Causes of maternal death in Ethiopia between 1990 and 2016: systematic review with meta-analysis

AbstractBackground: Even though Ethiopia has achieved the Millennium Development Goal targets for child health set for 2015 by the international community, it has failed to do so with regard to maternal health. Maternal deaths are still high, with an estimated maternal mortality ratio of 412 maternal deaths per 100,000 live births in 2016.The causes of maternal death and individual, environmental and health systems related gaps contributing to maternal death in Ethiopia remain unclear.Objectives: The main aim of this study was to document the causes of maternal deaths and risk factors contributing to deaths aggravated by pregnancy and its management in Ethiopia over the period 1990 to 2016, using a systematic review with meta-analysis.Methods: Manuscripts were reviewed on causes of maternal death that were published in scientific journals and grey literature, including the compendium of abstracts presented in the series of annual conferences of the Ethiopian Public Health Association, masters’ theses in public health from different public universities in Ethiopia, and periodic reports of the Federal Ministry of Health of Ethiopia. A comprehensive and reproducible literature search was used, employing the Cochrane systematic literature review technique. Medical subject heading terms – including maternal deaths, maternal mortality, causes of maternal mortality/death, maternal mortality/death in Ethiopia and etiology of maternal mortality/death in Ethiopia – were used to search the required articles. A total of 146 articles (134 from online sources and 12 hard copies) were identified on the basis of their titles and abstracts. Of these, 24 were found to be suitable for further analysis by applying the review criteria, which were then synthesized to identify the main causes of maternal death, as well as the risk factors affecting the patterns of deaths.Results: The main direct causes of maternal death in Ethiopia include obstetric complications such as hemorrhage (29.9%; 95% CI: 20.28%-39.56%), obstructed labor/ruptured uterus (22.34%; 95% CI: 15.26%-29.42%), pregnancy-induced hypertension (16.9%; 95% CI:11.2%-22.6%), puerperal sepsis (14.68%; 95% CI: 10.56%-18.8%), and unsafe abortion (8.6%; 95% CI: 5.0%-12.18%). In recent years, hemorrhage has been the leading cause of mortality, followed by hypertensive disorders of pregnancy and sepsis, while the contributions of obstructed labor and abortion have decreased over the period. The most reported indirect causes of maternal death were anemia (10.39%; 95% CI: 4.79%-15.98%) and malaria (3.55%; 95% CI: 1.50%-3.30%).Conclusions: The nationwide registration of causes of maternal death should be strengthened to understand the causes in detail, their attributes, as well as the patterns of causes of death. The health sector should sustain its current effort to tackle the diverse causes of maternal death in Ethiopia.  [Ethiop. J. Health Dev. 2018;32(4):225-242]Key words: maternal mortality, systematic review, causes of maternal death, Ethiopi

Causes of maternal death in Ethiopia between 1990 and 2016 : systematic review with meta-analysis

The study documented causes of maternal deaths, and risk factors contributing to deaths aggravated by pregnancy and its management in Ethiopia (1990 to 2016), using a systematic review with meta-analysis. The nationwide registration of causes of maternal death should be strengthened to understand the causes in detail, their attributes, as well as the patterns of causes of death. Findings reveal that the main direct causes of maternal death in Ethiopia include obstetric complications such as hemorrhage, obstructed labor/ruptured uterus, pregnancy-induced hypertension, puerperal sepsis, and unsafe abortion. The health sector should sustain its current effort to tackle the diverse causes of maternal death in Ethiopia

Under five causes of death in Ethiopia between 1990 and 2016 : systematic review with meta-analysis

The study worked to identify causes of death for neonatal, post-neonatal, infants and children under five years old in Ethiopia. Causes- targeted obstetric and child healthcare interventions will reduce mortality, and will require improving healthcare units. Major causes of death revealed in this study are bacterial sepsis, birth asphyxia, prematurity, acute lower respiratory infection and diarrheal diseases. Almost all causes are easily preventable and treatable and can be addressed by strengthening health extension services and improved quality of primary health care

Bibliography on HIV/AIDS in Ethiopia and Ethiopians in the Diaspora: The 2015 Update

No Abstrac

Bibliography on HIV/AIDS in Ethiopia and Ethiopians in the diaspora: The 2016 update

No Abstrac

Determinants of fertility in rural Ethiopia: the case of Butajira Demographic Surveillance System (DSS)

<p>Abstract</p> <p>Background</p> <p>Fertility is high in rural Ethiopia. Women in the reproductive age group differed in various characteristics including access to food and encounter to drought which requisite the assessment of determinants of fertility.</p> <p>Methods</p> <p>Reproductive age women were recruited from a DSS, the Butajira DSS database. A DHS maternity history questionnaire was administered on 9996 participants. Data quality was assured besides ethical clearance. Poisson regression crude and adjusted Incidence Rate Ratio with 95 Confidence Interval were used to identify determinants of fertility.</p> <p>Results</p> <p>Delayed marriage, higher education, smaller family, absence of child death experience and living in food-secured households were associated with small number of children. Fertility was significantly higher among women with no child sex preference. However, migration status of women was not statistically significant.</p> <p>Conclusions</p> <p>Policy makers should focus on hoisting women secondary school enrollment and age at first marriage. The community should also be made aware on the negative impact of fertility on household economy, environmental degradation and the country's socio-economic development at large.</p

Determinants of low family planning use and high unmet need in Butajira District, South Central Ethiopia

<p>Abstract</p> <p>Background</p> <p>The rapid population growth does not match with available resource in Ethiopia. Though household level family planning delivery has been put in place, the impact of such programs in densely populated rural areas was not studied. The study aims at measuring contraception and unmet need and identifying its determinants among married women.</p> <p>Methods</p> <p>A total of 5746 married women are interviewed from October to December 2009 in the Butajira Demographic Surveillance Area. Contraceptive prevalence rate and unmet need with their 95% confidence interval is measured among married women in the Butajira district. The association of background characteristics and family planning use is ascertained using crude and adjusted Odds ratio in logistic regression model.</p> <p>Results</p> <p>Current contraceptive prevalence rate among married women is 25.4% (95% CI: 24.2, 26.5). Unmet need of contraception is 52.4% of which 74.8% was attributed to spacing and the rest for limiting. Reasons for the high unmet need include commodities' insecurity, religion, and complaints related to providers, methods, diet and work load. Contraception is 2.3 (95% CI: 1.7, 3.2) times higher in urbanites compared to rural highlanders. Married women who attained primary and secondary plus level of education have about 1.3 (95% CI: 1.1, 1.6) and 2 (95% CI: 1.4, 2.9) times more risk to contraception; those with no child death are 1.3 (95% CI: 1.1, 1.5) times more likely to use contraceptives compared to counterparts. Besides, the odds of contraception is 1.3 (95% CI: 1.1, 1.6) and 1.5 (1.1, 2.0) times more likely among women whose partners completed primary and secondary plus level of education. Women discussing about contraception with partners were 2.2 (95% CI: 1.8, 2.7) times more likely to use family planning. Nevertheless, contraception was about 2.6 (95% CI: 2.1, 3.2) more likely among married women whose partners supported the use of family planning.</p> <p>Conclusions</p> <p>The local government should focus on increasing educational level. It must also ensure family planning methods security, increase competence of providers, and create awareness on various methods and their side effects to empower women to make an appropriate choice. Emphasis should be given to rural communities.</p

The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the global burden of disease study 2013

Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disabilityadjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for illdefined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made