Southern Ethiopian skilled birth attendant variations and maternal mortality: A multilevel study of a population-based cross-sectional household survey.

Studies examining skilled birth attendants (SBA) use and its correlation with maternal mortality at lower administrative levels are scarce. This study assessed the coverage and variations of SBA, the physical accessibility of health facilities for SBA, and the association of SBA with maternal mortality. A cross-sectional study using a population-based household survey was conducted in six Sidama National Regional State, southern Ethiopia districts, from July 2019 to May 2020. Women who had given birth in the past two years before the study were included. Stata 15 and ArcGIS 10.4.1 were used for data analysis. A multilevel logistic regression analysis was conducted to assess the effect of the sampling units and identify factors independently associated with SBA. The association between SBA and maternal mortality was examined using maternal mortality household survey data. A total of 3191 women who had given birth in the past two years and resided in 8880 households sampled for the associated maternal mortality household survey were interviewed. The coverage of SBA was 46.7%, with high variations in the districts. Thirty percent of SBA use was accounted for by the differences among the districts. One-third of the women travel more than two hours on foot to access the nearest hospital. Districts with low coverage of SBA and located far away from the regional referral centre had high maternal mortality. Education of the mother, occupation of the husband, pregnancy-related complications, use of antenatal care, parity, and distance to the nearest hospital and health centre were associated with the use of SBA. The coverage of SBA in the Sidama Region was low, with high variations in the districts. Low SBA use was associated with high maternal mortality. Due attention should be given to districts with low coverage of SBA and those located far away from the referral centre. Access to hospitals has to improve. All women should be encouraged to get antenatal care services.

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.

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.

Caesarean section rates analysed using Robson's 10-Group Classification System: a cross-sectional study at a tertiary hospital in Ethiopia.

OBJECTIVE: The aim of this study was to assess the caesarean section (CS) rates using Robson's 10-Group Classification System among women who gave birth at Hawassa University Referral Hospital in southern Ethiopia. DESIGN: Cross-sectional study design to determine CS rate using Robson's 10-Group Classification System. SETTING: Hawassa University Referral Hospital in south Ethiopia. PARTICIPANTS: 4004 women who gave birth in Hawassa University Referral Hospital from June 2018 to June 2019. RESULTS: The 4004 women gave birth to 4165 babies. The overall CS rate was 32.8% (95% CI: 31.4%-34.3%). The major contributors to the overall CS rates were: Robson group 1 (nulliparous women with singleton pregnancy at term in spontaneous labour) 22.9%; group 5 (multiparous women with at least one previous CS) 21.4% and group 3 (multiparous women without previous CS, with singleton pregnancy in spontaneous labour) 17.3%. The most commonly reported indications for CS were 'fetal compromise' (35.3%) followed by previous CS (20.3%) and obstructed labour (10.7%). CONCLUSION: A high proportion of women giving birth at this hospital were given a CS, and many of them were in a low-risk group. Few had trial of labour. More active use of partogram, improving fetal heartbeat-monitoring system, implementing midwife-led care, involving a companion during labour and auditing the appropriateness of CS indications may help to reduce the CS rate.

Prevalence and Predictor of Cervical Cancer Screening Service Uptake Among Women Aged 25 Years and Above in Sidama Zone, Southern Ethiopia, Using Health Belief Model.

Cervical cancer is the fourth most common cancer affecting women worldwide, and the second leading cancer in Ethiopia. Screening gives protective benefits associated with a reduction in the incidence of invasive cervical cancer and mortality. However, the level of cervical cancer screening uptake is not well document in the country. This study aimed to determine the prevalence and predictors of cervical cancer screening service uptake among women aged 25 years and above in Sidama zone, southern Ethiopia, 2019. A cross-sectional study was conducted among 838 women aged 25 and above years by using an interviewer-administered questionnaire. Multi-stage sampling technique was employed to identify households with women age of 25 and above years who were residing in the selected kebele for more than 6 months. Descriptive and multivariable logistic regression done. P-value <0.05 was considered as significant and presented by adjusted odds ratio (AOR) with 95% C.I. This study showed that among 838 women, only 17.8% (95%CI, 15.2%-20.5%) have undergone for cervical cancer screening. Being age of 35-39 (AOR = 5.2, 95% CI = 2.6-10.6), College and above Educational level (AOR = 3.8, 95% CI = 1.5-9.6), Ever had HIV test (AOR = 2.8, 95% CI = 1.82-4.4) and high perceived self-efficacy (AOR = 4.4, 95% CI = 1.527-12.84) were significant predictors for cervical cancer screening service uptake. The magnitude of cervical cancer screening uptake among women aged 25 years and above was lower than that of the recommended coverage of the target group by the national guideline. Age of women, educational status of women, ever had HIV test, and high perceived self-efficacy were important factors of cervical cancer screening service uptake. So it is very crucial improving cervical cancer screening uptake, through creating awareness and educating women, about the advantage of screening in early detection and management of cervical cancer screening utilization.