The Contributions of Maternity Care to Reducing Adverse Pregnancy Outcomes: A Cohort Study in Dabat District, Northwest Ethiopia
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This study was designed to evaluate the effect of maternity care by skilled providers on the occurrence of adverse pregnancy outcomes. A community-based cohort study was conducted at Dabat district, northwest Ethiopia, from December 1, 2011 to August 31, 2012. During the study period, 763 pregnant women were registered and followed until 42 days of their postpartum period. Use of skilled maternal care was the exposure variable. Reductions in occurrence of serious complications or death (adverse pregnancy outcomes) were used as outcome indicators. Data was collected at four time points; first contact, during the 9th month of pregnancy, within 1 week after delivery and at 42 days of postpartum. The effects of the exposure variable were evaluated by controlling potential confounders using logistic regression. One hundred and fifty-three (21 %) of the women encountered at least one obstetric complication or death during delivery and postpartum period. Hemorrhage and prolonged labor were the major types. Pregnancy outcomes for 41 women (5.6 %) were fetal, neonatal, or maternal deaths. Four or more ANC (antenatal care) visits, <4 ANC visits and delivery by skilled attendant showed 25 % (OR 0.75; 95 % CI 0.25, 2.75), 9 % (OR 0.91; 95 % CI 0.43, 1.69) and 31 % (OR 0.69; 95 % CI 0.36, 1.33) reduction in the occurrence of adverse pregnancy outcomes, respectively. Skilled maternal care showed reduction in adverse pregnancy outcomes (complications and deaths). However, the associations were not significant. Improving the quality of maternity care services and ensuring continuum of care in the health care system are imperative for effective maternal health care in the study area.
KeywordsSkilled maternal care Adverse pregnancy outcomes
We are very grateful to Addis Ababa University for its technical and financial support. We would like to extend our heartfelt thanks to Professor Henry Mosley for his valuable comments starting from proposal development to the final manuscript preparation. We would also like to thank all of the study subjects who participated in this study.
- 1.CSAEthiopia, ICFinternational. (2012). Ethiopia demographic and health survey 2011. Ethiopia: Addis Ababa.Google Scholar
- 3.Campbell, O. M. R. (1991). Measuring the determinants of maternal morbidity and mortality: Defining and selecting outcomes and determinants, and demonstrating associations. London: London School of Hygiene and Tropical Medicine.Google Scholar
- 4.World Health Organization (WHO). (2009). Monitoring emergency obstetric care: A handbook. Geneva: WHO.Google Scholar
- 5.World Health Organization (WHO). Making pregnancy safer: The critical role of the skilled attendant. WHO. http://www.who.int/maternal_child_adolescent/documents/9241591692/en/index.html.
- 7.Lerberghe, W. V., & Brouwere, V. D. (2001). Of blind alleys and things that have worked: History’s lessons on reducing maternal mortality. In V. D. Brouwere & W. V. Lerberghe (Eds.), Safe motherhood strategies: A review of the evidence (pp. 1–33). UK: ITG Press.Google Scholar
- 8.Graham, W. J., Bell, J. S., & Bullough, C. H. (2001). Can skilled attendance at delivery reduce maternal mortality in developing countries? In V. D. Brouwere & W. V. Lerberghe (Eds.), Safe motherhood strategies: A review of the evidence (pp. 97–129). UK: ITG Press.Google Scholar
- 9.Lawn, J. E., Kinney, M., Lee, A. C. C., et al. (2009). Reducing intrapartum-related deaths and disability: Can the health system deliver? International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 107(Suppl 1), S123–S142. doi: 10.1016/j.ijgo.2009.07.021.CrossRefGoogle Scholar
- 10.McClure, E. M., Goldenberg, R. L., & Bann, C. M. (2007). Maternal mortality, stillbirth and measures of obstetric care in developing and developed countries. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 96(2), 139–146. doi: 10.1016/j.ijgo.2006.10.010.CrossRefGoogle Scholar
- 13.Harvey, S. A., Ayabaca, P., Bucagu, M., et al. (2004). Skilled birth attendant competence: An initial assessment in four countries, and implications for the safe motherhood movement. International Journal of Gynecology & Obstetrics, 87(2), 203–210. doi: 10.1016/j.ijgo.2004.06.017.CrossRefGoogle Scholar
- 14.FDRE PCCo. (2008). Statistical report of the 2007 population and housing census of Ethiopia results. Addis Ababa: UNFPA, Population Census Commission.Google Scholar
- 15.Tadesse, T., Getachew, A., & Admassu, M., et al. (2011). Demographic and health survey at Dabat district in Northwest Ethiopia: Report of the 2008 baseline survey. Ethiopian Journal of Health and Biomedical Science, 4(Special issue), 1–16.Google Scholar
- 16.World Health Organization (WHO). (2007). Maternal mortality in 2005: Estimates developed by WHO, UNICEF, UNFPA, and the World Bank. Geneva: WHO.Google Scholar
- 20.Amano, A., Gebeyehu, A., & Birhanu, Z. (2012). Institutional delivery service utilization in Munisa Woreda, South East Ethiopia: A community based cross-sectional study. BMC Pregnancy and Childbirth, 12(1). doi: 10.1186/1471-2393-12-105.
- 24.Darmstadt, G. L., Lee, A. C. C., Cousens, S., et al. (2009). 60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths? International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 107(Suppl 1), S89–S112. doi: 10.1016/j.ijgo.2009.07.010.CrossRefGoogle Scholar
- 25.Warren, C. (2010). Care seeking for maternal health: Challenges remain for poor women. Ethiopian Journal of health development, 24(1). doi: 10.4314/ejhd.v24i1.62950.