Background
Methods
Study Area and period
Study participants
Regions | Type of hospitals | |||
---|---|---|---|---|
Primary
|
General
|
Specialized
|
Total
| |
Addis Ababa | 3 | 21 | 9 | 33 |
Afar | 5 | 1 | 0 | 6 |
Amhara | 41 | 10 | 5 | 56 |
Benishangul-Gumuz | 1 | 2 | 0 | 3 |
Dire Dawa | 2 | 3 | 1 | 6 |
Gambella | 0 | 1 | 0 | 1 |
Harari | 0 | 5 | 1 | 6 |
Oromia | 41 | 25 | 7 | 73 |
SNNP | 43 | 13 | 4 | 60 |
Somali | 4 | 6 | 0 | 10 |
Tigray | 20 | 16 | 3 | 39 |
Nationally
|
160
|
103
|
30
|
293
|
Inclusion criteria
Nature of the data
Operational definitions
-
Direct causes of obstetric deaths are those resulting from obstetric complications of pregnancy, childbirth and puerperium, from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. In this study, the following were considered as major direct causes of obstetric deaths: Antepartum Haemorrhage (APH), Postpartum Haemorrhage (PPH), retained placenta, prolonged/obstructed labour, ruptured uterus, severe eclampsia/preeclampsia, postpartum sepsis, complications of abortion and ectopic pregnancy.
-
Indirect obstetric deaths are those resulting from previously existing diseases or diseases that developed during pregnancy and which were not due to direct obstetric causes, but aggravated by the physiological effects of pregnancy [25]. These conditions include malaria, anaemia, hepatitis, HIV/AIDS, and other nonspecific potentially life-threatening conditions.
Data analysis
Results
Obstetric complications and maternal deaths
Obstetric complications | Women affected | Causes of Maternal Deaths | ||
---|---|---|---|---|
Number
|
Percent*
|
Number
|
Percent
a
| |
Direct (obstetric)
| ||||
Antepartum Haemorrhage (APH) | 4,462 | 6.6 | 23 | 5.3 |
Postpartum Haemorrhage (PPH) | 2,811 | 4.1 | 81 | 18.6 |
Retained placenta | 2,201 | 3.2 | 4 | 0.9 |
Prolonged/obstructed labour | 15,875 | 23.3 | 25 | 5.8 |
Ruptured uterus | 1,516 | 2.2 | 41 | 9.4 |
Postpartum sepsis | 1,460 | 2.2 | 17 | 3.9 |
Severe preeclampsia/eclampsia | 7,912 | 11.6 | 121 | 27.8 |
Abortion complications | 2,042 | 3.0 | 6 | 1.4 |
Ectopic pregnancy | 1,801 | 2.7 | 0 | 0.0 |
Otherb | 27,922 | 41.1 | 117 | 26.9 |
Total
|
68,002
|
100.0
|
435
|
100.0
|
Indirect (non-obstetric)
| ||||
Malaria | 165 | 1.6 | 1 | 2.2 |
Anaemia | 1,260 | 12.4 | 19 | 41.3 |
Hepatitis | 100 | 1.0 | 4 | 8.7 |
HIV/AIDS | 6,249 | 61.3 | 4 | 8,7 |
Other indirect causesc | 2,419 | 23.7 | 18 | 39.1 |
Total
|
10,193
|
100.0
|
46
|
100.0
|
Regional distribution of maternal mortality ratios
Regions in Ethiopia | Livebirths in hospitals (n) | Maternal deaths in hospital (n) | MMRs per 100,000 livebirths with 95% CI |
---|---|---|---|
Addis Ababa | 45,049 | 44 | 98 (71–131) |
Afar | 1,643 | 9 | 548 (251-1,037) |
Amhara | 43,899 | 95 | 216 (175–265) |
Benishangul Gumuz | 3,338 | 4 | 120 (33–307) |
Dire Dawa | 5,330 | 8 | 150 (65–296) |
Gambella | 1,667 | 6 | 360 (132–782) |
Harari | 4,823 | 15 | 311 (174–513) |
Oromia | 97,105 | 142 | 146 (123–172) |
SNNPR | 68,422 | 91 | 133 (107–163) |
Somali | 8,181 | 34 | 416 (288–580) |
Tigray | 44,367 | 33 | 74 (51–104) |
Total
|
323,824
|
481
|
149 (136–162)
|
Regional distribution of caesarean section rates
Regions in Ethiopia | Number of women who gave birth in hospitals (n) | Caesarean birth (n) | Caesarean birth Rate (%) (95% CI)a |
---|---|---|---|
Addis Ababa | 46,876 | 18,037 | 38.5 (38.1–38.9) |
Afar | 1,681 | 129 | 7.6 (6.4–9.1) |
Amhara | 46,379 | 10,317 | 22.2 (21.8–22.6) |
Benishangul Gumuz | 3,319 | 700 | 21.1 (19.7–22.5) |
Dire Dawa | 5,507 | 1,421 | 25.8 (24.6–26.9) |
Gambella | 1,729 | 135 | 7.8 (6.6–9.2) |
Harari | 5,399 | 1,296 | 24.0 (22.9–25.2) |
Oromia | 100,398 | 18,694 | 18.6 (18.4–18.9) |
SNNPR | 69,824 | 11,484 | 16.4 (16.2–16.7) |
Somali | 8,545 | 488 | 5.7 (5.2–6.2) |
Tigray | 45,397 | 5,320 | 11.7 (11.4–12.0) |
Total |
335,054
|
68,021
|
20.3 (20.1–20.4)
|
Causes of death among women who had caesarean section
Distribution of caesarean section rates and maternal mortality ratios by region
Regions in Ethiopia | Maternal mortality ratios (95% CI) | Caesarean section rates (95% CI) |
---|---|---|
Addis Ababa | 98 (71–131) | 38.5 (38.1–38.9) |
Afar | 548 (251-1,037) | 7.7 (6.4–9.1) |
Amhara | 216 (175–265) | 22.3 (21.9–22.7) |
Benishangul Gumuz | 120 (33–307) | 21.1 (19.7–22.6) |
Dire Dawa | 150 (65–296) | 25.8 (24.7–26.9) |
Gambella | 360 (132–782) | 7.8 (6.6–9.2) |
Harari | 311 (174–513) | 24.0 (22.9–25.2) |
Oromia | 146 (123–172) | 18.7 (18.4–18.9) |
SNNPR | 133 (107–163) | 16.5 (16.2–16.8) |
Somali | 416 (288–580) | 5.7 (5.2–6.2) |
Tigray | 74 (51–104) | 11.7 (11.4–12.0) |
Total
|
149 (136–162)
|
20.3 (20.2–20.5)
|
Association of MMRs and caesarean section rates
MMRs in Ethiopian regions | CS rates in Ethiopian regions | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
AA
|
Afar
|
Amhara
|
BG
|
DD
|
Gambella
|
Harari
|
Oromia
|
SNNP
|
Somali
|
Tigray
|
Total
| |
AA | -0.25 | |||||||||||
Afar | -0.43 | |||||||||||
Amhara | 0.43 * | |||||||||||
BG | 0.93 | |||||||||||
DD | 0.11 | |||||||||||
Gambella | - a | |||||||||||
Harari | 0.19 | |||||||||||
Oromia | -0.08 | |||||||||||
SNNP | 0.17 | |||||||||||
Somali | -0.03 | |||||||||||
Tigray | 0.47 * | |||||||||||
Total | -0.03 |