Abstract

Determinants of Maternal Mortality in Northwest Ethiopia: Unmatched Case-Control Study

Affiliation: University of Gondar, Ethiopia

Contact Address

Email: ejigugebeyezeleke@gmail.com

Phone: +251902744887

Background: Maternal death has devastating effects on the family and country level. Maternal mortality at health facility level is highly specific to local contextual conditions. However, previous studies did not include surviving mothers as a comparison group. Therefore, this study was done to determine the predictors of maternal death.

Objective: The aim of this study was to identify determinants of maternal mortality in Government Hospitals, Northwest Ethiopia.

Methods: Unmatched case-control study was conducted among mothers within 42 days termination of pregnancy from January 2017 to December 2019. A sample of 77 cases and 308 controls were used from six government hospitals. Cases were selected retrospectively and sequentially starting from December 2019 to January 2017 until the required sample size was achieved. Four controls were selected for each case. Epi-Info version 7.0 and SPSS Version 25 were used for data entry and analysis. Multivariable logistic regression model was used to identify determinants and odds ratios (OR) with 95% CI was reported.

Results: A total of 77 cases and 308 controls were included. Relative to controls, the odds of being aged group 21-34(AOR=0.11; 95% CI= 0.05, 0.26) and 35-49 (AOR=0.15; 95% CI=0.05, 0.42) years were 89% and 85% less risky for maternal deaths. The odds of living in rural (AOR=5.04; 95%CI: 2.27-11.19), having only one ANC visit (AOR=3.63: 95%CI: 1.16, 11.35), referral to hospital (AOR=2.52; 95%CI: 1.17, 5.44), induced mode of onset of labour (AOR=3.97; 95%CI:1.33, 11.80), CS delivery (AOR=4.41; 95%CI: 1.89, 10.32) and having  hypertension (AOR=5.52: 95%CI:1.98, 15.36) was higher among cases.

Conclusions: Maternal age, place of residence, antenatal care visit, referral status, mode of labour onset and delivery, HTN status, hemorrhage, and ruptured uterus were determinants of maternal mortality. Therefore, rural mothers and teenage pregnancy needs attention, strengthening ANC follow up at least four times and timely referral of labouring mothers with basic lifesaving interventions is important, health professionals need to review the indicative criteria for inducing labour and Cesarean section delivery, and early screening strategy and management of pregnancy induced hypertension is imperative.

Keywords: Maternal Mortality, Maternal Death, Ethiopia