Abstract
IntroductionEthiopia has achieved the fourth Millennium Development Goal by reducing under 5 mortality. Nevertheless, there are challenges in reducing maternal and neonatal mortality. The aim of this study was to estimate maternal and neonatal mortality and the socio-economic inequalities of these mortalities in rural south-west Ethiopia.MethodsWe visited and enumerated all households but collected data from those that reported pregnancy and birth outcomes in the last five years in 15 of the 30 rural kebeles in Bonke woreda, Gamo Gofa, south-west Ethiopia. The primary outcomes were maternal and neonatal mortality and a secondary outcome was the rate of institutional delivery.ResultsWe found 11,762 births in 6572 households; 11,536 live and 226 stillbirths. There were 49 maternal deaths; yielding a maternal mortality ratio of 425 per 100,000 live births (95% CI:318–556). The poorest households had greater MMR compared to richest (550 vs 239 per 100,000 live births). However, the socio-economic factors examined did not have statistically significant association with maternal mortality. There were 308 neonatal deaths; resulting in a neonatal mortality ratio of 27 per 1000 live births (95% CI: 24–30). Neonatal mortality was greater in households in the poorest quartile compared to the richest; adjusted OR (AOR): 2.62 (95% CI: 1.65–4.15), headed by illiterates compared to better educated; AOR: 3.54 (95% CI: 1.11–11.30), far from road (≥6 km) compared to within 5 km; AOR: 2.40 (95% CI: 1.56–3.69), that had three or more births in five years compared to two or less; AOR: 3.22 (95% CI: 2.45–4.22). Households with maternal mortality had an increased risk of stillbirths; OR: 11.6 (95% CI: 6.00–22.7), and neonatal deaths; OR: 7.2 (95% CI: 3.6–14.3). Institutional delivery was only 3.7%.ConclusionHigh mortality with socio-economic inequality and low institutional delivery highlight the importance of strengthening obstetric interventions in rural south-west Ethiopia.
Highlights
Ethiopia has achieved the fourth Millennium Development Goal by reducing under 5 mortality
We examined the dichotomous variables by using the principal component analysis (PCA) to produce a factor score for each household with households being assigned a rank according to the factor score
We found 308 neonatal deaths, which yields a neonatal mortality ratio (NMR) of 27 per 1,000 live births
Summary
Ethiopia has achieved the fourth Millennium Development Goal by reducing under 5 mortality. Four million newborns die during the neonatal period (28 days after birth) [2], while 3.2 million pregnancies end with stillbirths [3]. High maternal and neonatal deaths and stillbirths often occur because of inadequate care during pregnancy and childbirth. These deaths are considered sensitive indicators of the quality of a healthcare system in an area [5]. High neonatal deaths and stillbirths are often related to maternal health; complications during pregnancy, childbirth, and the post-natal period increase the risk of death for both the baby and the mother [6]
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