Factors associated with maternal mortality in eastern Ethiopia: A multicenter case–control study

Objective: The aim of this study was to identify factors associated with maternal mortality in 13 public hospitals with maternity units in eastern Ethiopia.

Methods: A nested case-control study embedded within the Ethiopian Obstetric Surveillance System (EthOSS) cohort. EthOSS was established in April 2021 to monitor women admitted with severe obstetric complications (e.g., obstetric hemorrhage, eclampsia, uterine rupture, sepsis, and severe anemia) during pregnancy, childbirth or within 42 days of termination of pregnancy. The cases were all women who died during pregnancy, childbirth, or postpartum in these hospitals, while women who survived these complications were the controls. For each case, we randomly selected three controls. The factors associated with maternal mortality were described using adjusted odds ratios (aOR) with their corresponding 95% confidence intervals (CI). Associations were examined using binary logistic regression analysis followed by multivariable logistic regression analysis for factors with P < 0.25. Finally, P < 0.05 was considered as the cut-off for a statistically significant association.

Results: A total of 280 women (70 cases and 210 controls) were included in the study. Compared to survivors, women who died were more likely to have given birth by caesarean section (aOR = 3.35; 95% CI 1.49–7.53), to have been admitted into an intensive care unit (aOR = 6.58; 95% CI 2.08–20.82), to have had postpartum hemorrhage (aOR = 6.39; 95% CI 2.56–15.94), and to have had a pre-existing medical condition (aOR = 5.39; 95% CI 1.16–24.99).

Conclusion: Improving maternal survival requires appropriate indications for caesarean sections, safe surgical conditions, seamless communication between facilities (particularly in high-risk pregnancies), adequate multidisciplinary care for women with pre-existing conditions, and effective intensive care.