Poor feto maternal outcomes and associated factors among labouring mothers referred to Nekemte city public hospitals, East Wallaga Zone, Oromia, Ethiopia.

doi:10.21203/rs.3.rs-3307139/v1

Download PDF

Research Article

Poor feto maternal outcomes and associated factors among labouring mothers referred to Nekemte city public hospitals, East Wallaga Zone, Oromia, Ethiopia.

https://doi.org/10.21203/rs.3.rs-3307139/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background: Deliveries are not always free from poor fetal and maternal outcomes. The majority of obstetric complications are referred to tertiary hospitals however, there is limited evidence regarding the magnitude of poor maternal and fetal outcomes and their associated factors among referred laboring mothers in Ethiopia and especially in the study area.

Objective: The study aimed to assess the magnitude ofpoor fetal and maternal outcomes and associated factors among laboring mothers referred to Nekemte City public Hospitals, Oromia region, Ethiopia.

Methods and Materials: Institutional-based cross-sectional study design was conducted among 420 referred laboring mothers in the two public hospitals of Nekemte City from February 10, 2023, to April 10, 2023. The data were entered to EPI- DATA software version 4.6 and then, exported to SPSS Version 26.0 for analysis. A binary Logistic regression was used to identify factors associated with poor feto-maternal outcomes. A bivariable binary logistic regression model was used to select candidate variables at p-value ≤ 0.25. A multivariable binary logistic regression model with 95% CI and Adjusted Odds Ratio (AOR) was used to identify variables associated with poor feto-maternal outcomes at a P-value < 0.05.

Result: Poor fetal and maternal outcome was 46.2% (95%CI: (41% - 51%) and 24.1% (95% CI: 20%- 29%) respectively. Unable to read and write (AOR: 3.64, 95% CI: (1.11-11.96), multiple pregnancies (AOR: 4.23, 95% CI: (1.26, 14.25), and Preeclampsia 3.9, 95% CI: (1.11-13.67) were significant factors for poor maternal outcome. Rural residence (AOR: 1.99, 95% CI: (1.21, 3.29), a cesarean delivery (AOR: 2.64, 95% CI: (1.56, 4.47), gestational age <37 weeks (AOR: 8.09, 95% CI: (1.52, 12.91), <4 antenatal care visit (AOR: 2.37, 95% CI: (1.23-4.58), were found to be significant factors for poor fetal outcome.

Conclusion and Recommendation: In this study, the poor fetal and maternal outcomes were linked to obstetric complications among referred pregnant women. Unable to read and write, multiple pregnancies, and, - pregnancy induced hypertention were factors associated with poor maternal outcomes. Rural residence, cesarean deliveries, Gastational age less than 37 weeks and less than four ANC visits were factors associated with poor fetal outcomes. Therefore, detecting and managing obstetric complications early, improving antenatal care further and pregnant women should also have their blood pressure checked regularly.

Poor feto-maternal outcome

labouring mothers

referral

Nekemte

Ethiopia

Birth outcomes are not always favorable, and both mothers and newborns may have poor outcomes (1). Stillbirth, preterm birth, low birth weight, and congenital abnormalities are the reported poor birth outcomes (2). The poor maternal outcome is when the mother developed one or more complications among the following complications: hemorrhage, genital tear, fistula, the need for blood transfusion, the need for major surgery, and death related to instrumental delivery (3).

The majority of poor fetal and maternal outcomes were related to a weak maternal referral system (8). Common obstetric complications that require referral for tertiary obstetric management are Hemorrhages, both antepartum and postpartum, hypertensive disorders during pregnancy, shoulder dystocia, a rupture of the uterus, sepsis, cord prolapse, and fetal distress (5). Although the majority of complications during pregnancy and childbirth are unpredictable and develop quickly, they are manageable (6).Therefore, this study aimed to assess the poor fetal and maternal outcomes of laboring mothers referred to Nekemte City public hospitals, Western Ethiopia.

Poor fetal and maternal outcome is the major public health problem both in low and middle-income countries. Every year, complications related to pregnancy and childbirth claim the lives of more than a quarter of a million women. A minimum of 536,000 women and 2 million newborns worldwide die each year due to pregnancy and delivery complications (9). Maternal & neonatal morbidity and mortality in developing countries especially in sub-Saharan countries are very high. In Africa, every day, 3,100 newborns die, 2,400 babies are stillborn, and 700 women die from pregnancy-related causes (9). Ethiopia as a member of sub-Saharan African countries, contributes a huge number of-maternal & neonatal morbidity and mortality. Ethiopia's MMR is 412 per 100,000 live births, while the newborn death rate was 29 per 1,000 live births (10).

One of the leading causes of newborn morbidity and mortality globally is low birth weight. Low birth weight (LBW) is one of the main newborn health issues that put newborns at risk for several problems, including hypoglycemia, hypothermia, and acute and long-term developmental disorders(11, 12). According to epidemiological studies, between 15 and 20 percent of newborns worldwide have low birth weights; of these, Ethiopia accounts for 4.53% (13, 14).

Worldwide, there are more than 7 million perinatal deaths every year, with 3.5 million stillbirths accounting for half the total deaths. According to estimates, the stillbirth rate in developed countries ranges from 4.2 to 6.8 per 1,000 live births, while it varies from 20 to 32 per 1,000 live births in middle-income countries(15). In sub-Saharan Africa, stillbirths claim the lives of more than 900,000 newborns(16). According to a systematic study conducted in Ethiopia from 1974 to 2013, the prevalence of stillbirths is 60 to 110 per 1,000 live births(17).

The-death of a mother can have long-lasting emotional, social, and financial consequences on family and community, especially in resource-constrained countries where health systems, access to, and utilization of basic health care are weak (23). The consequences of maternal mortality for children include increased mortality risk, decreased nutrition, and decreased schooling. Families may experience financial instability or poverty when an adult family member dies, especially if the mother is the household's primary provider. As a result, children may start working in the informal sector or as prostitutes to make money to support their families or buy food for themselves. A family with limited resources is more likely to suffer from malnutrition, infectious diseases, and a lack of education. These conditions enhance the cycle of poverty and death (24).

The primary causes of poor fetal and maternal outcomes include inadequately trained delivery attendants, a lack of education, the low status of women in society, impoverished families, women's financial burdens, and a delay in obtaining immediate treatment in cases of obstetric complications (25). The majority of poor fetal and maternal outcomes were related to a weak maternal referral system (8). Due to a lack of specialized services and transportation options, referrals to tertiary centers are delayed, which increases the risk of fetal and maternal morbidity and mortality (26). There are so many factors that are associated with poor fetal and maternal outcomes. These factors are better explained using the three delay models; delay in seeking care, delay in reaching care, and delay in receiving care (27). The majority of the population in Ethiopia lives in rural areas. Due to the disproportionate concentration of health services in urban areas and the inefficient accessibility to tertiary obstetrics services by the rural population, a significant number of obstetric emergencies are referred to referral hospitals and institutions for tertiary obstetric management.

The World Health Organization has undertaken initiatives to decrease the magnitude of fetal and maternal morbidity and mortality by preparing a manual and making recommendations for maternal and newborn health, with a focus on prenatal care and service integration in particular (28). The WHO proposed postnatal care for women and babies as another aspect of improving maternal and neonatal health (29). In 2014, the Ministry of Health, Ethiopia, developed a maternal death review as one of the strategies to reduce the high rate of maternal deaths in Ethiopia. In Ethiopia, the national reproductive health strategy 2014–2018 was developed in 2014 and implemented the number of activities to improve pregnancy outcomes are increasing midwives and emergency surgeons, equipping health centers with basic obstetrics and new-born care equipment, improving antenatal care, promoting institutional delivery, improving maternal referral system and health care financing (30). The Health Extension Program was established by the Ethiopian government in 2004 to expand physical health infrastructure (i.e., establish health posts) and train and deploy a cadre of Health Extension Workers to improve access to and equity of basic health services for the rural population. Despite enormous efforts undertaken to prevent deaths that could be related to pregnancy and childbirth, poor fetal and maternal poor outcomes continues to pose a significant problem in many developing nations (32).

Although a majority of obstetric complications are referred to tertiary hospitals for management, a study conducted on poor fetal and maternal outcomes among referred laboring mothers in the study area was scanty, and there is limited information regarding the magnitude of poor maternal and fetal outcomes among referred laboring mothers and associated factors in Ethiopia, especially in the study area.

Study Area and Period

The study was conducted at Nekemte City public hospitals among referred laboring mothers from February 10, 2023, to April 11, 2023. The city is located in Oromia Regional State Western Ethiopia, which is 328 km from Addis Ababa, the capital city of Ethiopia.. According to the Nekemte city health office, the health infrastructure of the city is organized by two public hospitals and two health centers. The two public hospitals that are providing delivery care services are Nekemte specialized hospital and Wollega University referral hospital. These two hospitals have been giving maternal health services to mothers who would be referred from lower-level health facilities. The obstetrics and gynecology department of Wallaga University referral hospital has 6 obstetrics and gynecology specialists, 3 medical doctors, and 28 midwives. The obstetrics and gynecology department of Nekemte specialized hospital has 3 obstetrics and gynecology specialists, 2 integrated surgery officer, and 22 midwives. The two public hospitals serve about 5 million people. The pregnant mothers who would be referred for tertiary obstetric management are approximately 53,456 from 65 public health centers of East Wallaga zones. The pregnant women of neighboring zones like West Wallaga and Horro Guduru Wallaga zones would also be referred to WURH and NSH for tertiary obstetric management (source: East Wollega zonal health department, 2014 Report).

Study design

Institutional based, cross-sectional study design was conducted at the two public hospitals of Nekemte City: Nekemte specialized hospital and Wallaga University referral Hospital.

Population

Source Population

The source population was all laboring mothers referred to the public hospitals of Nekemte City.

Study population

All laboring mothers who were referred to the two public hospitals of Nekemte City during the study period.

Inclusion and Exclusion Criteria

Inclusion criteria

All laboring mothers who come with referral papers within the study period.

Exclusion criteria

Mothers who were referred to other Hospitals.

Sample Size Determination

Sample size determination

The final sample size was the largest sample size determined by using single population proportion formula considering; a 95% confidence level (zα/2 = 1.96), 5% margin of error, 46.2% proportion of poor fetal outcome (APGAR score less than 7 at the 5th minute)(57). The total sample size was 420 laboring mothers referred to WURH and NSH during the study period after adding a 10% non-response rate.

Single population Proportion formula

The sample size for the factors associated with poor fetal and maternal outcome was determined by EPI INFO 7 using double population proportion formula by considering independent factors significantly associated with the poor fetal outcome; Age group 35 and above, Rural residence, and independent Variables significantly associated with the maternal poor outcome; Partograph follow up and birth preparedness and complication readiness (57–59). Assuming the following assumptions: the power of the study (1 - β) to be 80, 95% confidence interval (95% CI), and the incidence among exposed to the incidence among unexposed is 1:1 and a 10% non-response rate(Table 1).

Table 1

The sample size for the study of poor fetal and maternal outcomes and associated factors among laboring mothers referred to public hospitals of Nekemte city, East Wallaga zone, Oromia region, Ethiopia, from February 10, 2023, to April 11, 2023.
Poor Maternal outcome		Proportions of poor maternal outcome	Sample size	Final sample size(10% non-response rate		Reference
Uterine Rupture		6.1%	88	97		(57)
PPH		11%	150	165		(59)
poor Fetal outcome		Proportions of poor fetal outcome	Sample size	Final sample size(10% non-response rate)
Birth asphyxia		77.3%	270	297		(60)
Still birth		3.5%	52	57		(58)
APGAR score less than 7 at the 5th minute		46.2%	382	420		(57)
Variables significantly associated with poor fetal outcome	P1(proportion of diseases among exposed)	P2(proportion of diseases among non- exposed)	Sample size	Final sample size(10% non-response rate	Crude odds ratio	Reference
Age group 35 and above	29.23%	86.34%	24	26	15.5	(58)
Rural residence	59.59%	92.05%	54	59	7.9	(58)
Variables associated with poor maternal outcome	P1(proportion of diseases among exposed)	P2(proportion of diseases among non- exposed)	Sample size	Final sample size(10% non-response rate	Crude odds ratio	Reference
Partograph follow up	41.05%	55.55%	374	411	1.79	(57)
Birth preparedness	66.06%	85.84%	148	163	3.12	(59)

Sampling Procedure

The study participants were selected from the two public hospitals of Nekemte City. Based on the three months report, from May 20, 2022, to August 20, 2022, an average of 247 referred laboring mothers received obstetric management at the two public hospitals of Nekemte City. Therefore, 420 mothers were selected consecutively from February 10, 2023, to April 11, 2023. The determined sample size was proportionally allocated for the two hospitals of Nekemte City. The proportional allocation of sample size was made for both public hospitals of Nekemte city by using the following statistical formula.

ni = total sample size in selected hospital.

Ni = the total number of referred laboring mothers in each public hospital of Nekemte city.

n = total sample size determined for the study.

Study Variables

Dependent variable

Poor Fetal outcome, Poor maternal outcome

Independent variables

Socio-demographic factors

Age, educational status, ethnicity, marital status, maternal occupation, - and residence.

Referral-related factors: Distance between facilities, type of transport, and the mother being accompanied by a health professional.

Obstetric and medical-related factors

Parity, Previous C/S Scar, Gestational age, number of ANC visits, Mode of delivery, complications of current pregnancy, medical diseases, and the reason for referral.

Operational definitions

Maternal Outcome

was measured based on maternal mortality and complications in the hospital before discharge and classified as either a good or poor maternal outcome. Mothers were classified as having poor maternal outcomes, either maternal mortality occurred or one/more maternal complications identified among the following complications (postpartum hemorrhage, shock, genital tear, peripartum hysterectomy, fistula, and the need for blood transfusion (severe anemia). On the other hand mothers without any maternal complications are categorized as having good maternal outcomes (3).

Fetal Outcome

Classified as either a good or poor outcome. A poor fetal outcome is classified in the presence of at least one of the following (Admission to NICU, Anemia, Low Birth Weight, preterm birth, stillbirth, IUFD otherwise classified as a Good fetal outcome (3).

Data collection procedure

Data was collected by using a pre-tested and structured interviewer-administered tool which was prepared after reviewing different previous literature and customized based on the objectives of the study (53–56). The questionnaire has questions about socio-demographic factors, obstetrics-related factors,- and maternal-referral-related factors.

Before the data collection, the questionnaire was translated to Afaan Oromoo by independent translators and then back to English to check for consistency. Finally, the Afaan Oromo version of the questionnaire was used to collect the data. The enumerators (four BSc midwives), and the two supervisors (BSc in public health Officer) were trained for one day about the objectives of the study and data collection procedures. Mothers were approached within 24 hours of delivery and before discharge.

Data quality assurance

The data quality was maintained through the careful design of questionnaires that were translated from English to Afaan Oromo and back to English. The translation from Afaan Oromo back to English was done by other personnel to check the consistency of the questionnaire. A one-day training was given for data collectors and supervisors on the objective and relevance of the study, how to gather the appropriate information, procedures of data collection techniques, - and the whole contents of the questionnaire. The checklist was collected from data collectors each day by the principal investigator and checked for any errors. The checklist was pre-tested by taking 5 percent of the sample size from January 13–17, 2023 in the Gimbi Hospital and necessary modification in the checklist was made based on the nature of the gaps identified. Also, the data was entered and cleaned by the principal investigator.

Data Processing and Analysis

The collected data were checked for completeness by the investigator. The collected data was coded and cleaned. The data was entered into EPI- DATA software version 4.6 and then, exported into SPSS Version 26.0 for data analysis. Descriptive statistics such as mean, frequency and standard deviation were computed and described by graphs and tables. Binary Logistic regression was carried out to identify variables associated with poor fetal and maternal outcome. Multivariable binary logistic regression was done for variables that have a p-value < 0.25 during the bivariable binary logistic regression analyses and used to control confounders and identify independent significant factors of poor fetal and maternal outcomes among referred laboring mothers. Adjusted Odds ratio (OR) with 95% CI was used to measure the strengths of association between explanatory variables and the outcome variable. The p-value < 0.05 was considered statistically significant. The model fitness was checked using Hosmer and Lemshow's goodness of fit, which was (P > 0.05). Multicollinearity was assessed using the variance inflation factor (VIF). The findings were compiled and described using texts, tables, and figures.

Socio-demographic Factors of the study participants

A total of 407 respondents participated in this study with a response rate of 97%. The study revealed that the mean age of the participants was 26.33 years (SD ± 5.12), ranging from 16–40. The respondents that reside in rural areas were 261 (64.1%). Regarding the educational level of the study participants, 115 (28.3%) completed secondary education, followed by 97(23.8) in primary education (Table 2).

Table 2

socio-demographic factors of laboring mothers referred to Nekemte City public hospitals from February 10, 2023, to April 11, 2023.
S.N	Variables	Category	Frequency	Percent
1	Age	<20 20–34 35 and above	72 295 40	17.7 72.5 9.8
2	Educational status of the mother	Unable to read and write Able to read and write Primary education Secondary education College education and above	73 88 97 115 34	17.9 21.6 23.8 28.3 8.4
3	Educational status of the husband	Unable to read and write only read and write Primary level Secondary level College education and above	41 34 109 108 102	10.1 8.4 26.8 26.5 25.1
4	Marital Status	Single Married Others	9 392 6	2.2 96.3 1.5
5	Ethnicity	Amhara Oromo Others	46 331 30	11.3 81.3 7.4
6	Place of residence	Urban Rural	146 261	35.9 64.1

Ethnicity (Others) = Tigre and Gurage, Marital Status (Others) = Divorced and Widowed.

Obstetrics and Medical related factors of the study participants

The study showed that 196(48.2%) of the participants were multipara, 176(43.2%) were primipara and 35(8.6%) were grand multipara. Regarding modes of delivery, 179(44%) of the respondents were delivered by cesarean section, followed by 172(42.3%) delivered by SVD, and 56(13.8%) were delivered by instrumental assisted delivery. The participants who had no medical history were 365(89.7%) (Table 3).

Table 3

Obstetrics and medical illness among laboring mothers referred to Nekemte City public hospitals from February 10, 2023, to April 11, 2023.
S.N	Variables	Category	Frequency	Percent
1	Parity	Primipara Multipara Grand Multipara	176 196 35	43.2 48.2 8.6
2	Mode of delivery	Spontaneous vaginal delivery Assisted delivery Cesarean delivery	172 56 179	42.3 13.8 44
3	Types of Pregnancy	Singleton Multiple	373 34	91.6 8.4
4	Pregnancy Status	Wanted Un wanted	376 31	92.4 7.6
5	Gestational age	< 37 37–42 > 42	44 348 15	10.8 85.5 3.7
6	ANC follow-up	Yes No	385 22	94.6 5.4
7	Number of ANC follow-up	Two time Three times Four and above	83 136 167	20.4 33.4 41
8	Iron Supplementation	No Yes	93 305	22.9 74.9
9	counseling on BPCR	No Yes	263 144	64.6 35.4
10	Medical Illness	Yes No	42 365	10.3 89.7
11	Reason for Referral	Previous C/S Scar Multiple pregnancies APH Mal presentation PROM Prolonged Labour PIH	37 8 23 41 59 86 53	9.1 2.0 5.7 10.1 14.5 21.1 13.0
BPCR = birth preparedness and complication readiness, ANC = antenatal care,

Maternal referral system-related factors

The participants referred from health centers were 251(61.7%), 59(14.5%) were referred from primary hospitals, - and 54(13.3%) were referred from general hospitals. Regarding the mode of transport used during referral, 212(52.1%) of the participants used public transport during referral, and 175(43%) used an ambulance. Two-thirds of the participants were accompanied by a nurse/ midwife during referral, and 143(35.1%) were not accompanied by a nurse/midwife during referral (Table 4).

Table 4

Maternal referral system-related factors among laboring mothers referred to Nekemte town public hospitals from February 10, 2023, to April 11, 2023.
S.N	Variables	Category	Frequency	Percent
1	Referring health facility	Health post Private HCF Health center Primary hospital General Hospital	7 36 251 59 54	1.7 8.8 61.7 14.5 13.3
2	Mode of transport	By Ambulance By public transport By Tricycle	175 212 20	43 52.1 4.9
3	Nurse or midwife assisting during the referral	Yes No	143 264	35.1 64.9
4	Referral paper given	Yes No	376 31	92.4 7.6
5	Distance between HCF	<50 km >=50 km	234 173	57.5 42.5
6	Problem to reach the referred health care facility?	No Yes	299 108	73.5 26.5

HCF = health care facility

Maternal outcome

The poor maternal outcomes were 24.3%. PPH was the commonest poor maternal outcome 32(7.8%), followed by Anemia 36(7.8%), Genital tear 12(2.9%), Uterine rupture 8(2%), and Sepsis 6(1.5%). In addition, there was three maternal death. (Fig. 2).

Fetal outcome

During the study periods, 46.2% of the participants had poor fetal outcomes. Low birth weight was seen in 68(16.7%) and 79(19.4%) newborn admitted to NICU. There were 44(10.8%) still births. In addition, birth asphyxia was observed in 56(13.8%) and prematurity was seen in 39(9.6%) (Fig. 3).

Factors associated with poor maternal outcome among referred laboring mothers

On bivariable binary logistic regression analysis, the educational status of the mother, Ethnicity, Parity, Mode of delivery, types of pregnancy, gestational age, ANC follow-up, number of ANC visits, Iron supplementation, risk factors detected during ANC visits, history of medical illness, counseling for possible referrals on BPCR during ANC visit, the reason for referral and problems to reach to referred HCF, problems experienced to get service, distance, showed association with poor maternal outcome among referred laboring mothers.

On multivariable binary logistic regression analysis, Unable to read and write (AOR: 3.64, 95% CI: (1.11, 11.96), multiple pregnancies (AOR: 4.23, 95% CI: (1.26, 14.25), and PIH 3.9, 95% CI: (1.11–13.67) were factors associated with poor maternal outcome (Table 5).

The finding revealed that the odds of being unable to read and write were 3.6 times higher to develop poor maternal outcomes (AOR: 3.6, 95% CI: (1.11, 11.96). Respondents who had multiple pregnancies were 4.2 times more likely to develop poor maternal outcomes (AOR: 4.2, 95% CI: (1.26, 14.25)] than their counterparts.

Regarding the reason for referral, respondents who had PIH were about four times 3.9, 95% CI: (1.11–13.67) more likely to develop poor maternal outcomes than participants whose reason for referral was previous C/S scar.

Table 5

Bivariable and multivariable analysis of variables associated with poor maternal outcomes.
Variables	Category	Maternal outcome				COR 95% CI	AOR 95% CI
Variables	Category	Good		Poor		COR 95% CI	AOR 95% CI
Educational of mother	Unable to read and write	44	60.3%	29	39.7%	2.54(0.98–6.6)	3.64(1.11–11.96)*
	Able to read and write	67	76.1%	21	23.9%	1.21(0.46–3.17)	0.69(0.22–2.22)
	Primary	77	79.4%	20	20.6%	1(0.38–2.63)	0.28(0.08–1.05)
	Secondary	93	80.9%	22	19.1%	0.91(0.35–2.37)	0.58(0.19–1.76)
	College and above	27	79.4%	7	20.6%	1
mode of delivery	Spontaneous vaginal delivery	127	73.8%	45	26.2%	1
	Assisted delivery	37	66.1%	19	33.9%	1.45(0.76–2.77)	1.98(0.84–4.69)
	Cesarean delivery	144	80.4%	35	19.6%	0.69(0.42–1.13)	0.51(0.23–1.09)
Types of Pregnancy	Singleton	290	77.7%	83	22.3%	1
Types of Pregnancy	Multiple	18	52.9%	16	47.1%	3.11(1.52–6.36)	4.23(1.26–14.25)**
gestational age	< 37	29	65.9%	15	34.1%	0.78(0.23–2.59)	0.26(0.05–1.49)
	37–42	270	77.6%	78	22.4%	0.43(0.15–1.26)	0.30(0.07–1.31)
	> 42	9	60.0%	6	40.0%	1
Number of ANC follow up	Two times	53	63.9%	30	36.1%	2.5(1.3–4.77)	1.5(0.56-4)
	Three times	100	73.5%	36	26.5%	1.95(1.11–3.44)	1.68(0.76–3.7)
	Four and above	141	84.4%	26	15.6%	1
problem/risk factor detected during an ante-natal visit	Yes	243	79.4%	63	20.6%	0.52(0.31–0.87)	1.09(0.45–2.66)
problem/risk factor detected during an ante-natal visit	No	62	66.7%	31	33.3%	1
Medical illness	Yes	284	77.8%	81	22.2%	0.38(0.2–0.74)	0.57(0.18–1.83)
Medical illness	No	24	57.1%	18	42.9%	1
counseling for possible referrals	Yes	204	77.6%	59	22.4%	1
counseling for possible referrals	No	104	72.2%	40	27.8%	1.33(0.84–2.12)	0.9(0.46–1.75)
Distance(Km)	< 50	185	79.1%	49	20.9%	1
Distance(Km)	>=50	123	71.1%	50	28.9%	1.54(0.97–2.42)	1.1(0.53–2.29)
reason for Referral?	Previous C/S Scar	31	83.8%	6	16.2%	1
	PROM	54	91.5%	5	8.5%	0.47(0.14–1.7)	0.45(0.1–2.06)
	Prolonged Labour	73	84.9%	13	15.1%	0.92(0.32–2.64)	0.75(0.19–2.96)
	PIH	33	62.3%	20	37.7%	3.13(1.11–8.82)	3.9(1.11–13.67)*
	Fetal Distress	28	66.7%	14	33.3%	2.58(0.87–7.64)	2.58(0.69–9.59)
Problem to reach HCF	Yes	240	80.3%	59	19.7%	0.42(0.26–0.68)	1.18(0.53–2.62)
Problem to reach HCF	No	68	63.0%	40	37.0%	1

Variables that are significant on multivariable analysis at a P- value of < 0.05 are marked by the “*” sign, a P-value of < 0.01 are marked by the “**” sign, and a P-value of < 0.001 are marked by the “***” sign.

5.7 Factors associated with poor fetal outcomes.

Similarly, factors associated with poor fetal outcomes among referred laboring mothers were identified through bivariable and multivariable binary logistic regression analysis. On bivariable binary logistic regression analysis, the educational status of the mother, place of residence, mode of delivery, ANC follow-up, Number of ANC visits, problem or risk factor detected during ANC visit, medical illness, maternal age, distance, and gestational age, showed association with poor fetal outcomes among referred laboring mothers.

On multivariable binary logistic regression analysis, Rural residence (AOR: 1.99, 95% CI: (1.21, 3.29), a cesarean delivery (AOR: 2.64, 95% CI: (1.56–4.47), gestational age < 37 weeks (AOR: 8.09, 95% CI: (1.52–12.91), less than four ANC visit (AOR: 2.37, 95% CI: (1.23–4.58), were found to be significant factors for poor fetal outcomes (P value < 0.05) (Table 6).

Respondents who reside in rural areas were about 2 times (AOR: 1.99, 95% CI: (1.21, 3.29) more likely to develop poor fetal outcomes than those who reside in urban areas.

The finding also revealed that the odds of delivering by cesarean section were 2.6 times higher to developing poor fetal outcomes (AOR: 2.64, 95% CI: (1.56, 4.47).

Participants with gestational age less than 37 weeks were 8 times more likely (AOR: 8.09, 95% CI: (1.52, 12.91)] to develop poor fetal outcomes than respondents whose gestational age was ≥ 37 weeks.

Finally, the study showed that Respondents who had less than four ANC visits were 2.4 times more likely (AO2.4, R: 95% CI: (1.23, 4.58)] to develop poor fetal outcomes as compared with participants who visited ANC four and above.

Table 6

Bivariable and multivariable analysis of variables associated with poor fetal outcome.
Variables	Category	Fetal Outcome				COR 95% CI	AOR 95% CI
Variables	Category	Good		Poor		COR 95% CI	AOR 95% CI
Age in years	<20	10	35.7%	18	64.3%	1.31(0.48–3.58)	2.99(0.83–10.73)
	20–34	193	56.6%	148	43.4%	0.56(0.28–1.01))	0.94(0.41–2.13)
	35 and above	16	42.1%	22	57.9%	1
Educational of mother	Unable to read and write	38	52.1%	35	47.9%	1
	Able to read and write	37	42.0%	51	58.0%	1.93(0.82–4.52)	0.94(0.34–2.54)
	Primary education	53	54.6%	44	45.4%	2.88(1.25–6.64)	1.92.(0.76–4.83)
	Secondary education	68	59.1%	47	40.9%	1.74(0.76–3.95)	0.76(0.29–1.96)
	College education and above	23	67.6%	11	32.4%	1.44(0.64–3.25)	1.14(0.47–2.8)
Residence	Urban	95	65.1%	51	34.9%	1
Residence	Rural	124	47.5%	137	52.5%	2.06(1.36–3.13)	1.99(1.21–3.29)**
mode of delivery	Spontaneous vaginal delivery	97	56.4%	75	43.6%	1
	Assisted delivery	38	67.9%	18	32.1%	0.61(0.32–1.16)	1.01(0.5–2.05)
	Cesarean delivery	84	46.9%	95	53.1%	1.46(0.96–2.23)	2.64(1.56–4.47)***
gestational age	< 37	3	6.8%	41	93.2%	10.25(2.11–49.73)	8.09(1.52–12.91)*
	37–42	210	60.2%	139	39.8%	0.49(0.16–1.46)	0.38(0.12–1.22)
	> 42	6	42.9%	8	57.1%	1
Number of ANC visits	Less than four	36	43.4%	47	56.6%	2.16(1.26–3.68)	2.37(1.23–4.58)*
Number of ANC visits	Four and above	104	62.3%	63	37.7%	1
problem/risk factor detected during ANC visit	Yes	42	45.2%	51	54.8%	0.61(0.38–0.97)	0.67(0.34–1.29)
problem/risk factor detected during ANC visit	No	176	57.5%	130	42.5%	1
Medical illness	Yes	18	45.2%	24	54.8%	1
Medical illness	No	201	55.1%	164	44.9%	1.61(0.32–1.16)	0.71(0.31–1.61)
Distance(Km)	< 50	136	58.1%	98	41.9%	1
Distance(Km)	>=50	83	48.0%	90	52.0%	1.51(1.01–2.24)	1.17(0.72–1.92)

Variables that are significant on multivariable analysis at a P-value of < 0.05 are marked by the “*” sign, a P-value of < 0.01 are marked by the “**” sign, and a P-value of < 0.001 are marked by the “***” sign.

This study assessed poor fetal and maternal outcomes among referred laboring mothers and it revealed that the magnitude of poor maternal outcome in the study area was 24.1% (95% CI: 20% − 29%) and the magnitude of poor fetal outcome was 46.2% (95% CI: 41% − 51%). Unable to read and write, multiple pregnancies, -and pregnancy-induced hypertension were variables associated with poor maternal outcomes. Rural residence, cesarean deliveries, gestational age less than 37 weeks, and less than four ANC visits were factors associated with poor fetal outcomes.

The magnitude of poor maternal outcomes among referred laboring mothers in this study area was 24.1% (95% CI: 20%-29%). This finding was higher as compared to the study conducted in Tanzania (9.5%) (61). The discrepancy might be due to the difference in the maternal referral system and the majority of normal deliveries take place at health centers, whereas more complicated ones are sent to tertiary hospitals, where there are higher risks of poor maternal outcomes. However, it was lower as compared to studies done in southern Ethiopia (39%)(62) and West Shoa (52.4%) (57). The probable reason for this variation might be due to the study participants. The current study used referred laboring mothers as study participants but, the study conducted in West Shoa used obstructed labor as study participants.

Unable to read and write, multiple pregnancies and the reason for referral being Preeclampsia were variables associated with poor maternal outcomes among referred laboring mothers.

The finding also revealed that the odds of being unable to read and write were higher to develop poor maternal outcomes. This result might be mothers who don’t have formal education lack knowledge about early identification of complications and have delays in health care seeking during pregnancy and delivery. This finding was also supported by a study done in Kenya (63).

Respondents who had multiple pregnancies were 4.2 times more likely to develop poor maternal outcomes than their counterparts. Mothers who have multiple pregnancies face a higher risk of miscarriage, pre-eclampsia, APH, PPH, iron- and folic acid deficiency anemia, polyhydramnios, premature labor, PROM, and higher rates of cesarean delivery(64). This finding was supported by a study done in the Bale zone (65).

Regarding the reason for referral, the finding shows that the odds of having pregnancy-induced hypertension were higher in developing poor maternal outcomes. This could be due to a mother's risk of cardiac failure, heart attack, renal failure, and cerebrovascular accidents being increased by severe hypertension (66). This finding was supported by studies conducted in Ethiopia(67).

Additionally, the magnitude of poor fetal outcomes among referred laboring mothers was 46.2% (95%CI: 41%- 51%). This study found that it was higher as compared to a hospital-based study done in Tigray (22.6%) (68), Dessie (32.5%) (69), Hosana (24.5%) (70), and Nigeria (19%) (71). This discrepancy might be due to the study setting and study subjects of this study being referred laboring mothers, and the increasing number of referral cases from health centers and primary hospitals.

Rural residence, cesarean deliveries, gestational age less than 37 weeks, and visiting ANC two times were factors associated with poor fetal outcomes among referred laboring mothers.

The study showed that the odds of residing in rural areas were higher to develop poor fetal outcomes. This might be due to the disproportionate concentration of health services in urban areas and the inefficient accessibility to tertiary obstetrics services by the rural population. This study is supported by the study done in Gambia and Brazil (72, 73).

Regarding gestational age, the finding revealed that the odds of having gestational age less than 37 weeks were higher to develop poor fetal outcomes. This might be due to premature babies being at risk since they are not yet developed to adapt to the external environment. This study is supported by a study conducted in India (74).

The study also showed that the odds of having less than four ANC visits were higher for developing poor fetal outcomes. This might be because those participants who have visited less than four ANCs could not get counseling on birth preparedness and complication readiness and early treatment for potential problems during pregnancy and lack of health education on nutritional needs(75). This finding is supported by a study in Egypt (76).

The finding also revealed that the odds of delivering by cesarean section were higher to develop poor fetal outcomes. This might be a more extended recovery period, higher operating complications, an increased risk of unexplained stillbirths in subsequent pregnancies, and respiratory disorders for the newborn baby were all consequences of cesarean delivery (77). This result is supported by studies conducted in western Ethiopia (45).

LIMITATIONS

Even though this study has provided valuable evidence regarding poor fetal and maternal outcomes and determined associations of multiple factors of poor fetal and maternal outcomes, the study had some limitations. Women who managed to get to the referral hospitals after being referred by a rural facility were those who were only included in the current study. Mothers who were referred but weren't able to make it to the referral hospitals due to failure to secure transport or passing away in transit were not included thus, the number of such mothers was unknown. Despite this, the finding of this study will be used as evidence and input for HCPs, decision-makers, implementers, and managers of health service organizations at different levels to prevent poor fetal and maternal outcomes by counseling for possible referrals and birth preparedness and complication readiness during ante-natal care.

Conclusion

In this study, the poor fetal and maternal outcomes were linked to obstetric complications among pregnant women who were referred from rural facilities to tertiary hospitals. Unable to read and write, multiple pregnancies, and, - PIH were factors associated with poor maternal outcomes. Rural residence, cesarean deliveries, gestational age less than 37 weeks, and less than four ANC visits were factors associated with poor fetal outcomes. Therefore, detecting and managing obstetric complications early, improving antenatal care further and pregnant women should also have their blood pressure checked regularly.

7.2 RECOMMENDATION

Recommendation to Nekemte Specialized Hospital and Wallaga University referral Hospital

Referred labouring mothers should be classified as high-risk and monitored closely to prevent poor fetal and maternal outcomes.
There should be a trained nurse or midwife that escorts labouring mothers during referral.

Recommendation for Health Care Professionals attending delivery

Closely following or referring to a higher level of care, for all pregnant women who have pregnancy-induced hypertension.

Recommendation for pregnant women

Attending regular ante-natal care follow-up.

Recommendation for Researchers

Future researchers should conduct a study to compare the fetal and maternal outcomes of labouring mothers who are referred and who are not referred.

Ethical statement and consent to participate

Ethical clearance was obtained from the Institutional Review Board (IRB) of Wallaga University. Letters of support were received from the Wallaga University, department of public health. Before the beginning of data collection. Study participants of the two hospitals were informed about the purpose of the study and its contribution to maternal and fetal health improvement. Before collecting the data, written informed consent was secured. Participants’ full right to refuse, or reject part or all of the study was preserved. Names of the respondents were not used to ensure anonymity and confidentiality. All information obtained from the hospitals and the respondents was kept confidential. In this study, all methods were performed in accordance with the Declaration of Helsinki.

Consent to publish

Not applicable

Funding

This study was funded by Wallaga University. However, the funder had no role in the data collection, analysis and preparation of the manuscript, and publication decision.

Conflict of interest

All authors declared that they have no competing of interest in this study.

Acknowledgments

The authors thank the data collectors, data collectors’ supervisors and administrative staff of Wollega University referral Hospital hospital for their cooperation to conduct this research. We also extend our deepest gratitude to Wollega University and clinical staff of University of Nekemte comprehensive specialized Hospital for their unreserved support. Without them this work would not be realized.

Availability of data and material

Data generated/ analyzed during this study are found from the corresponding author.

Authors contribution

Roba T, Matiyos L, Seid W, Markos D, Emiru M participated in conceptualization, review and provide constructive feedback in the designing phase of the study, involved in the analysis, and review of the manuscript. Whereas, Imana R, Worku G, Hunde F and Garuma G participated in conceptualization, investigation, writing the document and data analysis. All authors involved in write, review and approve the final draft of the manuscript. All the authors read the manuscript before submitting it to a journal for publication. The authors read and approved the final manuscript.

Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth. 2016;10(1):1–22.
Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ. 2016;88:31–8.
Murphy DJ, Strachan BK, Bahl R. the Royal College of O, Gynaecologists. Assisted Vaginal Birth. BJOG: An International Journal of Obstetrics & Gynaecology. 2020;127(9):e70–e112.
Estimates by WHO U, UNFPA.,, and WBG, For more information pcDoRHaRtUNPD. TRENDS IN MATERNAL MORTALITY2000 to 2017. 2019.
Kant S, Kaur R, Malhotra S, Haldar P, Goel AD. Audit of emergency obstetric referrals from a secondary level hospital in Haryana, North India. J Family Med Prim Care. 2018;7(1):137–41.
Rohit DGP, Nitin DCS, Vasantrao DGN, editors. Maternal and Fetal Outcome in Referred Patients to Tertiary Care Center2016.
Gupta P, Chaudhari S, Gonnade N. Maternal and fetal outcome in referred patients to tertiary care center. Sch J App Med Sci. 2016;4(5C):1624–63.
Pembe AB, Paulo C, D’mello BS, van Roosmalen J. Maternal mortality at muhimbili national hospital in Dar-es-Salaam, Tanzania in the year 2011. BMC Pregnancy Childbirth. 2014;14(1):320.
World Health O. World health statistics 2016: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2016 2016.
Central Statistical Agency - CSA/, Ethiopia ICF. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia: CSA and ICF; 2017.
Seyum T, Ebrahim E. Proportion of neonatal hypothermia and associated factors among new-borns at Gondar University teaching and Refferal hospital, Northwest Ethiopia: a hospital based cross sectional study. General Medicine: Open Access. 2015;2015.
Rezende Chrisman J, Mattos IE, Koifman RJ, Koifman S, Moraes Mello Boccolini P, Meyer A. Prevalence of very low birthweight, malformation, and low Apgar score among newborns in Brazil according to maternal urban or rural residence at birth. J Obstet Gynecol Res. 2016;42(5):496–504.
WHO. World health ranking: Ethiopia low birth weight. 2014.
Targets WGN. 2025: Low birth weight policy brief. World Health Organization. 2014:7.
Mokuolu OA, Suleiman B, Adesiyun O, Adeniyi A. Prevalence and determinants of pre-term deliveries in the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Pediatr Rep. 2016;2(1):e3.
Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet. 2018;377(9774):1319–30.
Berhan Y, Berhan A. Perinatal mortality trends in Ethiopia. Ethiop J Health Sci. 2014;24(Suppl0 Suppl):29–40.
World Health O. Born too soon: the global action report on preterm birth. Geneva: World Health Organization; 2020.
Petrou S. The economic consequences of preterm birth during the first 10 years of life. BJOG. 2018;112(Suppl 1):10–5.
Negrato CA, Gomes MB. Low birth weight: causes and consequences. Diabetol Metab Syndr. 2018;5:49.
Wardlaw TM. Low birthweight: country, regional and global estimates: Unicef; 2014.
Pullar J, Wickramasinghe K, Demaio AR, Roberts N, Perez-Blanco KM, Noonan K, et al. The impact of maternal nutrition on offspring's risk of non-communicable diseases in adulthood: a systematic review. J Glob Health. 2019;9(2):020405.
Council NR. The consequences of maternal morbidity and maternal mortality: report of a workshop2020.
Council NR. Population Co. The Consequences of Maternal Morbidity and Maternal Mortality: Report of a Workshop. National Academies Press; 2020.
Ikenoue T, Ikeda T, Ibara S, Otake M, Schull WJ. Effects of environmental factors on perinatal outcome: neurological development in cases of intrauterine growth retardation and school performance of children perinatally exposed to ionizing radiation. Environ Health Perspect. 2018;101(Suppl 2):53–7.
Badal S, AG, Singh R. Pattern of term obstetric emergencies referred from health centers to RIMS. Eur J Pharm Med Res. 2017;1:376–82.
Pacagnella RC, Cecatti JG, Parpinelli MA, Sousa MH, Haddad SM, Costa ML, et al. Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study. BMC Pregnancy Childbirth. 2014;14:159.
World Health O. WHO recommended interventions for improving maternal and newborn health: integrated management of pregnancy and childbirth. Geneva: World Health Organization; 2017.
World Health O. WHO recommendations on postnatal care of the mother and newborn. Geneva: World Health Organization; 2014 2014.
MOH E. Federal Democratic Republic of Ethiopia Ministry of Health Health Sector Development Program IV October 2010 Contents. October 2020. 2014.
Nyamtema AS, Urassa DP, van Roosmalen J. Maternal health interventions in resource limited countries: a systematic review of packages, impacts and factors for change. BMC Pregnancy Childbirth. 2021;11(1):1–12.
Buekens P. Is estimating maternal mortality useful? Bull World Health Organ. 2021;79(3):179.
Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol. 2020;203(6):558. e1-. e7.
Sabale U, Patankar A, STUDY OF MATERNAL, AND PERINATAL OUTCOME IN REFERRED OBSTETRICS CASES. J Evol Med Dent Sci. 2015;4:4448–55.
Yego F, D'Este C, Byles J, Williams JS, Nyongesa P. Risk factors for maternal mortality in a Tertiary Hospital in Kenya: a case control study. BMC Pregnancy Childbirth. 2014;14:38.
Njoroge EW. The maternal and fetal outcomes among women with obstetric emergencies referred to the Kenyatta National Hospital. Nairobi, Kenya: University of Nairobi, Kenya; 2014.
Akaba GO, Ekele BA. Maternal and fetal outcomes of emergency obstetric referrals to a Nigerian teaching hospital. Trop Doct. 2018;48(2):132–5.
Busumani W, Mundagowa PT. Outcomes of pregnancy-related referrals from rural health facilities to two central hospitals in Harare, Zimbabwe: a prospective descriptive study. BMC Health Serv Res. 2021;21(1):1–11.
Khade SA, Pandya SP, Sarmalkar MS, Nayak AH. Fetomaternal Outcome in Referral Obstetric Patients in Tertiary Care Hospital. J South Asian Federation Obstet Gynecol. 2021;13(4):208.
Ong’era DO. Fetomaternal outcomes of mothers in labour referred to Moi Teaching and Referral Hospital: A descriptive prospective study. Moi University; 2021.
Narsaria K, Mukhopadhya P, Kyal A, Agarwal K, Agarwal A, Sanghi S. A Study of obstetric referrals-one year experience at a tertiary care centre in West Bengal. hospital. 2017;34:34.
Dutta I, Roy P, Dasgupta S, Khan M, Saha P. Obstetrics referrals: maternal and perinatal outcome in medical college hospital in eastern India. Indian J Obstet Gynecol Res. 2020;7(1):91–9.
Elizabeth N, Tom CO. Outcome of Obstetric Referrals to a Tertiary Referral Hospital in Northern Uganda.2016.
Ikwasa AI. Referral diagnosis and determinants of obstetric outcomes among referred women with obstetric emergency at Iringa regional referral hospital. The University of Dodoma; 2019.
Woyessa AH, Caffo JM, Palanichamy T, Magnitude. Characteristics, Maternal and Feto-Neonatal Outcomes of Obstetric Emergencies in Western Ethiopia, Nekemte, Ethiopia. Gynecol Obstet Reproductive Med. 2020;26(2):101–9.
Busumani W, Mundagowa PT. Outcomes of pregnancy-related referrals from rural health facilities to two central hospitals in Harare, Zimbabwe: a prospective descriptive study. BMC Health Serv Res. 2021;21(1):276.
Knight HE, Self A, Kennedy SH. Why are women dying when they reach hospital on time? A systematic review of the 'third delay'. PLoS ONE. 2013;8(5):e63846.
Mapunda OE, Msuya SE, Kapologwe NA, John B, Damian DJ, Mahande MJJ, editors. Assessment of Maternal Mortality and its Associated Causes at Shinyanga Regional Hospital in Tanzania2016.
Hirose A, Borchert M, Cox J, Alkozai AS, Filippi V. Determinants of delays in travelling to an emergency obstetric care facility in Herat, Afghanistan: an analysis of cross-sectional survey data and spatial modelling. BMC Pregnancy Childbirth. 2015;15(1):14.
Nkyekyer K. Peripartum referrals to Korle Bu teaching hospital, Ghana–a descriptive study. Tropical Med Int Health. 2020;5(11):811–7.
Nwameme AU, Phillips JF, Adongo PB. Compliance with emergency obstetric care referrals among pregnant women in an urban informal settlement of Accra, Ghana. Matern Child Health J. 2014;18(6):1403–12.
Murray SF, Pearson SC. Maternity referral systems in developing countries: current knowledge and future research needs. Soc Sci Med. 2016;62(9):2205–15.
Bailey PE, Keyes EB, Parker C, Abdullah M, Kebede H, Freedman L. Using a GIS to model interventions to strengthen the emergency referral system for maternal and newborn health in Ethiopia. Int J Gynaecol Obstet. 2021;115(3):300–9.
NASR ESS, Raeisi P, Motlagh M, Kabir M, Ashrafian AH. Evaluation of the performance of referral system in family physician program in Iran University of Medical Sciences: 2019. 2010.
Jandorf L, Cooperman JL, Stossel LM, Itzkowitz S, Thompson HS, Villagra C, et al. Implementation of culturally targeted patient navigation system for screening colonoscopy in a direct referral system. Health Educ Res. 2013;28(5):803–15.
Pembe AB, Carlstedt A, Urassa DP, Lindmark G, Nyström L, Darj E. Effectiveness of maternal referral system in a rural setting: a case study from Rufiji district, Tanzania. BMC Health Serv Res. 2020;10(1):326.
Getachew A, Wakgari N, Gishille T. Feto-Maternal Outcomes of Obstructed Labor and Associated Factors among Mothers Who Gave Birth in Public Hospitals of West Shoa Zone, Central Ethiopia: Cross-Sectional Study Alem Getachew1, Negash Wakgari2*, Tolosa Gishille3. Ethiop J Health Sci. 2021;31(3).
Abdo RA, Halil HM, Birhanu LZ, Defara DA, Kebede B. Prevalence and associated factors of adverse birth outcome among deliveries at Butajira hospital, Southern Ethiopia. J Gynecol Womens Health. 2019;15(4):555920.
Gudayu TW, Araya BM. Outcomes among mothers who gave birth in the health facility: does birth preparedness and complication readiness have a role? Obstetrics and gynecology international. 2019;2019.
Gendisha G, Gudayu T, Gurara M, Wakgari N, Shimbre M. Feto-maternal outcomes in obstructed labor in Suhul General Hospital, North Ethiopia. 2017:77–84.
Ikwasa AI. Referral diagnosis and determinants of obstetric outcomes among referred women with obstetric emergency at Iringa regional referral hospital: The University of Dodoma.
Yimer NB, Gedefaw A, Tenaw Z, Liben ML, Meikena HK, Amano A, et al. Adverse obstetric outcomes in public hospitals of southern Ethiopia: the role of parity. J Maternal-Fetal Neonatal Med. 2022;35(10):1915–22.
Jebet CJ. Factors Contributing to Adverse Pregnancy Outcomes in Public Health Facilities in Keiyo District, Kenya. Unpublished thesis, Kenyatta University. 2022.
Ananth CV, Smulian JC, Demissie K, Vintzileos AM, Knuppel RA. Placental abruption among singleton and twin births in the United States: risk factor profiles. Am J Epidemiol. 2021;153(8):771–8.
Degno S, Lencha B, Aman R, Atlaw D, Mekonnen A, Woldeyohannes D, et al. Adverse birth outcomes and associated factors among mothers who delivered in Bale zone hospitals, Oromia Region, Southeast Ethiopia. J Int Med Res. 2021;49(5):03000605211013209.
Gudeta TA, Regassa TM. Pregnancy induced hypertension and associated factors among women attending delivery service at mizan-tepi university teaching hospital, tepi general hospital and gebretsadik shawo hospital, southwest, Ethiopia. Ethiop J health Sci. 2019;29(1).
Mersha AG, Abegaz TM, Seid MA. Maternal and perinatal outcomes of hypertensive disorders of pregnancy in Ethiopia: systematic review and meta-analysis. BMC Pregnancy Childbirth. 2019;19:1–12.
Adhena T, Haftu A, Gebreegziabher B. Assessment of magnitude and associated factors of adverse birth outcomes among deliveries at Suhul hospital Shire, Tigray, Ethiopia from September, 2015 to February, 2016. Biomedical J Sci Tech Res. 2017;1(7):2045–52.
Cherie N, Mebratu A. Adverse birth out comes and associated factors among delivered mothers in dessie referral hospital. North East Ethiopia. 2018:1–6.
Abdo R, Endalemaw T, Tesso F. Prevalence and associated factors of adverse birth outcomes among women attended maternity ward at Negest Elene Mohammed Memorial General Hospital in Hosanna Town, SNNPR, Ethiopia. J Women’s Health Care. 2016;5(4):324.
Agarwal K, Agarwal A, Agrawal V, Agrawal P, Chaudhary V. Prevalence and determinants of low birth weight among institutional deliveries. Annals of Nigerian medicine. 2021;5(2):48.
Jammeh A, Sundby J, Vangen S. Maternal and obstetric risk factors for low birth weight and preterm birth in rural Gambia: a hospital-based study of 1579 deliveries. Open J Obstet Gynecol. 2021;1(03):94.
Chrisman J, Sarcinelli P, Koifman R, Koifman S, Meyer A, editors. Adverse pregnancy outcomes and maternal urban or rural residence at birth. ISEE Conference Abstracts; 2021.
Uma S, Nisha S, Shikha S. A prospective analysis of etiology and outcome of preterm labor. J Obstet Gynecol India. 2017;57(1):48–52.
Adane AA, Ayele TA, Ararsa LG, Bitew BD, Zeleke BM. Adverse birth outcomes among deliveries at Gondar University hospital, Northwest Ethiopia. BMC Pregnancy Childbirth. 2014;14:1–8.
El-Sayed Azzaz MS, Martínez‐Maestre A, Torrejón‐Cardoso MA. Antenatal care visits during pregnancy and their effect on maternal and fetal outcomes in pre‐eclamptic patients. J Obstet Gynecol Res. 2016;42(9):1102–10.
Smith GC, Pell JP, Dobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet. 2013;362(9398):1779–84.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Poor feto maternal outcomes and associated factors among labouring mothers referred to Nekemte city public hospitals, East Wallaga Zone, Oromia, Ethiopia.

Status:

Version 1

Abstract

Figures

BACKGROUND

METHODS AND MATERIALS

Study Area and Period

Study design

Population

Source Population

Study population

Inclusion and Exclusion Criteria

Inclusion criteria

Exclusion criteria

Sample Size Determination

Sample size determination

Single population Proportion formula

Sampling Procedure

Study Variables

Dependent variable

Independent variables

Operational definitions

Data collection procedure

Data quality assurance

Data Processing and Analysis

RESULTS

Socio-demographic Factors of the study participants

Obstetrics and Medical related factors of the study participants

Maternal referral system-related factors

Maternal outcome

Fetal outcome

Factors associated with poor maternal outcome among referred laboring mothers

DISCUSSION

LIMITATIONS

CONCLUSION AND RECOMMENDATION

Conclusion

7.2 RECOMMENDATION

Recommendation to Nekemte Specialized Hospital and Wallaga University referral Hospital

Recommendation for Health Care Professionals attending delivery

Recommendation for pregnant women

Recommendation for Researchers

Declarations

Ethical statement and consent to participate

Consent to publish

Funding

Conflict of interest

Acknowledgments

Availability of data and material

Authors contribution

References

Additional Declarations

Status:

Version 1