aforementioned risk factors. Evidence-based practice intended to decrease delays in providing maternal care services does indeed improve perinatal outcomes.
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Affiliation(s)
- Wogene Morka
- Department of Midwifery, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Getu Megersa
- Department of Midwifery, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Elias Bekele
- Department of Midwifery, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Abdi Deksisa
- Department of Midwifery, College of Health Sciences, Arsi University, Asella, Ethiopia
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Debela DE, Aschalew Z, Bante A, Yihune M, Gomora D, Hussein F, Sahile A, Mersha A. Maternal delay for institutional delivery and associated factors among postnatal mothers at Southeastern Ethiopia: a cross sectional study. BMC Pregnancy Childbirth 2024; 24:206. [PMID: 38500066 PMCID: PMC10949752 DOI: 10.1186/s12884-024-06416-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Maternal delay in timely seeking health care, inadequate health care and the inability to access health facilities are the main causes of maternal mortality in low and middle income countries. The three-delay approach was used to pinpoint responsible factors for maternal death. There was little data on the delay in decision making to seek institutional delivery service in the study area. Therefore, the aim of this study was to assess the extent of the first maternal delay for institutional delivery and its associated factors among postpartum mothers in the Bale and east Bale zones. METHODS An institutional-based cross-sectional study was conducted among 407 postpartum mothers from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analysis was done by using binary logistic regression model to identify factors associated with maternal delay for institutional delivery services. Statistical significance was declared at P-value < 0.05. RESULTS In this study, the magnitude of the first maternal delay in making the decision to seek institutional delivery service was 29.2% (95% CI: 24.9, 33.9). Previous pregnancy problems (AOR = 1.8; 95% CI: 1.06, 3.08), knowing the danger signs of labor and childbirth (AOR = 1.78; 95% CI: 1.11, 2.85) and decision-making (AOR = 0.42; 95% CI: 0.20, 0.85) were significantly associated with the first maternal delay. CONCLUSION This study identified a significant number of postnatal mothers experienced delay in making decisions to seek institutional delivery service in the study area. Promoting women's empowerment and building on key danger signs should be emphasized.
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Affiliation(s)
- Derese Eshetu Debela
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia.
| | - Zeleke Aschalew
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Agegnehu Bante
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Manaye Yihune
- School of Public Health, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Feisal Hussein
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Shashamane, Ethiopia
| | - Ayele Sahile
- Department of Midwifery, College of Medicine & Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Abera Mersha
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Eshetu D, Aschalew Z, Bante A, Negesa B, Gomora D, Ejigu N, Geta G, Mersha A. Delay in reaching health facilities for emergency obstetric care and associated factors among postpartum mothers at Bale zones, Ethiopia. A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002964. [PMID: 38416745 PMCID: PMC10901325 DOI: 10.1371/journal.pgph.0002964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
Maternal mortality occurs in developing nations as a result of inadequate health care, delayed medical attention and the inability to access medical facilities. The three-delay model was employed to determine the causes of maternal death. There was limited data on maternal delay in reaching health facilities for emergency obstetric care services in the study area. Therefore, the aim of this study was to assess the prevalence of delay in reaching health facilities for emergency obstetric care and associated factors among postpartum mothers at Bale and east Bale zones. An institutional-based cross-sectional study was conducted among 407 postnatal women from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariable and multivariable analysis was done by using a binary logistic regression model to identify factors associated with delay in traveling for emergency obstetric care services. Statistical significance was declared at P-value < 0.05. In this study, the prevalence of delay in reaching health facilities during emergency obstetric care was 38.1% (95%CI: 33.3, 43). The following factors showed significant association with delay in reaching health facilities during emergency obstetric care: Average monthly income (AOR = 1.87; 95% CI: 1.12, 3.14), distance (AOR = 4.35; 95% CI: 2.65, 7.14), a referral from other health facilities (AOR = 1.77; 95% CI: 1.01, 3.11) and delay one (AOR = 2.9; 95% CI: 1.7, 4.93). This study showed that the prevalence of delay in reaching health facilities for emergency obstetric care services in the study area was high. Promoting road accessibility and transport mechanisms and strengthening referral mechanisms shall be emphasized.
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Affiliation(s)
- Derese Eshetu
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Zeleke Aschalew
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Agegnehu Bante
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Belda Negesa
- Department of Midwifery, Institute of Health Sciences, Bule Hora University, Bule Hora, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Neway Ejigu
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Girma Geta
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Abera Mersha
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Regassa WM, Gemeda GM, Wakwoya EB, Gelete BW. Magnitude of maternal near-misses and associated factors in Arsi Zone public hospitals in Oromia, Ethiopia, 2022. Heliyon 2024; 10:e24910. [PMID: 38312699 PMCID: PMC10834814 DOI: 10.1016/j.heliyon.2024.e24910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 02/06/2024] Open
Abstract
Background Investigation of maternal near-misses is useful for monitoring and evaluating the quality of obstetrics care services. Despite its importance, data has been limited in Arsi Zone public hospitals. Objective To assess the magnitude of maternal near-miss and associated factors in Arsi Zone public hospitals, Ethiopia, 2022. Method Institution-based cross-sectional study design was conducted on 327 study participants from December 2021 to June 2022. The study participants were selected through systematic random sampling. Trained data collectors used pre-tested structured questionnaires to collect data from study participants. Pertinent data were also extracted from clients' logbook. The data were entered to Epi Data version 3.1 and exported to SPSS version 25.0 for analysis. Multivariable logistic regression were employed to control for possible confounders where a significance level was set to a P-value of 5 %. Result A total of 326 study participants responded, resulting in a 99.7 % response rate. The magnitude of maternal near-miss was 34.4 % [95 % CI (29.2-39.8)]. Hypertensive disorders (35 %), hemorrhage (35 %), ruptured uterus (11 %), unsafe abortion (8 %), obstructed labour (7 %), and infection/sepsis (4.5 %) were the direct while anemia (20 %) was one of the indirect causes of maternal near-misses. ANC visit received (AOR = 2.5, 95 % CI: 1.04-5.84), First ANC booked trimester (AOR = 0.26, 95 % CI: 0.1-0.9), delay in seeking care (AOR = 3.1, 95 % CI: 1.2-8.1), delay two (AOR = 2.7, 95 % CI: 1.0-6.8) and mode of delivery (AOR = 2.8, 95 % CI: 1.3-6.1) were factors associated with maternal near-misses. Conclusion The prevalence of maternal near-miss was high. To improve the identified factors and minimize their consequences, appropriate interventions are required at all levels to improve the quality of obstetrics care services aimed at improving positive pregnancy outcomes.
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Affiliation(s)
- Wogene Morka Regassa
- Department of Midwifery, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Getu Megersa Gemeda
- Department of Midwifery, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Elias Bekele Wakwoya
- Department of Midwifery, College of Health Sciences, Arsi University, Asella, Ethiopia
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Gelaw KA, Atalay YA, Zerefu F, Gebeyehu NA. Delays in the decision to seek care and associated factors among mothers who delivered in rural health centers in Wolaita Zone, Southern Ethiopia. Front Glob Womens Health 2024; 4:1236242. [PMID: 38273874 PMCID: PMC10808602 DOI: 10.3389/fgwh.2023.1236242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
Background Delays in seeking care in health facilities during pregnancy and childbirth can potentially lead to adverse outcomes for women with obstetric complications. These complications lead to maternal mortality and morbidity in developing countries such as Ethiopia. The magnitude and underlying causes of maternal first delay in Ethiopia, particularly in rural areas of the country, are not well documented. This study aims to assess the magnitude of delay in the decision to seek care and associated factors among mothers who gave birth in rural health centers in Wolaita Zone, Southern Ethiopia. Method and materials A facility-based cross-sectional study was undertaken among mothers who gave birth in rural health centers of Wolaita Zone, Southern Ethiopia, from 30 June 2020 to 30 July 2022. A sample size of 410 study participants was selected from each public health center using the systematic random sampling method. Data were collected from a pretested and structured questionnaire using an Open Data Kit; analysis was carried out using SPSS version 25. The determining factors for the first delay were identified using binary logistic regression. Variables with a p-value of less than 0.25 in binary analysis were selected for a multivariable analysis. Variables with a p-value of less than 0.05 were considered statistically significant. Results The magnitude of delay in the decision to seek care in health facilities was 42.1% among mothers who gave birth in rural health centers in the Wolaita Zone, Southern Ethiopia. Unemployed mothers (Adjusted Odd Ratio, 2,529; 95% CI, 1.546, 4.136), husbands with no formal education (Adjusted Odd Ratio, 1.290; 95% CI, 1.029, 1.616), mothers who had negative attitudes towards seeking care in health facilities, and (Adjusted Odd Ratio; 1.695; 95% CI, 1.061, 2.709) were significantly associated with a delay in the decision to seek care at a health facility. Conclusion The magnitude of the first maternal decision to seek care at health facilities among mothers was high in the study area. Efforts should be made to strengthen the literacy level of the husbands of mothers and increase household income through various income-generating approaches. In addition, the dissemination of health information could effectively raise community awareness of the importance of institutional delivery.
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Affiliation(s)
- Kelemu Abebe Gelaw
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, WolaitaSodo, Ethiopia
| | - Yibeltal Assefa Atalay
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Firehiwot Zerefu
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, WolaitaSodo, Ethiopia
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Gurara MK, Draulans V, Jacquemyn Y, Van Geertruyden JP. Evaluation of a community-based intervention package to improve knowledge of obstetric danger signs, birth preparedness, and institutional delivery care utilization in Arba Minch Zuria District, Ethiopia: a cluster-randomized trial. Reprod Health 2023; 20:169. [PMID: 37980484 PMCID: PMC10657004 DOI: 10.1186/s12978-023-01713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/10/2023] [Indexed: 11/20/2023] Open
Abstract
INTRODUCTION Maternal healthcare utilization, particularly the institutional delivery, is disproportionately low in rural Ethiopia. This study aimed to evaluate the effectiveness of an integrated package of community-based interventions on the improved knowledge of obstetric danger signs, birth preparedness, and institutional delivery services utilization in rural areas of Gamo zone, southern Ethiopia. METHODS We conducted cluster-randomized controlled trial (NCT05385380) from 2019 to 2021 at the Arba Minch Health and Demographic Surveillance System site. We randomly assigned the 10 kebele clusters to intervention and control arm. We used a package of interventions, which included providing information on safe motherhood via video and/or audio with a birth preparedness card for pregnant women, training for community volunteers and health extension workers, and improving maternity waiting home services. Women in the control arm received routine services only. We used generalized mixed-effects logistic regression models to evaluate the effectiveness of the intervention on the outcome variables. RESULTS The study enrolled 727 pregnant women across the 10 clusters, with a 617 (84.9%) successful follow-up rate. The proportion of institutional delivery in the intervention arm was increased by 16.1% from 36.4% (174/478) at the baseline to 52.5% (224/427) at the endline (Adjusted odds ratio [AOR] for McNemar's Test = 1.5; 95% confidence interval [CI]: 1.1 to 2; p < 0.001). In the control arm, however, there was a 10.3% fall in the proportion of institutional delivery (from 164/249 to 105/190). Pregnant women who received the intervention were significantly more likely to give birth in a health institution than those who did not (AOR 2.8; 95% CI: 1.2, 6.4). CONCLUSION The study demonstrates that an integrated community-based intervention package that included video-based storytelling and upgrading maternity waiting homes increased institutional delivery care utilization among rural women. We recommend that audio-visual storytelling, starting during pregnancy and continuing postpartum, be incorporated into routine maternal healthcare services to address access to care inequalities in rural settings. TRIAL REGISTRATION The study protocol was registered in the clinicaltrials.gov with registry number NCT05385380.
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Affiliation(s)
- Mekdes Kondale Gurara
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Veerle Draulans
- Faculty of Social Sciences, Centre for Sociological Research, KU Leuven, Louvain, Belgium
| | - Yves Jacquemyn
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Obstetrics and Gynaecology, Antwerp University Hospital, UZA, Edegem, Belgium
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Berihun A, Abebo TA, Aseffa BM, Simachew Y, Jisso M, Shiferaw Y. Third delay and associated factors among women who gave birth at public health facilities of Gurage zone, southern Ethiopia. BMC Womens Health 2023; 23:369. [PMID: 37438692 DOI: 10.1186/s12905-023-02526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 07/04/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The third delay is a delay in accessing emergency obstetric care timely and appropriately once a woman reaches a health facility. The third delay plays a crucial role as an indicator to assess the quality of obstetrics services and is often the leading contributing factor to maternal mortality in developing countries. Although considerable research has been conducted on pre-facility delays in healthcare access, there is a lack of focus on delays experienced upon arrival at health facilities, particularly in Ethiopia and the specific study areas of Gurage zone. This study aimed to assess the magnitude of the third delay and associated factors among women who gave birth at Public Health Facilities of Gurage Zone, Southern Ethiopia. METHOD A facility-based cross-sectional study was conducted with 558 women who gave birth at public health facilities of Gurage Zone from January 01/2020 to March 30/2020. Multi-stage stratified sampling technique was used to select the nine facilities. The data was collected using a structured interviewer administer questionnaire and an observational checklist. Women who waited more than an hour to receive delivery services after arriving at the health facility were classified as experiencing the third delay. The data were entered and analyzed using Epi Data version 3.1 and SPSS version 20.0 software, respectively. Binary logistic regression was employed to identify the determinant factors for the third delay. Variables having a P-value < 0.25 in the binary analysis were a candidate for multivariable analysis. Variables with P < 0.05 were considered statistically significant. RESULT The magnitude of the third delay was 193 [(34.8%; 95% CI; (30.8%, 38.8%)]. Complication during labor [AOR = 2.0; 95% CI, (1.4, 3.0)], Presence of functional generator in a health facility [AOR = 2.8; 95% CI, (1.3, 6.3)], level of health institution [AOR = 2.8; 95% CI, (1.04, 7.8)] and BEMONC training in the last two years [AOR = 1.6; 95% CI, (2.0, 6.5)] were significantly associated with third delay. CONCLUSION The magnitude of third delay was high compared to some low income countries, which shows most of mothers were not getting the service timely after they arrived at the health facility. Equipping health facilities with trained manpower and with necessary materials and infrastructure will contribute to hastening the provision of obstetric care.
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Affiliation(s)
| | - Teshome Abuka Abebo
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Bethelhem Mezgebe Aseffa
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Yilkal Simachew
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia.
| | - Meskerem Jisso
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Yemisrach Shiferaw
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Eshetu D, Aschalew Z, Bante A, Fikedu G, Abebe M, Gomora D, Silesh E, Belay R, Getachew T, Acha A, Mersha A. Delay in receiving emergency obstetric care and associated factors among mothers who gave birth in public hospitals of Bale and East Bale zones, Oromia region, South East Ethiopia: Facility based cross-sectional study. Heliyon 2023; 9:e18217. [PMID: 37501971 PMCID: PMC10368818 DOI: 10.1016/j.heliyon.2023.e18217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Delays in timely seeking care, failure to reach health institutions and receiving ineffective health care cause maternal mortality in developing countries. The three maternal delay was used to identify contributing factors to maternal death. There was limited data on the maternal delay in receiving emergency obstetric care services in the study area. Therefore, the aim of this study was to assess the magnitude of delay in receiving emergency obstetric care and associated factors among postnatal mothers in the Bale and east Bale zones. Methods A facility-based cross-sectional study was conducted among 407 postnatal women from April 6 to May 6, 2022. A systematic random sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analyses were done by using a binary logistic regression model to identify factors associated with delay in receiving emergency obstetric care services. Statistical significance was declared at P-value < 0.05. Results In this study, the magnitude of delay in receiving institutional delivery service utilization was 34.6% with [95% CI (30.0_39.5)]. Delay one was found to be statistically associated with maternal delay in receiving institutional delivery services (AOR = 2.07; 95% CI: 1.21, 3.53). Mothers with low monthly income had shown higher odds of delay (AOR = 1.79; 95% CI: 1.03, 3.10). Moreover, the delay in receiving emergency obstetric care was 89% less likely among mothers who had not been referred multiple times than among those who had been referred many times (AOR = 0.10; 95% CI: 0.06, 0.18). Conclusion This study showed that the magnitude of the delay in receiving the utilization of emergency obstetric care services in the study area was high. Factors such as delay one, average monthly income and multiple referrals of mothers were found significant factors for delay in receiving care. Therefore, it is important to reduce delay in receiving institutional delivery by working on promoting road accessibility, transport mechanisms and building health education on key danger signs.
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Affiliation(s)
- Derese Eshetu
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Zeleke Aschalew
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Agegnehu Bante
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Genet Fikedu
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, College of Medicine & Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Eden Silesh
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Rediet Belay
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Tewodros Getachew
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Aregash Acha
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Abera Mersha
- School of Nursing, College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Kalter HD, Setel PW, Deviany PE, Nugraheni SA, Sumarmi S, Weaver EH, Latief K, Rianty T, Nandiaty F, Anggondowati T, Achadi EL. Modified Pathway to Survival highlights importance of rapid access to quality institutional delivery care to decrease neonatal mortality in Serang and Jember districts, Java, Indonesia. J Glob Health 2023; 13:04020. [PMID: 37054399 PMCID: PMC10101726 DOI: 10.7189/jogh.13.04020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Background Three-quarters of births in Indonesia occur in a health facility, yet the neonatal mortality rate remains high at 15 per 1000 live births. The Pathway to Survival (P-to-S) framework of steps needed to return sick neonates and young children to health focuses on caregiver recognition of and care-seeking for severe illness. In view of increased institutional delivery in Indonesia and other low- and middle-income countries, a modified P-to-S is needed to assess the role of maternal complications in neonatal survival. Methods We conducted a retrospective cross-sectional verbal and social autopsy study of all neonatal deaths from June through December 2018, identified by a proven listing method in two districts of Java, Indonesia. We examined care-seeking for maternal complications, delivery place, and place and timing of neonatal illness onset and death. Results The fatal illnesses of 189/259 (73%) neonates began in their delivery facility (DF), 114/189 (60%) of whom died before discharge. Mothers whose neonate's illness started at their delivery hospital and lower-level DF were more than six times (odds ratio (OR) = 6.5; 95% confidence interval (CI) = 3.4-12.5) and twice (OR = 2.0; 95% CI = 1.01-4.02) as likely to experience a maternal complication as those whose neonates fell fatally ill in the community, and illness started earlier (mean = 0.3 vs 3.6 days; P < 0.001) and death came sooner (3.5 vs 5.3 days; P = 0.06) to neonates whose illness started at any DF. Despite going to the same number of providers/facilities, women with a labour and delivery (L/D) complication who sought care from at least one other provider or facility on route to their DF took longer than those without a complication to reach their DF (median = 3.3 vs 1.3 hours; P = 0.01). Conclusions Neonates' fatal illness onset in their DF was strongly associated with maternal complications. Mothers with a L/D complication experienced delays in reaching their DF, and nearly half the neonatal deaths occurred in association with a complication, suggesting that mothers with complications first seeking care at a hospital providing emergency maternal and neonatal care might have prevented some deaths. A modified P-to-S highlights the importance of rapid access to quality institutional delivery care in settings where many births occur in facilities and/or there is good care-seeking for L/D complications.
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Affiliation(s)
- Henry D Kalter
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Poppy E Deviany
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Sri A Nugraheni
- Faculty of Public Health, Diponegoro University, Semarang, Indonesia
| | - Sri Sumarmi
- Faculty of Public Health, Airlangga University, Surabaya, Indonesia
| | - Emily H Weaver
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kamaluddin Latief
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Tika Rianty
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Fitri Nandiaty
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Trisari Anggondowati
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Endang L Achadi
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
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Tesfay N, Tariku R, Zenebe A, Habtetsion M, Woldeyohannes F. Place of death and associated factors among reviewed maternal deaths in Ethiopia: a generalised structural equation modelling. BMJ Open 2023; 13:e060933. [PMID: 36697051 PMCID: PMC9884926 DOI: 10.1136/bmjopen-2022-060933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The study aims to determine the magnitude and factors that affect maternal death in different settings. DESIGN, SETTING AND ANALYSIS A review of national maternal death surveillance data was conducted. The data were obtained through medical record review and verbal autopsies of each death. Generalised structural equation modelling was employed to simultaneously examine the relationships among exogenous, mediating (urban/rural residence) and endogenous variables. OUTCOME Magnitude and factors related to the location of maternal death. PARTICIPANTS A total of 4316 maternal deaths were reviewed from 2013 to 2020. RESULTS Facility death constitutes 69.0% of maternal deaths in the reporting period followed by home death and death while in transit, each contributing to 17.0% and 13.6% of maternal deaths, respectively. Educational status has a positive direct effect on death occurring at home (β=0.42, 95% CI 0.22 to 0.66), obstetric haemorrhage has a direct positive effect on deaths occurring at home (β=0.41, 95% CI 0.04 to 0.80) and death in transit (β=0.68, 95% CI 0.48 to 0.87), while it has a direct negative effect on death occurring at a health facility (β=-0.60, 95% CI -0.77 to -0.44). Moreover, unanticipated management of complication has a positive direct (β=0.99, 95% CI 0.34 to 1.63), indirect (β=0.05, 95% CI 0.04 to 0.07) and total (β=1.04, 95% CI 0.38 to 1.70) effect on facility death. Residence is a mediator variable and is associated with all places of death. It has a connection with facility death (β=-0.70, 95% CI -0.95 to -0.46), death during transit (β=0.51, 95% CI 0.20 to 0.83) and death at home (β=0.85, 95% CI 0.54 to 1.17). CONCLUSION Almost 7 in 10 maternal deaths occurred at the health facility. Sociodemographic factors, medical causes of death and non-medical causes of death mediated by residence were factors associated with the place of death. Thus, factors related to the place of death should be considered as an area of intervention to mitigate preventable maternal death that occurred in different settings.
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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Rozina Tariku
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Medhanye Habtetsion
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Department, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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13
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Mislu E, Seid A, Bililign N, Woyo T, Dulla D. Maternal Third Delay and Associated Factors among Women Admitted for Emergency Obstetric Care in Public Hospitals in Sidama Regional State, Ethiopia. J Pregnancy 2023; 2023:7767208. [PMID: 37091530 PMCID: PMC10118880 DOI: 10.1155/2023/7767208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Background Timing to get obstetric care is critical in preventing maternal death and disability. Maternal third delay, the delay in receiving care after reaching health facilities, involves factors related to organization, quality of care, patient referral, and availability of staff and equipment. However, data is limited on maternal third delay and its associated factors at higher health facilities in Ethiopia. Objective This study is aimed at assessing the magnitude of maternal third delay and associated factors among women admitted for emergency obstetric care in public hospitals in Sidama Regional State, Ethiopia, 2021. Methods An institution-based cross-sectional study was conducted from September to November 2021. Face-to-face interview with a structured questionnaire and data extraction from medical charts were carried out in selected 542 women (using systematic sampling method). The collected data were coded and entered using EpiData, and bivariable and multivariable logistic regression analyses were done using SPSS version 25. Statistical significances were declared at p value less than 0.05. Results Maternal third delay was identified among 29.3% (95%CI = 25.2 - 33.5) of the respondents. Additionally, women who arrived with a referral from other health facilities (AOR = 0.311, 95%CI = 0.181 - 0.534), well prepared for birth and its complications (AOR = 2.418, 95%CI = 1.51 - 3.869), self-employed (AOR = 0.223, 95%CI = 0.122 - 0.409), being a government employee (AOR = 0.157, 95%CI = 0.063 - 0.396), having ANC follow-up (AOR = 2.795, 95%CI = 1.318 - 5.928), and absence of health professional (AOR = 4.63, 95%CI = 2.857 - 7.50) were significantly associated with maternal third delay. Conclusion This study identified that maternal third delay was high, which indicates that women have not received emergency obstetric care in the recommended time range after they arrived at the health facilities.
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Affiliation(s)
- Esuyawkal Mislu
- Department of Midwifery, School of Midwifery, College of Health Science, Woldia University, Ethiopia
| | - Ali Seid
- Basic Health Science, Dessie Health Science College, Dessie, Ethiopia
| | - Nigus Bililign
- Department of Midwifery, School of Midwifery, College of Health Science, Woldia University, Ethiopia
| | - Terefe Woyo
- Department of Midwifery, College of Medicine and Health Science, Hawassa University, Ethiopia
| | - Dubale Dulla
- Department of Midwifery, College of Medicine and Health Science, Hawassa University, Ethiopia
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Kassa BG, Tiruneh GA, Solomon AA. Delay in reaching health facilities and its associated factors among mothers giving birth in South Gondar zone hospitals, Northwest Ethiopia, 2020: A facility-based cross-sectional study. Front Glob Womens Health 2023; 4:916978. [PMID: 37020903 PMCID: PMC10068871 DOI: 10.3389/fgwh.2023.916978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 02/20/2023] [Indexed: 04/07/2023] Open
Abstract
Background Delays in reaching health facilities are one of three models identified as major contributors to maternal mortality and morbidity in developing countries, including Ethiopia. However, little is known about the prevalence and associated factors of delays in reaching healthcare facilities in Ethiopia, particularly in rural areas. Objective The aim of this study was to assess the prevalence of delays in reaching health facilities and associated factors among mothers who gave birth in South Gondar zone hospitals, Northwest Ethiopia, 2020. Methods A cross-sectional study design was used from 28 November to 25 December 2020, with 417 mothers who had recently given birth participating in the study, selected through a simple random sampling technique. Data were collected using a face-to-face interview with pretested structured questionnaires. The EpiData software (version 3.1) was used to record collected data and then exported to SPSS (version 23) for statistical analysis. Bivariable and multivariable analyses were conducted, and the odds ratio with 95% CI was used to identify factors associated with delays in reaching health facilities. The statistical significance was declared at p < .05. Results The prevalence of delay in reaching health facilities among mothers who gave birth in South Gondar zone hospitals were 50.6%. Mothers who had no antenatal care (ANC) visits [adjusted odd ratio (AOR) = 3.16, 95% CI = 1.52, 6.56], an unplanned pregnancy (AOR = 1.78, 95% CI = 1.16, 2.72), and a distance from home to a health facility greater than 5 km (AOR = 1.69, 95% CI = 1.08, 2.65) were positively associated with delays in reaching health facilities. Conclusions The prevalence of delays in reaching health facilities was higher in the study area. Women's empowerment through health education about ANC follow-up, choice of family planning methods, and creating accessibility to health facilities are essential measures to minimize delays in reaching health facilities.
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Affiliation(s)
- Bekalu Getnet Kassa
- Department of Midwifery, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
- Correspondence: Bekalu Getnet Kassa
| | | | - Abayneh Aklilu Solomon
- Department of Women and Family Health, School of Midwifery, College of Health Science, University of Gondar, Gondar, Ethiopia
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Tesfay N, Tariku R, Zenebe A, Mohammed F, Woldeyohannes F. Area of focus to handle delays related to maternal death in Ethiopia. PLoS One 2022; 17:e0274909. [PMID: 36121828 PMCID: PMC9484697 DOI: 10.1371/journal.pone.0274909] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Maternal delay factors, together with medical factors, have a substantial role in determining maternity outcomes. Although several studies were conducted on delay factors that contribute to maternal death in Ethiopia, the studies were mostly focused either on an individual or at a provincial level factor with a limited number of study participants. In response to this gap, this study is aimed at exploring the magnitude and factors related to delay factors that contribute to maternal death in Ethiopia.
Methods
The study used maternal death surveillance data collected from different regions of Ethiopia, compiled between 2013 and 2021. A total of 4530 maternal deaths were reviewed during the study period. A Multilevel multinomial logistic regression model was applied to examine factors associated with delays related to maternal death. An adjusted relative risk ratio with a 95% confidence interval was stated and variables with p-values less than 0.05 were declared as significant predictors of maternal delay.
Result
Delay three (delay in receiving adequate and appropriate care once reached a health facility) has contributed to 36.3% of maternal deaths followed by delay one (delay in deciding to seek care when experiencing an obstetric emergency) and delay two (delay in reaching to an appropriate obstetric facility) where each of them contributed to 36.1% and 27.6% of maternal deaths respectively. In the multivariate multilevel multinomial model, maternal age, education status, and place of death were among the individual level factors associated with both delay two and delay three. Conversely, marital status and ANC follow-up were associated with delay two alone, while the timing of maternal death was associated with delay three. Residence and type of facility were provincial-level factors linked with both delay two and delay three, while the type of region was related to delay three of maternal death.
Conclusion
Both delay one and three have a major contribution to maternal death in Ethiopia. Individual and provincial level factors played an important role in determining delays related to maternal death. Therefore, it is crucial to account for measures that provide emphasis on the area of raising awareness on the utilization of Antenatal care (ANC) service, improving facility readiness to handle obstetrics emergencies, and narrowing down inequality among regions in service provision.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
- * E-mail:
| | - Rozina Tariku
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fetiya Mohammed
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Tesfay N, Tariku R, Zenebe A, Woldeyohannes F. Critical factors associated with postpartum maternal death in Ethiopia. PLoS One 2022; 17:e0270495. [PMID: 35749471 PMCID: PMC9231747 DOI: 10.1371/journal.pone.0270495] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
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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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Rozina Tariku
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Birhane BM, Bayih WA, Mekonen DK, Chanie ES, Demis S, Shimelis H, Asferie WN, Abebe E, Addisu D, Nibret G, Endalamaw A, Munye T, Jember DA, Nebiyu S, Tiruneh YM, Belay DM. Level of Postnatal Checkup in Ethiopia - Implications for Child Health Services. Front Pediatr 2022; 10:895339. [PMID: 35774098 PMCID: PMC9237481 DOI: 10.3389/fped.2022.895339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background High neonatal mortality rates continue to be a major public health issue in Ethiopia. Despite different maternal and neonatal care interventions, neonatal mortality in Ethiopia is at a steady state. This could be due to the low utilization of neonatal checkups. Thus, nationally assessing the level and predictors of postnatal checkups could provide important information for further improving neonatal healthcare services. Materials and Methods A secondary data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) was performed on 7,586 women who had live births in the 2 years before the survey. All variables with a p-value of ≤0.25 in the bivariable analysis were entered into the final model for multivariable analysis, and the level of statistical significance was declared at a P-value of <0.05. Results According to the national survey, only 8.3% [95% CI: 8.19, 8.41] of neonates received postnatal checkups. About two-thirds of women, 62.8% had antenatal care visits, 67.9%, gave birth at home, and 95.7% were unaware of neonatal danger signs. Distance from health care institutions [AOR = 1.42; 95% CI: 1.06, 1.89], giving birth in a healthcare facility [AOR = 1.55; 95% CI: 1.12, 2.15], antenatal care visit [AOR = 3.0; 95% CI: 1.99, 4.53], and neonatal danger signs awareness [AOR = 3.06; 95% CI: 2.09, 4.5] were all associated with postnatal care visits. Conclusion The number of neonates who had a postnatal checkup was low. Increasing antenatal care visit utilization, improving institutional delivery, raising awareness about neonatal danger signs, increasing access to health care facilities, and implementing home-based neonatal care visits by healthcare providers could all help to improve postnatal checkups.
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Affiliation(s)
| | | | | | | | - Solomon Demis
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Shimelis
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Eskeziaw Abebe
- College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Dagne Addisu
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tigabu Munye
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Samuel Nebiyu
- College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Abdisa DK, Jaleta DD, Feyisa JW, Kitila KM, Berhanu RD. Access to maternal health services during COVID-19 pandemic, re-examining the three delays among pregnant women in Ilubabor zone, southwest Ethiopia: A cross-sectional study. PLoS One 2022; 17:e0268196. [PMID: 35511923 PMCID: PMC9071126 DOI: 10.1371/journal.pone.0268196] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/24/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND All women require access to high-quality care during pregnancy, labor, and after childbirth. The occurrence of delay at any stage is one of the major causes of maternal mortality. There is, however, a scarcity of data on women's access to maternal health services during the COVID-19 pandemic. Therefore, the goal of this study was to assess the magnitude of delays in maternal health service utilization and its associated factors among pregnant women in the Ilubabor zone during the COVID-19 pandemic. METHODS A facility-based cross-sectional study was conducted among 402 pregnant women selected by systematic random sampling. Data were analyzed using IBM SPSS Statistics version 26. Descriptive and summary statistics were used to describe the study population. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with the outcome variables. Adjusted odds ratio with respective 95% CI was used to report significant covariates. RESULTS A total of 402 pregnant women participated in this study. The median age of the respondents was 25 years (IQR = 8). On average, a woman stays 1.76 hours (SD = 1.2) to make a decision to seek care. The prevalence of first, second and third delay were 51%, 48%, and 33.3%, respectively. Being unmarried [AOR (95% CI)], [0.145 (0.046-0.452)], being unemployed [AOR (95% CI)], [4.824 (1.685-13.814)], age [AOR (95% CI)], [0.227 (0.089-0.0579)], fear of COVID-19 [AOR (95% CI)], [1.112 (1.036-1.193)], urban residence [AOR (95% CI)], [0.517 (0.295-0.909)], and lack of birth preparedness [AOR (95% CI)], [6.526 (1.954-21.789)] were significantly associated with first delay. Being unmarried [AOR (95% CI)], [5.984 (2.930-12.223)], being unemployed [AOR (95% CI)], [26.978 (3.477-209.308)], and age [AOR (95% CI)], [0.438 (0.226-0.848)] were significantly associated with second delay. Having lengthy admission [AOR (95% CI)], [7.5 (4.053-13.878)] and non-spontaneous vaginal delivery [AOR (95% CI)], [1.471 (1.018-1.999)] were significantly associated with third delay. CONCLUSION This study identified a significant proportion of mothers experiencing delays, although there were no data to suggest exacerbated delays in utilizing maternal health services due to fear of the COVID-19 pandemic. The proportion of maternal delay varies with different factors. Improving the decision-making capacity of women is, therefore, essential.
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Affiliation(s)
- Diriba Kumara Abdisa
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Debela Dereje Jaleta
- Department of Nursing, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Jira Wakoya Feyisa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
| | - Keno Melkamu Kitila
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
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Ayalew Tiruneh G, Melkamu Asaye M, Solomon AA, Tiruneh Arega D. Delays during emergency obstetric care and their determinants among mothers who gave birth in South Gondar zone hospitals, Ethiopia. A cross-sectional study design. Glob Health Action 2021; 14:1953242. [PMID: 34328059 PMCID: PMC8330726 DOI: 10.1080/16549716.2021.1953242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The majority of maternal deaths occur during delivery and the immediate postnatal period as a result of delays in seeking care, failure to reach health institutions, and receiving inappropriate health care. In developing countries, delayed access to timely healthcare contributes to high maternal mortality and morbidity. Objective This study aimed to assess the delays during emergency obstetric care and associated factors with delays during emergency obstetric care. Method A cross-sectional study design was conducted. We chose five hospitals at random in the South Gondar zone, Ethiopia. Face-to-face Interviews were conducted with 459 participants using a systematic sampling technique. For this analysis, bi-variable and multivariable logistic regression models were used. The Adjusted Odds Ratio was used to determine the statistical association with delays during emergency obstetric care at p-value <0.05 with a 95% confidence interval. Results The proportion of delays during emergency obstetric care were found to be 59.7% in this study. The respondents’ mean age was 27.23 years old, with a standard error of 5.67. Pregnant mothers living in the rural areas (AOR: 4.1, 95%, CI: 2.36 to 6.25), no ANC visit (AOR: 1.8, 95% CI: 1.32 to 3.18), uneducated women (AOR: 4.6, 95% CI: 2.45 to 8.59) and referral to a higher level of care (AOR: 2.7, 95% CI: 1.60 to 4.44), were all significantly associated with delay. Conclusion Delay during emergency obstetric care was found to be 59.7 percent. Rural residency, absence of ANC visit, uneducated mothers, and referred mothers from one level to the next level of care were factors that contributed to delays in emergency obstetric care in the study area.
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Affiliation(s)
- Gebrehiwot Ayalew Tiruneh
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Health Science, University of Gondar, Gondar, Ethiopia
| | - Abayneh Aklilu Solomon
- Department of Women and Family Health, School of Midwifery, College of Health Science, University of Gondar, Gondar, Ethiopia
| | - Dawit Tiruneh Arega
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Hendrickson ZM, Tibbels N, Sidikiba S, Mills H, Vondrasek C, Gurman T. 'I can't leave everything in the hands of my husband': Economic constraints and gender roles in care-seeking in post-Ebola Guinea. Glob Public Health 2021; 17:1578-1593. [PMID: 34242118 DOI: 10.1080/17441692.2021.1953107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2014-2016 Ebola epidemic in West Africa had enduring effects on health systems and healthcare utilisation. This study explores the intersection of economic constraints and gender roles in Guinea to understand delays in care-seeking post-Ebola. In-depth interviews (n = 45) and focus group discussions (n = 24) were conducted with mothers, male heads of household, grandmothers, and health workers in rural and urban areas in Basse-Guinée and Guinée Forestière. A thematic analysis identified salient themes related to gender and economic constraints on health care-seeking. Participants, particularly men, emphasised the high cost of seeking care, which led to delays as women secured funds. Men's engagement in care-seeking included providing funds and permission, picking up medication, and giving appointment reminders. As principal actors when 'navigating' the healthcare system, women were intimately involved in economic decisions and responsible for securing funds for services - even when lacking direct financial control. Essentialist descriptions of men as 'providers' and women as 'navigators', therefore, masked nuances in care-seeking and economic responsibilities. Programmes must acknowledge men's engagement in care-seeking and address both the economic barriers women face when seeking care and their economic roles. Greater attention to the complex intersection of economic constraints and gender roles could address care-seeking delays.
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Affiliation(s)
- Zoé Mistrale Hendrickson
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Natalie Tibbels
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sidibé Sidikiba
- Public Health Department, Africa Center of Excellence for Prevention and Control of Communicable Diseases (CEA-PCMT), Université Gamal Abdel Nasser de Conakry , Conakry, Guinea
| | - Hannah Mills
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claudia Vondrasek
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tilly Gurman
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Habte A, Wondimu M. Determinants of maternal near miss among women admitted to maternity wards of tertiary hospitals in Southern Ethiopia, 2020: A hospital-based case-control study. PLoS One 2021; 16:e0251826. [PMID: 33999941 PMCID: PMC8128231 DOI: 10.1371/journal.pone.0251826] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A maternal near-miss (MNM) refers to when a gravely ill woman survives a complication as a result of the standard of care she receives or by chance during gestation, childbirth, or within 42 days of the termination of pregnancy. Rescuers of near-miss events share several features with mothers who have died and identifying MNM determinants will aid in improving the capacity of the health system to reduce severe maternal morbidity and mortality. Ethiopia is one of the countries in sub-Saharan Africa with high maternal mortality and morbidity, but there is little evidence on determinants of a MNM based on a WHO criteria. Hence, this study aimed at identifying determinants of MNM among women admitted to tertiary hospitals in southern Ethiopia, 2020. METHODS A facilities-based unmatched case-control study was conducted in five selected tertiary hospitals found in central southern Ethiopia from February 1 to June 1, 2020. A total of 322 (81 cases and 241 controls) study participants were included in the study. At the time of their discharge, cases were recruited consecutively, while controls were selected using a systematic sampling method. The cases were women admitted to hospitals during pregnancy, childbirth, or 42 days following termination of pregnancy who met at least one of the WHO near-miss criteria. Whereas the controls comprised of women who were admitted during pregnancy, childbirth, or 42 days following termination of pregnancy and discharged without severe obstetric complications. Data collection was conducted using the interviewer-administered structured questionnaire and data abstraction tool. The data was coded and entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. Multivariable logistic regression analysis was conducted and determinants of MNM were established at p-value<0.05. RESULTS Severe postpartum hemorrhage (50.6%) and sepsis (23.4%) were the most common reasons for admission of cases. Lack of ANC [AOR = 3.25; 95%CI: 2.21,7.69], prior history of Cesarean section [AOR = 3.53; 95%CI:1.79,6.98], delaying more than 60 minute to access final place of care [AOR = 3.21; 95%CI:1.61,6.39], poor practice of Birth preparedness and complication readiness (BPCR) [AOR = 3.31; 95%CI:1.50,7.29], and history of preexisting medical disorders [AOR = 2.79; 95%CI:1.45,5.37] were identified as significantly determinants of maternal near miss. CONCLUSION AND RECOMMENDATION Stakeholders need to enhance their efforts for improving access to roads and transportations. Besides, women who have a prior history of Caesarean section, chronic medical conditions, and no ANC need special attention from their families and health care providers to proactively mitigate the occurrence of serious obstetric complications. More attention has to be paid to birth preparedness and complication readiness activities.
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Affiliation(s)
- Aklilu Habte
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Southern Ethiopia
| | - Merertu Wondimu
- School of Nursing and Midwifery, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Southwest Ethiopia
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Nour TY, Farah AM, Ali OM, Osman MO, Aden MA, Abate KH. Predictors of immunization coverage among 12-23 month old children in Ethiopia: systematic review and meta-analysis. BMC Public Health 2020; 20:1803. [PMID: 33243208 PMCID: PMC7689978 DOI: 10.1186/s12889-020-09890-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/15/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Immunization is one of modern medicine's greatest achievements in the last three decades. Annually it can prevent nearly 2 to 3 million deaths. Understanding the determinants of effective immunization coverage is a critical undertaking. Accordingly, we set out to check the best available evidence of outstanding predictors of immunization coverage among children aged 12-23 months in Ethiopia. METHOD Electronic databases including PubMed, Google Scholar, HINARI, and SCOPUS, Web of Science, African Journals Online, Ethiopian Medical Journals were searched. The search process, study selection, critical appraisal, and data extraction were done independently by two reviewers using Joanna Briggs Institute Meta-analysis for Review Instrument (JBI-MAStARI). The difference between reviewers was resolved with a third person. The risk of bias was assessed by the Newcastle Ottawa Tool for observational studies. Data were extracted using the Microsoft Excel checklist and exported to STATA 13. Heterogeneity was assessed using I2, Funnel plot and Egger's test was used to check for publication bias. RESULTS We identified 26 studies with 15,042 children with mothers/caretakers to assess factors associated with immunization coverage and significant factors were: maternal formal education, (OR = 2.45; 95% CI: 1.62-3.72), paternal formal education, (OR = 1.01; 95% CI: 0.27-3.77), residence, (OR = 2.11; 95% CI: 1.00-4.45), birth at health facility (OR = 1.86; 95% CI: 0.99-3.49), family size less than four, (OR = 1.81; 95% CI: 1.16-2.84), knowledge on age of immunization to be completed (OR = 6.18;95% CI: 3.07-12.43), knowledge on immunization schedule (OR = 2.49; 95% CI: 1.35-4.59), time to travel to health faculties, (OR = 1.74; 95% CI: 0.62-4.89), antennal care, (OR = 3.11; 95% CI: 1.64-5.88), and tetanus toxoid vaccination, (OR = 4.82; 95% CI: 2.99-7.75). CONCLUSION Our findings showed that literacy, residence, awareness, family size, maternal health services use, and proximity of the health facilities were factors associated with full immunization. This implies that there is a need for primary health service expansion and health education to "hard to reach areas" to improve immunization coverage for children aged 12-23 months.
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Affiliation(s)
- Tahir Yousuf Nour
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
| | - Alinoor Mohamed Farah
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
| | - Omer Moelin Ali
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
| | - Mohamed Omar Osman
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
| | - Mowlid Akil Aden
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
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