Caesarean section rates analysed using Robson’s 10-Group Classification System: a cross-sectional study at a tertiary hospital in Ethiopia

Objective The aim of this study was to assess the caesarean section (CS) rates using Robson’s 10-Group Classification System among women who gave birth at Hawassa University Referral Hospital in southern Ethiopia. Design Cross-sectional study design to determine CS rate using Robson’s 10-Group Classification System. Setting Hawassa University Referral Hospital in south Ethiopia. Participants 4004 women who gave birth in Hawassa University Referral Hospital from June 2018 to June 2019. Results The 4004 women gave birth to 4165 babies. The overall CS rate was 32.8% (95% CI: 31.4%–34.3%). The major contributors to the overall CS rates were: Robson group 1 (nulliparous women with singleton pregnancy at term in spontaneous labour) 22.9%; group 5 (multiparous women with at least one previous CS) 21.4% and group 3 (multiparous women without previous CS, with singleton pregnancy in spontaneous labour) 17.3%. The most commonly reported indications for CS were ‘fetal compromise’ (35.3%) followed by previous CS (20.3%) and obstructed labour (10.7%). Conclusion A high proportion of women giving birth at this hospital were given a CS, and many of them were in a low-risk group. Few had trial of labour. More active use of partogram, improving fetal heartbeat-monitoring system, implementing midwife-led care, involving a companion during labour and auditing the appropriateness of CS indications may help to reduce the CS rate.publishedVersio

Factors Associated with Management Outcome of Incomplete Abortion in Yirgalem General Hospital, Sidama Zone, Southern Ethiopia

Background. Each year, several millions of women who underwent abortion also bear several consequences, including infection, massive blood loss, chronic pelvic pain, infertility, and death. Poor treatment outcomes also cause disability and death. The aim of this study was to determine factors associated with management outcomes of incomplete abortion in Yirgalem General Hospital. Methods. Health facility-based cross-sectional study design was used. Medical record review of 186 women who received abortion service from July 1st 2015 to June 30 2017 was done. Then the data were entered into the computer using epi info version 7.2 and exported into SPSS version 20, Descriptive analysis was done to determine social, demographic characteristics, and bivariate and multivariate logistic regression analysis were done to identify factors associated with management outcome of incomplete abortion, 95% CI and odds ratio used to present the result. Results. A total of 180 (96.7%) of cases managed for incomplete abortion was included in the study. Of this, 53.3% of patients with incomplete abortion belonged to age group of 18–25 years old. More than half incomplete abortion cases were managed surgically 122 (67.8%). Of the total, 36 (19.4%) of the patients developed unfavorable management outcome. Gestational age at which abortion occurs AOR = 3.39, 95% (1.29, 8.89) and delayed seeking of medical help AOR = 2.96, 95% (1.04, 8.4) were found to be significantly associated with unfavorable management outcome. Conclusion. High numbers of cases managed for abortion resulted unfavorable management outcome. However, no death occurred and major surgery done as the result of abortion management. Delayed seeking of medical care and seeking care past 1st trimester are significantly associated with unfavorable management outcomes. Therefore, awareness creation for adolescent and youth about prompt health-care seeking after the start of the first sign and symptom of spontaneous abortion should be strengthened

Factors of Primary Postpartum Hemorrhage among Women Delivered at Yirgalem General Hospital Southern, Ethiopia: A case control study

Background: Primary postpartum hemorrhage continues to be the top leading cause of maternal mortality and morbidity all over the world, contributing about one third of all maternal mortality. Despite its public health importance of this problem, little is known about factors that contribute to primary postpartum hemorrhage especially in Ethiopia. The aim of this study was to assess the risk factors of primary postpartum hemorrhage. Subjects and Method: Hospital based unmatched case control study design was used. The study was conducted in July 2019, among delivered women at Yirgalem general hospital from January 1, 2014 to December 30, 2018; to all cases of primary postpartum hemorrhage (n= 218) and 436 controls selected by using simple random sampling techniques. Women with primary postpartum hemorrhage were cases and women who had not diagnosed for primary postpartum hemorrhage were controls. Descriptive statistics and logistic regression analysis were made. Statistical association was measured by AOR and its 95% CI. Results: Incidence of primary postpartum hemorrhage was 221 in 8,506 live births (2.6%) in the study period. Primiparas (AOR= 0.37 ;95% CI= 0.23 to 0.6; p= 0.001), grand multiparas (AOR= 5.80; 95% CI= 2.90 to 11.6; p <0.000) and rural maternal address (AOR= 1.90; 95% CI= 1.20 to 3.00; p= 0.008) were factors that have a statistically significant association with primary postpartum hemorr¬hage. Conclusion: Parity and rural residence were associated factors. Therefore, the government and other responsible stakeholders should give attention to women with grand multiparas and those women residing in rural area. Immediate identification of risk factors and management might reduce largely the occurrence of primary PPH and related maternal deaths.Keywords: Primary postpartum hemorrhage, case-control, risk factors, Ethiopia.Correspondence: Achamyelesh Gebretsadik College of Medicine and Health Science, Hawassa University, Hawa-ssa, Ethiopia.Email: [email protected]. Mobile: +251911303128.Journal of Maternal and Child Health (2021), 06(06): 739-748https://doi.org/10.26911/thejmch.2021.06.06.12 

Discontinuation rate of Implanon and its associated factors among women who ever used Implanon in Dale District, Southern Ethiopia

Abstract Background Early discontinuation of the Implanon contraceptive method and reasons for such discontinuation remains a major concern for family planning programs. In less developed countries, contraceptive discontinuation due to health concerns is generally higher, these complaints are often related to service quality. Significant numbers of women become exposed to conception after discontinuation and accidental pregnancies that end up with abortion & stillbirth. The aim of this study was to assess the early discontinuation rate of Implanon and identify its associated factors among women who ever used Implanon in 2016 in Dale district, Southern Ethiopia. Methods Community based cross-sectional study design was conducted from January to February, 2017. A total number of 711 women who ever used Implanon in 2016 were selected using multistage sampling. The data were entered and cleaned in Epi Info and analyzed using SPSS. Multivariate logistic regression analysis was used to determine the effect of factors on the outcome variables. Finally, the results were presented using adjusted odds ratio (AOR) & confidence interval of 95%. Result Early Implanon discontinuation rate in this study was 160 (23.4%) with a mean duration of Implanon use of 9.6 ± 2.5 months. The main reasons for discontinuation of Implanon were 55 (34.4%) the facing of side effects. Factors for discontinuation of Implanon were women age 20–24 years (AOR =. 44 (95% CI: 23-. 85), 25–29 years (AOR =. 52 (95% CI: 27-. 96), 35+ years, (AOR =. 08 (95% CI: 02-. 41), less likely to discontinue. Women who weren’t counseled about the side effects during Implanon insertion were 1.93 times (AOR = 1.93 (95% CI: 1.27–2.93), women who didn’t satisfied by the service (AOR = 2.55(CI: 95%: 1.63–3.97), women who didn’t appointed for follow up (AOR = 3.13 (CI: 95%: 2.0–4.95), women who didn’t choose the method by themselves (AOR = 1.83 (CI: 95%: 1.18–2.83) and women who didn’t have information on family planning before Implanon insertion (AOR = 1.52 (CI: 95%: 1.1–2.28) were the predictors of Implanon discontinuation. Conclusions Implanon discontinuation rate in this study area was high. Appropriate counseling prior to insertion and proper follow up, autonomous choice will improve the continuation rate of Implanon

Retrospective review of maternal deaths in Hawassa Comprehensive Specialised Hospital, in Southern Ethiopia

The aim of this study was to evaluate the causes of and contributors to maternal death at Hawassa Referral Comprehensive Specialised Hospital (HRCSH). A health facility–based, maternal death review was used. All maternal deaths that occurred between January 2016 and August 2017 in HRCSH were included. Data were collected using a structured data collection sheet and analysed. Eighty-two maternal deaths that occurred over a 20-month period were reviewed, of which 77 met the inclusion criteria. A total of 8466 births occurred in HRCSH during the study period. The overall facility-based maternal mortality rate (MMR) was 910 deaths per 100,000 live births. The majority of maternal deaths (69 deaths; 89.6%) were due to direct causes, with pregnancy-induced hypertension as the leading direct cause of 33 deaths (42.8%). Eight avoidable factors were identified in this review. Twenty-six patients (33.9%) died as a result of a combination of three or more factors. Patient-oriented and transport/referral factors were the most common avoidable factors, with each contributing to 62 deaths (80.5%). Prenatal patients would benefit from receiving information regarding danger signs that could assist in the early detection of health problems and increase the likelihood that they seek health care.Impact Statement What is already known on this subject? Most maternal deaths are preventable. However, maternal mortality rates remain high despite the presence of multiple measures in the southern part of Ethiopia. There is no adequate information about the maternal death rate in the study setting. What do the results of this study add? Hawassa Referral Comprehensive Specialised Hospital is a regional health centre. This study found that combinations of several factors may be contributing to a high maternal death rate. Most notably, transport, delay management initiation after admission and referral factors account for the majority of maternal deaths. What is the implication of these findings for clinical practice/or further research? Identification of potential problems could assist context-based management of problems. It helps in improving the level of practical skills for the management of pregnancy-related complications like hypertension. It also solves problems in the health services system like access to interventions. It insists on intersectoral collaboration to solve the transportation problems

Determinants of Maternal Death in a Pastoralist Area of Borena Zone, Oromia Region, Ethiopia: Unmatched Case-Control Study

Background. Globally, more than 830 maternal deaths happen daily, and nearly, all of these occur in developing countries. Similarly, in Ethiopia, maternal mortality is still very high. Studies done in pastoralist women are almost few. Therefore, the objective of this study was to assess the determinant factors of maternal death in the pastoralist area of Borena zone, Oromia region, Ethiopia. Methods. Community-based unmatched case-control study was conducted on 236 mothers (59 maternal deaths (cases) and 177 controls). The sample included pregnant women aged 15–49 years from September 2014 to March 2017. Data were collected using a structured questionnaire adapted from Maternal Death Surveillance and Response Technical Guideline, entered into the EpiData, exported into SPSS for analyses. Odds ratios (ORs) and 95% confidence interval (CI) were computed to determine contributing factors of maternal death and control potential confounding variables. Results. About 51 (86%) of all maternal deaths were due to direct obstetric causes. Of this, hemorrhage (45%), hypertensive disorders of pregnancy (23%), and obstructed labor (18%) were the leading direct causes of maternal deaths. Husbands who had no formal education were 5 times higher compared with their counterparts (AOR = 5.1, 95% CI: 1.6–16). Mothers who were not attending ANC were 5 times more at risk for death than those who attend (AOR 5.3, 95% CI 2.3–12.1). Mothers who gave birth at home/on transit were twice to die compared to health facility delivery (AOR 2.6, 95% CI 2.4–6) that were contributing factors of maternal deaths. Conclusions. Husband’s level of education, lack of antenatal care, and home delivery were the factors contributing to maternal deaths in the zone. Frequent and tailored antenatal care, skilled delivery, and access to education also need due attention

Contraceptive use among reproductive-age females with disabilities in central Sidama National Regional State, Ethiopia: a multilevel analysis

Background Contraceptive use is an important and cost-effective intervention to prevent unwanted pregnancies. People with disabilities face discrimination when it comes to using contraception and are doubly burdened by unwanted pregnancies. However, the status of contraceptive use and associated factors among reproductive-aged females with disabilities was not adequately determined in Ethiopia. Objective This study aimed to assess contraceptive use and associated factors among reproductive-age females with disabilities in Dale and Wonsho districts and Yirgalem city administration of central Sidama National Regional State, Ethiopia. Methods A community-based cross-sectional study was conducted among randomly selected 620 reproductive-age females with disabilities living in the selected districts from June 20 to July 15, 2022. The data were collected through face-to-face interviewing techniques using a structured questionnaire. A multilevel logistic regression analysis model was employed to analyze the data. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. Results In this study, 27.3% (95% CI [23.8%–31.0%]) of the reproductive-age females with disabilities were current contraceptive users. Regarding the methods, 82 (48.5%) of the reproductive-age females with disabilities used implants. Having good contraceptive knowledge (AOR = 9.03; 95% CI [4.39–18.6]), transport accessibility to health facilities (AOR = 2.28; 95% CI [1.32–3.94]), being an adult (25 to 34 years old) (AOR = 3.04; 95% CI [1.53–6.04]), having a hearing disability (AOR = 0.38; 95% CI [0.18, 0.79]), having paralysis of the extremities (AOR = 0.06; 95% CI [0.03–0.12]), and wheel-chaired disability (AOR = 0.10; 95% CI [0.05–0.22]) were factors associated with contraceptive use. Conclusion Contraceptive use among reproductive-age females with disabilities is low. Transport accessibility, contraceptive knowledge, being in the age groups of 25 to 34 years, and the types of disability determine their contraceptive use. Therefore, designing appropriate strategies to provide contraceptive education and information and provide contraceptive services in their homes is important to enhance contraceptive use

Sexual lives of reproductive-aged people with disabilities in Central Sidama National Regional State, Ethiopia: a mixed-methods study

Abstract Background Sexuality is an important part of human life; people with disabilities have the same sexual desires as people without disabilities. However, the status of the sexual lives of reproductive-aged people with disabilities is unfolded in Ethiopia. Therefore, this study was aimed to assess sexual lives and its associated factors among reproductive-aged people with disabilities in central Sidama National Regional State, Ethiopia. Methods A mixed-methods study was conducted among randomly selected 685 reproductive-age people with disabilities and fifteen (15) in-depth interviews among individuals who have sexual practice experience from June 20 to July 15, 2022. The quantitative data were collected through face-to-face interviewing techniques using a structured and semi-structured questionnaire. A multilevel logistic regression analysis model was employed to analyze the data. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. The qualitative data were managed and analyzed using the phenomenological research analysis approach. Results In this study, 59.9% (95% CI: 56.1, 63.5) of the people with disabilities have practiced sexual intercourse. Of these, 30.8% (95% CI: 27.4, 34.4) were males and 29.1% (95% CI: 25.7, 32.6) were females with disabilities. Being female (AOR = 2.81; 95% CI: 1.70, 4.62), having an occupation (AOR = 7.55; 95% CI: 4.03, 14.1), having a disability and being in a wheelchair (AOR = 0.27; 95% CI: 0.09, 0.82), having a good self-perception (AOR = 0.46; 95% CI: 0.28, 0.77), and having a rich economic status (AOR = 2.05; 95% CI: 1.08, 3.89) were factors associated with the sexual practice. The qualitative findings revealed that having sexuality information (training) is the facilitator, and community discrimination and low economic income are the barriers to sexual practice. Conclusion Sexual practice among people with disabilities is low in the Dale and Wonsho districts and Yirgalem city administration. Socio-demographic and economic factors and sexuality training are the associated factors. Therefore, creating job opportunities and economic empowerment, providing sexuality training, and creating community awareness are crucial to improving the sexual practice of reproductive-age people with disabilities

Unintended pregnancy and its associated factors among women with disabilities in central Sidama National Regional State, Ethiopia: a multilevel analysis

Abstract Background Unintended pregnancy is one of the most common reproductive health problems. The problem makes women with disabilities doubly burdened by their disabilities. The previous evidences are inconsistent and do not address all women with disabilities. The study aimed to assess the prevalence of unintended pregnancy and its associated risk factors among women with disabilities in Dale and Wonsho districts and Yirgalem city administration central Sidama National Regional State, Ethiopia. Methods A community-based cross-sectional study design was conducted among 355 randomly selected women with disabilities living in the selected districts from June 20 to July 15, 2022. The data were collected through face-to-face interviews using a structured questionnaire. A multilevel logistic regression analysis model was employed to identify factors associated with an unintended pregnancy. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. Results In this study, the prevalence of unintended pregnancy among women with disabilities was 65.6% (95% CI: 60.4, 70.6). After adjusting for potential confounding variables, middle economic status (AOR = 2.07; 95% CI: 1.02, 4.20), giving birth (AOR = 2.20; 95% CI: 1.21, 3.99), extremity paralysis types of disability (AOR = 0.26; 95% CI: 0.12, 0.57), living in urban residences (AOR = 0.22; 95% CI: 0.12, 0.40) and alcohol using (AOR = 0.28; 95% CI: 0.11, 0.74) were risk factors with unintended pregnancy. Conclusions Unintended pregnancy among women with disabilities is remarkably high in central Sidama National Regional State, Ethiopia. Economic status, giving birth, types of disability, residence, and alcohol use were factors associated with an unintended pregnancy. As a result, economic empowerment, strengthening education and information about unintended pregnancy and its prevention strategies in rural settings are vital