Ataguadil Mekonnen Demmen, Abate Bekele, Gelila Goba
Background: In Ethiopia, 20,000 women die each year from complications during pregnancy, childbirth and the post-partum period. For every woman who dies of pregnancy complications, about 20 more experience injury, infection, disease, or disability. In Ethiopia, few studies have been performed on MNM, and little is known regarding determinant factors. This study aims to identify determinants of MNM among women in Gambella Region, Ethiopia. Methods: Unmatched case-control study in hospitals in Gambella Region, southwest of Ethiopia, from July 01 - August 30, 2019. The sample included 103 cases and 205 controls recruited from women seeking obstetric care at six public hospitals. Clients having a life-threatening obstetric complication including hemorrhage, hypertensive diseases of pregnancy, dystocia, infections, and anemia or clinical signs of severe anemia in women without hemorrhage were taken as cases and those with normal obstetric outcomes were considered as controls. Cases were selected based on proportional to size allocation while systematic sampling was employed for controls. Data on socio-economic and demographic factors, reproductive history and nutrition related factors were collected using a structured questionnaire. Blood sample were collected to analyze biochemical indicators. Data was coded and entered into Epi-info version 3.5.4 and exported to SPSS version 20 for further cleaning and analysis. Multivariable logistic regression analysis was employed to assess the relative effect of various explanatory variables on the outcome variables. Variables with P-value less than 0.05 at 95 % confidence interval were considered as statistically significance. Results: The largest share of cases and controls were between the ages of 20–29 years, accounting for 39(37.9%) of cases and 65(31.7%) of controls. Ninety-two (90.2%) of cases and 185(89.3%) of controls were married. About two-thirds of controls and 47(45.6%) of cases had gestational age between 37-41 weeks. History of chronic medical conditions was reported in 57(55.3%) of cases and 68(33.2%) of controls. Women with no formal education [AOR=3.2;95%CI:1.24, 8.12], being less than 16 years old at first pregnancy [AOR=2.5; 95%CI:1.12,5.63],induced labor[AOR=3; 95%CI:1.44, 6.17],history of C-section [AOR=4.6; 95%CI: 1.98, 7.61] and chronic medical disorder[AOR=3.5;95%CI:1.78, 6.93], and women who traveled more than 60 minutes before reaching their final place of care[AOR=2.8;95% CI: 1.19,6.35] all had higher odds of experiencing MNM. Conclusions: The Government of Ethiopia should continue efforts to address lack of road and health facility access and education. Work should also be continued to educate women and providers about common predictors of MNM like history of C-section and chronic illness as well as teenage pregnancy at the facility, community, family and individual levels. Targeted follow-up to women with history of chronic disease and C-section could also be a practical way to reduce MNM.
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