Research Article

iMedPub Journals Health Science Journal 2016

http://www.imedpub.com/ Vol.10 No.5:16
ISSN 1791-809X
DOI: 10.21767/1791-809X.1000100518

Trends and Determinants of Maternal Mortality in Mizan-Tepi University

Teaching and Bonga General Hospital from 2011 – 2015: A Case Control Study
Tegene Legese1, Kebadnew Mulatu1 and Tensay Kahsay2*
1Department of Public health, College of Health Sciences, Mizan -Tepi University, Ethiopia
2Department of Nursing, College of Health Sciences, Mekelle University, Ethiopia
*Correspondence:
Tensay Kahsay, Department of Nursing, College of Health Sciences, Mekelle University, Ethiopia, Tel: +251912937986; E-mail:
tensay1221@gmail.com
Received: 08.08.2016; Accepted: 02.09.2016; Published: 12.09.2016

researchers should dig out others cause and alternative

solution for maternal death.
Abstract
Keywords: Trend; Associated factors; Maternal death;
Maternal death is high in developing countries due to five Ethiopia
major direct obstetric complications: hemorrhage,
infection, unsafe abortion, hypertensive disorders of
pregnancy, and obstructed labor. 70–80% of maternal
death is due to direct obstetric causes (complications of Introduction
pregnancy, labor, delivery or the postpartum period).
Indirect causes of maternal death account for women Maternal mortality ration (MMR) globally has fallen by 45%
who die from any other disease during pregnancy. Indirect from 523,000 (380/100,000) in 1990 to 289 000 (210/100,000)
causes represent a varying spectrum of the burden of in 2013 yielding an average annual decline of 2.6%. It is one of
maternal deaths (4% in Latin America, 13% in Asia and the statistics showing the largest degree of disparity between
17% in Africa). The aim of this study was to asses Trends developed and developing countries. It clearly highlights the
and determinants of maternal mortality in Mizan-Tepi huge gap between developed and developing countries [1-5].
university Teaching and Bonga general hospital from 2011 In 2013, Developing countries account for 99% (286 000) of
– 2015. the global maternal deaths, of thoses sub-Saharan Africa
region alone accounting for 62% (179 000) followed by
Method: A case control study was conducted. A total of Southern Asia (69 000). Oceania is the region with the fewest
975 charts, 195 cases and 780 controls were reviewed for maternal deaths at 510. The MMR in developing regions was
the study. Pre-tested and structured questionnaire was 14 times higher than developed regions. All regions
used to collect the data. Both bi-variate and multivariate experienced a decline of 37% or more in MMR between 1990
logistic regression were carried out to assess the and 2013. The highest reduction in the 23-year period was in
association of independent variables with hypertension Eastern Asia (65%). In Africa there is 47% reduction in MMR
and P value <0.05 was considered as significant. between 1990 and 2013 from 870 to 460 per 100,000. The
highest reduction in Africa is experienced in North Africa which
Result: A total of 595(119 cases and 476 controls) charts is (57%) [6,7].
were included in the analysis. The trends of maternal
mortality are fluctuating over the year. Attending ANC In general in SSA there is 49% reduction from 990 to 510 per
(AOR = 2.4, 95%CI 1.19 -4.83), length of labor (AOR= 4, 100,000, but eastern Africa reduces MMR by 57% from 1000
95% CI. 1.86-8.74), Presence of obstetric complications to 440 per 100,000 which are highest in SSA. Ethiopia
(AOR =7.2, 95% CI 3.08, 16.72), uterine rupture (AOR= decreased maternal death from 1400 to 420 per 100,000 MMR
11.4 95% CI 4.27, 30.41), abnormal puerperium (AOR= between 1990 and 2013 which is making progress to achieve
10.9, 95% CI 1.96, 59.97), and antenatal risks(AOR= 3.8, MDG 5 by 2015 [2,3,7].
95% CI 1.64,8.61) were found to be significant factors that
influence maternal mortality The majority of maternal deaths in developing countries are
due to five major direct obstetric complications: hemorrhage,
Conclusion and recommendation: The pattern of infection, unsafe abortion, hypertensive disorders of
maternal death fluctuates over time. Women who do not pregnancy, and obstructed labor. 70–80% is due to direct
have ANC follow up; presence of obstetric complications, obstetric causes (complications of pregnancy, labor, delivery or
women who had ante or intra natal risks and women who the postpartum period). Indirect causes of maternal death
had prolonged labour increases the likelihood of maternal account for women who die from any other disease during the
death. Health professionals including HEWs should have maternal period (pregnancy and up to 42 days postpartum or
to work in strengthen approach to improve awareness of post abortion). Indirect causes represent a varying spectrum of
the community about pregnancy, its complication and co the burden of maternal deaths [7].
morbidities, and ANC uptake. Academicians and

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 Health Science Journal 2016
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Societies that have achieved the lowest level of maternal didn’t include the assessment of admission and status of
mortality through preventing pregnancies, reducing incidence mother (dead or alive) during discharge were excluded.
of certain pregnancy complications, and having adequate
Sample size was determined using epi-info version 7 by
facilities and well trained staff to treat the complications
taking the following assumptions: 95% CI, and 90% power,
[8-12].
odds ratio of 0.27 (odds of women having less than 24 labour
Ethiopia is making progress to achieve MDG 5a by reducing length over odds of women having greater than 24hr labour
MMR by 69% from 1990 MMR, even though there are length) from study done in Tigray region, case to control ratio
inconsistencies between figures at international, national level 1:4 and the prevalence of exposure among controls were
and different regional data’s. Between1st July 2010 to 30th 97.6% (proportion of controls delivered in less than 24hr)
June 2012 there were an increase of MMR in public hospitals taken from unmatched case control study done in Tigray
of Tigray regional state. The 2011 EDHS (676/100,000) shows regional state [14]. A total of 975 charts, 195 cases and 780
that there is bit increment of MMR from 2005 EDHS controls were planned to include in the study. But due to poor
(673/100,000), even though the 95 % CI is coinciding. 2005 registration and shortage of sample, we included 595 samples,
EDHS report (673/100,000) and joint estimation by WHO, 119 cases and 476 controls [15,16].
UNICEF, UNFPD and world bank in same year (740/100,000)
Records of both cases and controls were selected from
have wide variation [7,13-16].
delivery ward, operation theatre, PNC ward; gynecologic ward
Although our country reduces the maternal death from which full fills the inclusion and exclusion criteria of the study
previous times as the report of international organizations, still [17-20].
the number of death that occurs currently is high as WHO
First cases were identified from log book or registration
maternal death classification. In contrary, some hospital based
book, which were found in the study period, from respective
study in our country shows inconsistency in death trend. So
wards then sampling frame was prepared in both hospitals.
the need of further study is unquestionable to identify trend
Then after, 119 cases were proportionally allotted for each
and factors affecting maternal death. Particularly institutions
hospital. After identifying the cases included in the sample the
based study is important to observe the trend, and associated
time of admission was identified for each selected cases
factors of maternal death.
[21,22]. For each case, four controls were selected, which were
admitted immediately preceding or following a case. Selected
Methods 119 maternal death and 476 controls charts were reviewed.
Maternal death charts which were included in the sample but
Study area and period missed charts were replaced by random selection from charts
which were not included in the sample. When maternal death
The study was conducted in Mizan-Tepi university teaching charts were replaced the controls were also replaced together
& Bonga general hospital. Which are located southwest, with case [23-26].
Ethiopia. The hospitals provide care for south-western Ethiopia
with a catchment population of about 5 million. Internal Data collection instrument was adapted from Maternal
medicine, surgery, obstetrics and gynecology and pediatrics Death Surveillance and Response Technical Guideline of
are the major departments. Institution based case control Ethiopia [27]. The checklist consists of socio-demographic
study design was used from 2011 – 2015 charts. data, obstetric and delivery history, presence of co morbidities,
cause of death, antenatal and intranatal risks and presence of
The source Population of the study was all charts of mothers complications. Three midwives were recruited and trained for
who visited Mizan-Tepi university teaching & Bonga general two days. The training was cover about the contents of the
hospital for maternal health service utilization. Whereas the tool, ethical considerations and way of extraction of necessary
Study Population for case was all charts of mothers who were information from chart. Two public health supervisors were
passed away during pregnancy, delivery and 42 days after monitored and followed data collection while the principal
delivery in Mizan-Tepi university teaching & Bonga general investigator supervised the overall data collection process.
hospital between 2011 to 2015, cases was ascertained based
on the information of chart. If death was reported on the To assure the quality of data, data collectors were trained
chart, it has been taken as a case. While, all charts of mothers until they became well familiar with the instrument. Every day
who visited Mizan-Tepi university teaching & Bonga general filled checklist was reviewed and checked for completeness
hospital for maternal health service utilization from 2011 to and relevance by supervisors and principal investigator.
2015 were Controls. After data collection, each filled checklist was given a unique
The sample population was randomly selected cards of code by the principal investigator. Then the data was entered
cases and controls during the study period. Cases that fulfill in to epi-info version 3.5.1 after that exported to SPSS version
the standard definitions of maternal mortality given by ICD – 21 for analysis. Frequencies were used to check for entry
10 and controls which came for maternal health service errors, missed values and outliers. Any identified error was
utilization were included. But cases that were registered on corrected with the revision of the original data using the code
the log book but whose charts’ were missed and Charts that numbers.

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Multiple imputations were considered if there is greater or seven (39.8%) of the women were developed labor
equal to 0.001% of missing values. The maximum number of abnormality. However, 245 (41.8%) of women were delivered
missing values allowed for multiple imputations was 30%. If by spontaneous vaginal delivery (SVD). More than half, 341
there was more than 30% missing values the chart was (57.3%) of the births were attended by midwifery. From
replaced by random selection from available charts. Missed women who had 3 – 4 gravidity, 3 – 4 parity, and women who
charts and charts which don’t include the final assessment of don’t have ANC were 26%, 27%, and 63% were died
admission and status during discharge were replaced by respectively (Table1).
random selection from cases which were not included in
About, 37% and 35% of women were died from women who
sample together with controls.
had length of labour greater than 24 hrs more and who had
Bivariate analysis was used to determine the association labor abnormality respectively. From all women who undergo
between different factors and the outcome variable. Variables destructive delivery procedures, half of them were died (Table
that have p value less than or equal to 0.05 was entered into 1). Pertaining to mode of delivery, 197(33.6%) of women were
multivariate binary logistic regression to identify independent delivered by C/S. while, 245(41.8%) were delivered by
predictors of maternal mortality. Confidence interval of 95% spontaneous vaginal delivery (SVD) (Figure 2).
was used to see the precision of the study and the level of
significance was taken at p value ≤ 0.05. The adjusted odds
ratio with the 95% CI was reported. Graphical presentation
such as tables, line graphs and pie charts was used to present
the result findings of the study.
Maternal mortality trend was done using the total number
of cases occurred in the study period. Trend was shown using
MMRatio. The total MMRatio in five year and each year MMR
was calculated using the following formula:
����� ������ �� �������� ����ℎ �� �ℎ� ����� ������
��� = ����� ������ �� ���� ����ℎ� �� �ℎ� ����� ������
× 100, 000
Figure 1 Shows age of women delivered from 2011 -2015 at
Prior to data collection, ethical clearance was obtained from Mizan–Tepi university teaching and Bonga hospitals 2016.
Research and Ethics committee of the College of Health
sciences, Mizan-Tepi University. Written permission letter was
also received from Mizan-Tepi university teaching & Bonga
general hospital CEO. In order to establish anonymous linkage
only the codes, not the names of the participant from the
chart, was registered on the questionnaire.

Result
A total of 119 cases (dead women) and 476 controls
(survived women) were included in the study. Variables such
as, ethnicity, educational status, marital status, occupation,
Figure 2 Shows mode of delivery among women delivered
and income were incomplete in 99% of charts: As a result, they
from 2011 -2015 in Mizan Tepi university teaching and
were excluded from analysis.
Bonga hospitals, 2016.

Age distribution
Majority, 397 (66.7%) of women in this study were in the Obstetric complications
age group of 20-34 years. While the least age group was age
greater or equal to 35 years old. More than 22% of females Thirty two (94.6%) of women had co morbidity, of those
died from the age group of 20 – 34 years old (Figure 1). anemia and HIV/AIDs accounts 15 (46.9%) each. Whereas, 25
(4.2%) were developed abnormal puerperium. Of which, PPH
was the most common that accounts 17 (68%) (Table 2).
Obstetric and delivery history
Taking into account, risk during antenatal period 68(11.4%)
Regarding to obstetric and delivery history around 393 of the women’s were presented with different antenatal risks
(66.1%) were gravid 1-2 and 480 (80.7%) were in parity 0-2. (placenta previa, multiple gestation, & abruption placenta). Of
Majority, 413 (69.4%) were attending ANC. of those 187 those, more than half of them were died. From total women
(45.2%) were attended 4 times and more. From the total
women, 227 (38.2%) were come to the hospitals through
referral due to different complication. Two hundred thirty

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who had abnormal puerperium only 20% of them were Mode of delivery
survived (Table 2).
SVD 218 (89%) 27 (11%)

Table 1 Shows obstetric and delivery history among women Vaginal assisted (instrumental,
who gave birth from 2011 -2015 in Mizan –Tepi university episo..) 126 (89.4%) 15 (10.6%)
teaching and Bonga hospitals 2016. C/S 126 (64%) 71 (36%)

Status of the women Destructive delivery 6 (50%) 6 (50%)

Variables Alive Dead

Table 2 Obstetric complications, co morbidity, abnormal
Gravidity puerperium and maternal death in among women delivered
from 2011-2015 at Mizan –Aman and Bonga hospitals, 2016.
1-2 321 (81.7%) 72 (18.3%)

3-4 89 (73.6%) 32 (26.4%) Variables Status of the women

>=5 66 (81.5%) 15 (18.5%) Presence of co morbidities Alive Dead

Parity Yes 21 (65.6%) 11 (34.4%)

0-2 388 (80.8%) 92 (19.2%) No 455 (80.8%) 108 (19.2%)

3-4 55 (72.4%) 21 (27.6%) Types of co morbidity

>= 5 33 (84.6%) 6 (15.4%) Anemia 7 (46.7%) 8 (53.3%)

Attending ANC HIV/AIDs 12 (80%) 3 (20%)

Yes 360 (87.2%) 53 (12.8%) Malaria 0 3 (100%)

No 116 (63.7%) 66 (36.3%) Other morbidities 3 (50%) 3 (50%)

Number of visit Abnormal puerperium

1 visit 44 (74.6%) 15 (25.4%) Yes 5 (20%) 20 (80%)

2 visit 54 (85.7%) 9 (14.3%) No 471 (82.6%) 99 (17.4%)

3 visit 90 (86.5%) 14 (13.5%) Types of abnormalities*

4 & above visit 172 (92.0%) 15 (8.0%) PPH 2 (11.8%) 15 (88.2%)

Place of ANC visits Puerperal sepsis 3 (100%) 0

Health post 42 (77.8%) 12 (22.2%) Wound infection 2 (20%) 8 (80%)

Health center 139 (82.7%) 29 (17.3%) Presence of antenatal risks

Hospital 176 (93.6%) 12 (6.4%) No 435 (82.5%) 92 (17.5%)

Private clinic 3 (100%) 0 Yes 41 (60.3%) 27 (39.7%)

Length of labor Types of antenatal risks*

Less than 24hrs 382(85.8%) 63(14.2%) Placenta previa 9 (33.3%) 18 (66.7%)

>=24hrs 94(62.7%) 56(37.3%) Previous C/S 6 (50%) 6 (50%)

Labor abnormality Multiple gestation 18 (85.7%) 3 (14.3%)

Yes 154 (65%) 83 (35%) Abruption placenta 4 (40%) 6 (60%)

No 322 (89.9%) 36 (10.1%) Others 6 (100%) 0

Birth attendant *more than one response

Doctors 55 (43.0%) 73 (57%)

Midwives 312 (91.5%) 29 (8.5%) Trends of maternal death

MSc surgery & obstetrics 109 (86.5%) 17 (13.5%) The maternal mortality was higher in 2013 and lower in
2015. The number of live birth more or less has an increasing
Is referred?
pattern which was having highest number of live births in 2015
Yes 162 (71.4%) 65 (28.6%) and lowest number of live birth in 2011. The maternal
mortality was higher in MTU teaching hospital 1002/105 than
No 314 (85.3%) 54 (14.7%)
Bonga hospitals (Figure 3).

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Factors associated with maternal mortality

The result of binary logistic regression analysis in relation to
maternal mortality, attending ANC, length of labor, labor
abnormality, presence of obstetric complications, hemorrhage,
uterine rupture, abortion, presence of co-morbidity, anemia,
abnormal puerperium, antenatal risks, birth attendant, and
mode of delivery had significant association. But the result of
multiple logistic regression analysis showed that attending
ANC, length of labor, Presence of obstetric complications,
uterine rupture, abortion, abnormal puerperium, antenatal
risks, and mode of delivery were found to be significantly
associated with maternal mortality as clearly described on
table (Table 3).
Figure 3 Shows trend of maternal death among women
delivered from 2011 -2015 at Mizan-Aman and Bonga
hospitals, 2016.

Table 3 Bivariate and multivariate logistic regression analysis of factors associated with maternal mortality in Mizan- Tepi
university teaching and Bonga hospitals town (n=595), May 2016.

Maternal status

Variable Live dead COR, 95%CI AOR, 95% CI

Attending ANC

No 116 66 3.9 (2.55, 5.87)* 2.4 (1.19, 4.83)*

Yes 360 53 1 1

Length of labor

Less than 24hrs 382 63 1 1

>= 24hrs 94 56 3.6 (2.36, 5.52)* 4.0 (1.86,8.74)*

Labor abnormality

No 322 36 1 1

Yes 154 83 4.8 (3.18, 7.45)* 0.6 (0.23,1.33)

Presence of obstetric complications

No 397 21 1 1

Yes 79 98 23.4 (13.81, 39.83)* 7.2 (3.08,16.72)*

Hemorrhage

No 471 95 1 1

Yes 5 24 23.8 (8.86,63.94)* 3.3 (0.76,14.62)

Uterine rupture

No 465 66 1 1

Yes 11 53 33.9 (16.87, 68.27)* 11.4 (4.27,30.41)*

Abortion

No 473 107 1 1

Yes 3 12 17.7 (4.90, 63.75)* 33.5 (4.98,224.98)*

Presence of co-morbidity

No 455 108 1 1

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Yes 21 11 2.21 (1.03, 4.71)* 0.12(0.01,1.08)

Anemia

No 469 111 1 1

Yes 7 8 4.8 (1.72, 13.59)* 2.9 (0.23,35.59)

Abnormal puerperium

No 471 99 1 1

Yes 5 20 19.0 (6.98, 51.92)* 10.9 (1.96,59.97)*

Antenatal risks

No 435 92 1 1

Yes 41 27 3.1(1.82,5.32)* 3.8(1.64,8.61)*

Birth attendant

Doctors 55 73 14.3 (8.52, 23.95)* 1.1 (0.29,4.26)

MSc in surgery & obs. 109 17 1.7 (0.89, 3.17) 0.23 (0.05,1.09)

Midwives 312 29 1 1

Mode of delivery

SVD 218 27 1 1

Vaginal assisted delivery (induc,epi) 126 15 0.96 (0.49, 1.87) 0.57 (0.19,1.69)

C/S 126 71 4.6 (2.78, 7.46)* 1.5 (0.37,6.24)

Destructive delivery 6 6 8.1 (2.43, 26.81)* 10.9 (2.13,56.2)*

N.B: * Shows variable that are significantly associated

There is strong association between attending ANC and death than who delivered spontaneous vaginal delivery (SVD)
maternal mortality. That is women who were not attending (AOR=10.9, 95% CI 2.13, 56.2) (Table 3).
ANC were 2.4 times more at risk for death than those who
attend (AOR=2.4, 95% CI 1.19-4.83). And those who develop
prolonged labor or whose labor greater than 24hrs were 4
Discussion
times more at risk for death than labor less than 24 hrs Maternal death in our country has a decreasing trend as
(AOR=4, 95% CI. 1.86-8.74). depicted by different reports and reviews. As, 2013 combined
Similarly presences of obstetric complications were reports of WHOM, UNICEF, the World Bank and UNFPD,
significantly associated with maternal mortality. Women who Ethiopia shows a decreasing pattern of maternal death.
develop different obstetric complications were 7.2 times more However, the general MMR in these hospitals was 960/105. It
at risk for death compared to counterparts (AOR=7.2, 95% CI has a fluctuation pattern from 764 to 1265/105. It was highest
3.08, 16.72). In addition, uterine rupture was other in 2013 with 1265/105 and lowest in 2015 with 764/105 than
determinant for maternal mortality. Women who develop other study periods in the study period. But, Review of
uterine rupture were 11.4 times more at risk when compared different community and hospital based studies by Ahmed
to their counter parts (AOR=11.4 95% CI 4.27, 30.41). Abdela shows a decreasing pattern of maternal death. Review
made in jimma hospital before 15 years back and in Ambo
There is also statistically significant association between hospital before 5 years back shows fluctuation of MMR from
abnormal puerperium and maternal mortality. That is those 671-3986 per 105 but it was higher in general than the current
who had abnormal puerperium were 10.9 times more at risk of our finding. Review of maternal death from 2002–2006 in
for death than those who had not developed (AOR=10.9, 95% JUSH also shows a decreasing pattern with total MMR of
CI 1.96,59.97). Again, those who had antenatal risks ( placenta 888/105 [7,18,28–30]. Decrease in occurrences of death from
previa, Abruption placenta, Previous C/S & Multiple gestation) previous years in these hospitals particularly after 2010 might
were 3.8 times more likely to die than their complements be because of increasing awareness of community about
(AOR= 3.8, 95% CI 1.64, 8.61). institutional delivery, organizational and policy factors.
Strong association was also found between mode of Organizational factors might be service expansion and human
delivery and maternal mortality. That is women who delivered power expansion, increasing availability and accessibility of
with destructive delivery were 10.9 times more at risk for health institution. The other factor might be after 2010 in our
country there was country wide mobilization to decrease

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death of mother with slogan of “no mother should die while 11.4 times more at risk to die than their counter parts (AOR=
she gave birth.” In the other extreme it might be because of 11.4 95% CI 4.27, 30.41). In Senegal women who had uterine
under reporting of death due to fear of bad criticism and rupture were 28 times more likely to die than their counter
captivity of health professionals and health facility. These parts AOR=28.07 95% CI (11.34 69.51) [31,32]. The reason
things might be the reason. might be uterine rupture is the major source of concealed and
revealed hemorrhage that finally leads to death.
Factors affecting maternal death Those who had ante or intranatal risks (placenta previa,
The study revealed that maternal death was significantly Abruption placenta, Previous C/S & Multiple gestation) were
different among women who did not attending ANC and those 3.8 times more likely to die when compared to their
who attend ANC. Women who did not attend ANC were 2.4 counterparts (AOR= 3.8, 95% CI 1.64,8.61). These risks are the
times more at risk for death than those who attend (AOR = 2.4, sources of uterine rupture and hemorrhage which are the
95%CI 1.19 -4.83). This finding was in line with study done in most prominent cause of death.
china and Kenya , those who have not attended ANC were
more likely at risk of death (AOR, 22.3; 95% CI, 4.3-116.0) and Conclusion and Recommendation
AOR 4.1, 95% CI 1.6-10.4) respectively. Attending ANC as a
protective factor from death is observed in public hospital of The number of maternal death has a fluctuation pattern
Tigray [AOR= 0.26, 95% CI (0.12-0.57)]. Similarly study done in over the year. Women who do not have ANC follow up;
Ambo shows that maternal death were higher among women presence of obstetric complications, women who had ante or
who did not attend ANC (11% had ANC Vs 38% had no ANC) intra natal risks and women who had prolonged labour are
[14,18,20,25]. In ante natal care there are many things more at risk for maternal death. Based on the findings from
performed like provisions of iron, folate and other health this study the following recommendations are made. Health
promotive and preventive activities. In addition ANC professionals including HEWs should have to work in
attendance makes the women to prepare for birth and for strengthen approach to improve awareness of the community
complication readiness. These activities prevent death of about pregnancy, its complication and co morbidities, and ANC
mothers. That is why not attending ANC is a risk factor or uptake. Academicians and researchers should dig out
attending ANC become a protective factor. alternative solution for maternal death.

In this study, the likelihood of maternal death increases as Competing interests

length of labor increase. Those whose labor length greater We declare that we do not have any conflict of interests.
than 24hrs were 4 times more at risk of death than women This study was funded by Mizan-Tepi University.
who had labor length less than 24 hrs (AOR= 4, 95% CI.
1.86-8.74). This finding is consistent with study conducted in Authors' contributions
public hospital of Tigray, which reveals that Women who had Tegene Legese, Kebadnew M and Tensay K conceived the
labor length less than 24 hours was protected from maternal study, involved in the study design, data analysis, drafting the
death than women who had labor length more than 24 hours manuscript and critically reviewing the manuscript. All authors
[AOR=0.27, 95% CI (0.07-0.89)]. Research finding from Nigeria read and approved the final manuscript.
maternity hospital AOR - 2.86 and 95% CI (1.39, 5.9) shows
prolonged labour was the major risk factor for maternal death Authors' information
[14,21]. Most (70%) of women who had obstructed labour (OL) All authors are academicians. TL has MPH in reproductive
had prolonged labour. The other reason might be unnecessary health, KM has MPH in Epidemiology and Biostatics and TK has
delay from patient side or HI which is evidenced by 40% of MSc in Reproductive and Maternal health Nursing.
referred women has prolonged labour. This in turn results
uterine rupture. Presences of obstetric complications were Acknowledgements
also significantly associated with maternal mortality. Women We are grateful to Mizan-Tepi University for funding the
who develop different obstetric complications were 7.2 times study and other supports. We would like to acknowledge MTU
more at risk for death than their counterparts (AOR =7.2, 95% teaching and Bonga hospitals for their cooperation in
CI 3.08, 16.72). The obstetric complications like conducting this study. We would also like to express our
malpresentation, post term pregnancy, and PROM are some of deepest gratitude to data collectors for their hard work and
the complications included in this category. These sincere contribution.
complications increase the risk of dying in different ways.
Malpresentation prolongs labour in intrapartum period.
Prolonged labour will in turn expose the women for infections References
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