Characteristics and outcomes of pregnant women hospitalized with severe maternal outcomes in eastern Ethiopia: Results from the Ethiopian Obstetric Surveillance System study

Abera Kenay Tura; Marian Knight; Sagni Girma; Redwan Ahmed; Mohammed Yuya; Delayehu Bekele; Tahir Ahmed Hassen; Jelle Stekelenburg; Thomas van den Akker

doi:10.1002/ijgo.15240

Characteristics and outcomes of pregnant women hospitalized with severe maternal outcomes in eastern Ethiopia: Results from the Ethiopian Obstetric Surveillance System study

Abera Kenay Tura^*, Marian Knight, Sagni Girma, Redwan Ahmed, Mohammed Yuya, Delayehu Bekele, Tahir Ahmed Hassen, Jelle Stekelenburg, Thomas van den Akker

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objective: The aim of the present study was to identify facility-based incidence of severe obstetric complications through a newly established obstetric surveillance system in eastern Ethiopia. Methods: Monthly registration of obstetric hemorrhage, eclampsia, uterine rupture, severe anemia and sepsis was introduced in 13 maternity units in eastern Ethiopia. At each hospital, a designated clinician reported details of women admitted during pregnancy, childbirth or within 42 days of termination of pregnancy from April 01, 2021 to March 31, 2022 developing any of these conditions. Detailed data on sociodemographic characteristics, obstetric complications and status at discharge were collected by trained research assistants. Results: Among 38 782 maternities during the study period, 2043 (5.3%) women had any of the five conditions. Seventy women died, representing a case fatality rate of 3.4%. The three leading reasons for admission were obstetric hemorrhage (972; 47.6%), severe anemia (727; 35.6%), and eclampsia (438; 21.4%). The majority of the maternal deaths were from obstetric hemorrhage (27/70; 38.6%) followed by eclampsia (17/70; 24.3%). Conclusion: Obstetric hemorrhage, severe anemia and eclampsia were the leading causes of severe obstetric complications in eastern Ethiopia. Almost one in 29 women admitted with obstetric complications died. Audit of quality of care is indicated to design tailored interventions to improve maternal survival and obstetric complications.

Original language	English
Pages (from-to)	714-720
Journal	International Journal of Gynecology and Obstetrics
Volume	164
Issue number	2
Early online date	14 Nov 2023
DOIs	https://doi.org/10.1002/ijgo.15240
Publication status	Published - Feb 2024

Bibliographical note

Funding Information:
The study was funded by MRC (MR/T037962/1) as part of the 2019 Global Maternal and Neonatal Health Funding call. MK is a National Institute for Health and Care Research (NIHR) Senior Investigator. The views expressed are those of the authors and not necessarily those of the NHS, the MRC, the NIHR or the Department of Health and Social Care. The funders have no role in the study design, data collection and analysis, manuscript preparation or the decision for publication.

Publisher Copyright:
© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

Funding

We would like to thank MRC for funding this study. We would also like to thank EthOSS Steering Committee members listed in alphabetical order. Abdulaziz Abdurahman (East Hararghe Zone Health Desk, Harar, Ethiopia); Ahmedin Mohamed (West Hararghe Zone Health Desk, Chiro, Ethiopia); Abera Kenay Tura (College of Health and Medical Sciences, Harar, Ethiopia; Secretary); Adane Bekele (Chelenko Hospital, Chelenko, Ethiopia); Getahun Tiruye (Ethiopian Midwifery Association, Ethiopia); Ibsa Musa (Harari Regional Health Bureau, Harar, Ethiopia), formerly Ibsa Ibrahim (former head of Harari Regional Health Bureau, Harar, Ethiopia); Lemlem Bezabih (Dire Dawa Regional Health Bureau, Dire Dawa, Ethiopia); Melaku Getachew (Hiwot Fana Specialized University Hospital, Harar, Ethiopia); Merga Dheresa (College of Health and Medical Sciences, Harar, Ethiopia); Redwan Ahmed (College of Health and Medical Sciences, Harar, Ethiopia); Roba Ararso (Ethiopian Society of Obstetricians and Gynecologists, Harar, Ethiopia); Sagni Girma (College of Health and Medical Sciences, Harar, Ethiopia); Seble Mengistu (Hiwot Fana Specialized University Hospital, Harar, Ethiopia); Sheleme Humnessa (Federal Ministry of Health, Addis Ababa, Ethiopia; Chairperson); Tadesse Gure (Hiwot Fana Specialized University Hospital, Harar, Ethiopia); Tariku Dingeta (Health, Nutrition and Wellness Theme leader, College of Health and Medical Sciences, Harar, Ethiopia); Tolosa Lemi (Gelemso Hospital, Gelemso, Ethiopia); Yadeta Dessie (College of Health and Medical Sciences, Harar, Ethiopia; Vice Chair). We would like to thank MRC for funding this study. We would also like to thank EthOSS Steering Committee members listed in alphabetical order. Abdulaziz Abdurahman (East Hararghe Zone Health Desk, Harar, Ethiopia); Ahmedin Mohamed (West Hararghe Zone Health Desk, Chiro, Ethiopia); Abera Kenay Tura (College of Health and Medical Sciences, Harar, Ethiopia; Secretary); Adane Bekele (Chelenko Hospital, Chelenko, Ethiopia); Getahun Tiruye (Ethiopian Midwifery Association, Ethiopia); Ibsa Musa (Harari Regional Health Bureau, Harar, Ethiopia), formerly Ibsa Ibrahim (former head of Harari Regional Health Bureau, Harar, Ethiopia); Lemlem Bezabih (Dire Dawa Regional Health Bureau, Dire Dawa, Ethiopia); Melaku Getachew (Hiwot Fana Specialized University Hospital, Harar, Ethiopia); Merga Dheresa (College of Health and Medical Sciences, Harar, Ethiopia); Redwan Ahmed (College of Health and Medical Sciences, Harar, Ethiopia); Roba Ararso (Ethiopian Society of Obstetricians and Gynecologists, Harar, Ethiopia); Sagni Girma (College of Health and Medical Sciences, Harar, Ethiopia); Seble Mengistu (Hiwot Fana Specialized University Hospital, Harar, Ethiopia); Sheleme Humnessa (Federal Ministry of Health, Addis Ababa, Ethiopia; Chairperson); Tadesse Gure (Hiwot Fana Specialized University Hospital, Harar, Ethiopia); Tariku Dingeta (Health, Nutrition and Wellness Theme leader, College of Health and Medical Sciences, Harar, Ethiopia); Tolosa Lemi (Gelemso Hospital, Gelemso, Ethiopia); Yadeta Dessie (College of Health and Medical Sciences, Harar, Ethiopia; Vice Chair). The study was funded by MRC (MR/T037962/1) as part of the 2019 Global Maternal and Neonatal Health Funding call. MK is a National Institute for Health and Care Research (NIHR) Senior Investigator. The views expressed are those of the authors and not necessarily those of the NHS, the MRC, the NIHR or the Department of Health and Social Care. The funders have no role in the study design, data collection and analysis, manuscript preparation or the decision for publication.

Funders	Funder number
Abera Kenay Tura
Addis Ababa
Getahun Tiruye
Lemlem Bezabih
Melaku Getachew
Merga Dheresa
Sagni Girma
Seble Mengistu
Sheleme Humnessa
Tariku Dingeta (Health, Nutrition and Wellness Theme leader
Yadeta Dessie
Medical Research Council	MR/T037962/1
Bundesministerium für Gesundheit

Keywords

audit
Ethiopia
maternal mortality
severe maternal morbidity
surveillance

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10.1002/ijgo.15240

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Tura, A. K., Knight, M., Girma, S., Ahmed, R., Yuya, M., Bekele, D., Hassen, T. A., Stekelenburg, J., & van den Akker, T. (2024). Characteristics and outcomes of pregnant women hospitalized with severe maternal outcomes in eastern Ethiopia: Results from the Ethiopian Obstetric Surveillance System study. International Journal of Gynecology and Obstetrics, 164(2), 714-720. https://doi.org/10.1002/ijgo.15240

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abstract = "Objective: The aim of the present study was to identify facility-based incidence of severe obstetric complications through a newly established obstetric surveillance system in eastern Ethiopia. Methods: Monthly registration of obstetric hemorrhage, eclampsia, uterine rupture, severe anemia and sepsis was introduced in 13 maternity units in eastern Ethiopia. At each hospital, a designated clinician reported details of women admitted during pregnancy, childbirth or within 42 days of termination of pregnancy from April 01, 2021 to March 31, 2022 developing any of these conditions. Detailed data on sociodemographic characteristics, obstetric complications and status at discharge were collected by trained research assistants. Results: Among 38 782 maternities during the study period, 2043 (5.3%) women had any of the five conditions. Seventy women died, representing a case fatality rate of 3.4%. The three leading reasons for admission were obstetric hemorrhage (972; 47.6%), severe anemia (727; 35.6%), and eclampsia (438; 21.4%). The majority of the maternal deaths were from obstetric hemorrhage (27/70; 38.6%) followed by eclampsia (17/70; 24.3%). Conclusion: Obstetric hemorrhage, severe anemia and eclampsia were the leading causes of severe obstetric complications in eastern Ethiopia. Almost one in 29 women admitted with obstetric complications died. Audit of quality of care is indicated to design tailored interventions to improve maternal survival and obstetric complications.",

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note = "Funding Information: The study was funded by MRC (MR/T037962/1) as part of the 2019 Global Maternal and Neonatal Health Funding call. MK is a National Institute for Health and Care Research (NIHR) Senior Investigator. The views expressed are those of the authors and not necessarily those of the NHS, the MRC, the NIHR or the Department of Health and Social Care. The funders have no role in the study design, data collection and analysis, manuscript preparation or the decision for publication. Publisher Copyright: {\textcopyright} 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.",

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Tura, AK, Knight, M, Girma, S, Ahmed, R, Yuya, M, Bekele, D, Hassen, TA, Stekelenburg, J & van den Akker, T 2024, 'Characteristics and outcomes of pregnant women hospitalized with severe maternal outcomes in eastern Ethiopia: Results from the Ethiopian Obstetric Surveillance System study', International Journal of Gynecology and Obstetrics, vol. 164, no. 2, pp. 714-720. https://doi.org/10.1002/ijgo.15240

Characteristics and outcomes of pregnant women hospitalized with severe maternal outcomes in eastern Ethiopia: Results from the Ethiopian Obstetric Surveillance System study. / Tura, Abera Kenay; Knight, Marian; Girma, Sagni et al.
In: International Journal of Gynecology and Obstetrics, Vol. 164, No. 2, 02.2024, p. 714-720.

Research output: Contribution to Journal › Article › Academic › peer-review

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N2 - Objective: The aim of the present study was to identify facility-based incidence of severe obstetric complications through a newly established obstetric surveillance system in eastern Ethiopia. Methods: Monthly registration of obstetric hemorrhage, eclampsia, uterine rupture, severe anemia and sepsis was introduced in 13 maternity units in eastern Ethiopia. At each hospital, a designated clinician reported details of women admitted during pregnancy, childbirth or within 42 days of termination of pregnancy from April 01, 2021 to March 31, 2022 developing any of these conditions. Detailed data on sociodemographic characteristics, obstetric complications and status at discharge were collected by trained research assistants. Results: Among 38 782 maternities during the study period, 2043 (5.3%) women had any of the five conditions. Seventy women died, representing a case fatality rate of 3.4%. The three leading reasons for admission were obstetric hemorrhage (972; 47.6%), severe anemia (727; 35.6%), and eclampsia (438; 21.4%). The majority of the maternal deaths were from obstetric hemorrhage (27/70; 38.6%) followed by eclampsia (17/70; 24.3%). Conclusion: Obstetric hemorrhage, severe anemia and eclampsia were the leading causes of severe obstetric complications in eastern Ethiopia. Almost one in 29 women admitted with obstetric complications died. Audit of quality of care is indicated to design tailored interventions to improve maternal survival and obstetric complications.

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KW - Ethiopia

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Characteristics and outcomes of pregnant women hospitalized with severe maternal outcomes in eastern Ethiopia: Results from the Ethiopian Obstetric Surveillance System study

Abstract

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