Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia.
Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia.
PLoS One. 2023 May 9;18(5):e0285465. doi: 10.1371/journal.pone.0285465. eCollection 2023.
Ethiopia is one of the countries facing a very high burden of perinatal death in the world. Despite taking several measures to reduce the burden of stillbirth, the pace of decline was not that satisfactory. Although limited perinatal mortality studies were conducted at a national level, none of the studies stressed the timing of perinatal death. Thus, this study is aimed at determining the magnitude and risk factors that are associated with the timing of perinatal death in Ethiopia.
National perinatal death surveillance data were used in the study. A total of 3814 reviewed perinatal deaths were included in the study. Multilevel multinomial analysis was employed to examine factors associated with the timing of perinatal death in Ethiopia. The final model was reported through the adjusted relative risk ratio with its 95% Confidence Interval, and variables with a p-value less than 0.05 were declared statistically significant predictors of the timing of perinatal death. Finally, a multi-group analysis was carried out to observe inter-regional variation among selected predictors.
Among the reviewed perinatal deaths, 62.8% occurred during the neonatal period followed by intrapartum stillbirth, unknown time of stillbirth, and antepartum stillbirth, each contributing 17.5%,14.3%, and 5.4% of perinatal deaths, respectively. Maternal age, place of delivery, maternal health condition, antennal visit, maternal education, cause of death (infection and congenital and chromosomal abnormalities), and delay to decide to seek care were individual-level factors significantly associated with the timing of perinatal death. While delay reaching a health facility, delay to receive optimal care health facility, type of health facility and type region were provincial-level factors correlated with the timing of perinatal death. A statistically significant inter-regional variation was observed due to infection and congenital anomalies in determining the timing of perinatal death.
Six out of ten perinatal deaths occurred during the neonatal period, and the timing of perinatal death was determined by neonatal, maternal, and facility factors. As a way forward, a concerted effort is needed to improve the community awareness of institutional delivery and ANC visit. Moreover, strengthening the facility level readiness in availing quality service through all paths of the continuum of care with special attention to the lower-level facilities and selected poor-performing regions is mandatory.
埃塞俄比亚是世界上围产期死亡负担极高的国家之一。尽管采取了多项措施来降低死产负担，但下降速度并不令人满意。尽管在国家层面进行了一些有限的围产儿死亡率研究，但没有一项研究强调围产儿死亡的时间。因此，本研究旨在确定与埃塞俄比亚围产儿死亡时间相关的规模和危险因素。
本研究使用了国家围产儿死亡监测数据。共纳入 3814 例审查后的围产儿死亡。采用多水平多项分析检查与围产儿死亡时间相关的因素。最终模型通过调整后的相对风险比及其 95%置信区间报告，p 值小于 0.05 的变量被宣布为围产儿死亡时间的统计学显著预测因子。最后，进行了多组分析，以观察选定预测因子之间的区域间差异。
在所审查的围产儿死亡中，62.8%发生在新生儿期，其次是产时死产、未知时间死产和产前死产，分别占围产儿死亡的 17.5%、14.3%和 5.4%。产妇年龄、分娩地点、产妇健康状况、产前检查、产妇教育、死亡原因（感染和先天性及染色体异常）以及决定寻求护理的延迟是与围产儿死亡时间相关的个体水平因素。而到达医疗机构的延迟、获得最佳护理的延迟、医疗机构类型和地区类型是与围产儿死亡时间相关的省级因素。由于感染和先天性异常，在确定围产儿死亡时间方面观察到了统计学上显著的区域间差异。
十分之六的围产儿死亡发生在新生儿期，围产儿死亡时间由新生儿、产妇和医疗机构因素决定。作为前进的方向，需要共同努力提高社区对机构分娩和 ANC 检查的认识。此外，必须加强医疗机构在通过护理连续体的所有途径提供优质服务方面的准备工作，特别关注较低水平的设施和表现不佳的选定地区。
