BACKGROUND In sub-Saharan Africa, maternal death due to direct obstetric complications remains an important health threat for women. A high direct obstetric case fatality rate indicates a poor quality of obstetric care. Therefore, this study was aimed at assessing the magnitude and determinants of the direct obstetric case fatality rate among women admitted to hospitals with direct maternal complications. METHODS In 2015, the Ethiopian Public Health Institute conducted a national survey about emergency obstetric and newborn care in which data about maternal and neonatal health indicators were collected. Maternal health data from these large national dataset were analysed to address the objective of this study. Descriptive statistics were used to present hospital specific characteristics and the magnitude of direct obstetric case fatality rate. Logistic regression analysis was performed to examine determinants of the magnitude of direct obstetric case fatality rate and the degree of association was measured using an adjusted odds ratio with 95% confidence interval at p < 0.05. RESULTS Overall, 335,054 deliveries were conducted at hospitals and 68,002 (20.3%) of these women experienced direct obstetric complications. Prolonged labour (23.4%) and hypertensive disorders (11.6%) were the two leading causes of obstetric complications. Among women who experienced direct obstetric complications, 435 died, resulting in the crude direct obstetric case fatality rate of 0.64% (95% CI: 0.58-0.70%). Hypertensive disorders (27.8%) and maternal haemorrhage (23.9%) were the two leading causes of maternal deaths. The direct obstetric case fatality rate varied considerably with the complications that occurred; highest in postpartum haemorrhage (2.88%) followed by ruptured uterus (2.71%). Considerable regional variations observed in the direct obstetric case fatality rate; ranged from 0.27% (95% CI: 0.20-0.37%) at Addis Ababa city to 3.82% (95% CI: 1.42-8.13%) at the Gambella region. Type of hospitals, managing authority and payment required for the service were significantly associated with the magnitude of direct obstetric case fatality rate. CONCLUSIONS The high direct obstetric case fatality rate is an indication for poor quality of obstetric care. Considerable regional differences occurred with regard to the direct obstetric case fatality rate. Interventions should focus on quality improvement initiatives and equitable resource distribution to tackle the regional disparities.

中文翻译：

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埃塞俄比亚妇女中产妇死亡的直接原因的产妇病死率的大小和决定因素：一项全国性横断面研究。

背景技术在撒哈拉以南非洲，由于直接的产科并发症导致的产妇死亡仍然是对妇女的重要健康威胁。直接的产科病死率高表明产科护理质量差。因此，本研究旨在评估直接产妇并发症住院的妇女中直接产科病死率的大小和决定因素。方法2015年，埃塞俄比亚公共卫生研究所进行了一次全国紧急产科和新生儿护理调查，收集了有关孕产妇和新生儿健康指标的数据。分析了来自这些大型国家数据集的孕产妇健康数据，以解决本研究的目标。描述性统计数据用于介绍医院的具体特征和直接产科病死率的大小。进行逻辑回归分析以检查直接产科病死率的大小的决定因素，并使用具有95％置信区间且p <0.05的调整比值比来测量关联度。结果总体上，在医院进行了335,054例分娩，其中68,002名（20.3％）妇女经历了直接的产科并发症。长期分娩（23.4％）和高血压疾病（11.6％）是产科并发症的两个主要原因。在经历直接产科并发症的妇女中，有435人死亡，导致直接直接产科病死率为0.64％（95％CI：0.58-0.70％）。高血压疾病（27.8％）和孕产妇出血（23.9％）是孕产妇死亡的两个主要原因。产科直接病死率因发生的并发症而有很大差异。产后出血最高（2.88％），其次是子宫破裂（2.71％）。在直接产科病死率中观察到的区域差异很大；从亚的斯亚贝巴市的0.27％（95％CI：0.20-0.37％）到Gambella地区的3.82％（95％CI：1.42-8.13％）。医院的类型，管理权限和服务所需的费用与直接产科病死率的大小密切相关。结论产科直接病死率高表明产科护理质量差。在直接产科病死率方面发生了相当大的地区差异。