Reduction in maternal mortality ratio varies by district in Sidama National Regional State, southern Ethiopia: Estimates by cross-sectional studies using the sisterhood method and a household survey of pregnancy and birth outcomes

Aschenaki Zerihun Kea; Bernt Lindtjorn; Achamyelesh Gebretsadik Tekle; Sven Gudmund Hinderaker

doi:10.1371/journal.pone.0276144

Reduction in maternal mortality ratio varies by district in Sidama National Regional State, southern Ethiopia: Estimates by cross-sectional studies using the sisterhood method and a household survey of pregnancy and birth outcomes

PLoS One. 2023 Oct 12;18(10):e0276144. doi: 10.1371/journal.pone.0276144. eCollection 2023.

Authors

Aschenaki Zerihun Kea^{1

2}, Bernt Lindtjorn^{1

2}, Achamyelesh Gebretsadik Tekle¹, Sven Gudmund Hinderaker²

Affiliations

¹ School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
² Centre for International Health, University of Bergen, Bergen, Norway.

Abstract

Background: Few studies assess the magnitude, variations, and reduction of maternal mortality at a lower administrative level. This study was conducted to estimate the life time risk (LTR) of maternal death and the maternal mortality ratio (MMR) and assess the reduction in MMR.

Methods: This is a population-based cross-sectional study conducted in six districts of Sidama National Regional State, southern Ethiopia, from July 2019 to May 2020. The study was conducted with men and women aged 15-49 years. By creating a retrospective cohort of women of reproductive age, we calculated the LTR of maternal mortality and approximated the MMR using the total fertility of the rural Ethiopian population. Variations in maternal mortality was assessed based on characteristics of the respondents, like age, sex, and the districts where they lived. Reduction in MMR was examined using the estimates of the sisterhood method and the 5-year recall of pregnancy and birth outcome household survey.

Results: We analysed 17374 (99.6%) respondents: 8884 (51.1%) men and 8490 (48.9%) women. The 17,374 respondents reported 64,387 maternal sisters. 2,402 (3.7%) sisters had died; 776 (32.3%) were pregnancy-related deaths. The LTR of maternal death was 3.2%, and the MMR was 623 (95% CI: 573-658) per 100,000 live births (LB). The remote district (Aroresa) had a MMR of 1210 (95% CI: 1027-1318) per 100,000 LB. The estimates from male and female respondents were not different. A significant reduction in MMR was observed in districts located near the regional centre. However, no reduction was observed in districts located far from the regional centre.

Conclusions: The high MMR with district-level variations and the lack of mortality reduction in districts located far from the centre highlight the need for instituting interventions tailored to the local context to save mothers and accelerate reductions in MMR.

Copyright: © 2023 Kea et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Ethiopia / epidemiology
Female
Humans
Male
Maternal Death*
Maternal Mortality*
Mothers
Pregnancy
Retrospective Studies
Risk Factors

Grants and funding

This study was funded by Grand Challenges IDRC Canada through the Liverpool School of Tropical Medicine and REACH Ethiopia, a non-profit organization. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.