Background: Adverse birth outcomes are the most common public health problem in both developed and developing countries, including Ethiopia.
Objective: This study aimed to assess the prevalence and associated factors of adverse birth outcome among deliveries at Butajira Hospital, Southern Ethiopia.
Methods: An institution-based cross-sectional study was conducted from February 1- 21, 2019 at Butajira Hospital. Three hundred thirteen mothers’ card was obtained using the systematic sampling method. A pre-tested checklist was used to collect data. Data were entered into Epi-data version 3.1 and analyzed using SPSS version 22. Multiple logistic regression was used to identify associated factors of adverse birth outcome with 95% CI and P value <0.05.
Result: The overall prevalence of adverse birth outcome was 18.2%. The factors significantly associated with the adverse birth outcome were as follows: being rural residence [AOR=3.2; 95%CI (1.5, 7.7)], mothers aged 35 and above [AOR=8.7; 95% CI (3.1, 24.5)], history of abortion [AOR=2.4; 95%CI (1.1, 5.4)], and pregnancy complication [AOR= 12.9; 95% CI (4.8, 35.2)].
Conclusion and recommendation: Adverse birth outcome is quite common in the study area. Mothers aged 35 and above, being rural residence, pregnancy complication, and history of abortion were associated factors of adverse birth outcome. Health education during antenatal follow-up of pregnant mothers about the need to attend maternity ward early, as soon as possible during labor recommended to reduce adverse birth outcome.
Over the last two decades, the world made substantial progress in reducing mortality among children. Despite of these in 2017 alone, an estimated 5.4 million under age 5 died, mostly from preventable causes. Neonatal deaths account for a greater, and growing, share of all deaths among children younger than 5 . An estimated 2.5 million newborns died in the first month of life -approximately 7,000 every day-most of whom died in the first week after birth. About 36% died the same day they were born, and close to three-quarters of all newborn deaths in 2017 occurred in the first week of life . It accounts for
about half (47%) of under-five child deaths [1-3]. The major causes of neonatal deaths are complications of prematurity, intrapartum-related deaths, and severe neonatal infections [4,5]. Adverse birth outcome is a common and serious health problem globally. The rate of adverse birth outcomes has been increasing worldwide, including developed countries . Preterm birth and low birth weight infants are at greater risk for mortality and a variety of health and developmental problems .
Preterm birth is defined as a live birth before 37 completed weeks of gestation . Globally, 15(9.5%) million babies are born too soon every year and more than ¾ occur in Africa and
South Asia and this number is increasing. Over 1 million (35%)
children die each year due to complication of preterm birth. It
is leading cause of newborn deaths and now the second leading
cause of death after pneumonia in children under the age of 5
[3,8]. Many survivors face a short term complications such as
acute respiratory, gastrointestinal, immunologic, and central
nervous system problems and long-term effects of preterm
birth, including motor, cognitive, visual, hearing, behavioral,
social-emotional, health, and growth problems, may not become
apparent for years and may persist throughout a child’s life into
Low birth weight is defined as weight at birth less than
2500g (5.5lb) . Low birth weight continues to be a significant
public health problem globally and is associated with a range of
both short-and long-term consequences. Overall, it is estimated
that 15% to 20% of all births worldwide are low birth weight
babies, representing more than 20 million births a year. The
great majority of low birth weight births occur in low- and
middle-income countries [10,11]. Low birth weight increases
the risk for non-communicable diseases such as diabetes and
cardiovascular disease later in life [12,13]. The consequences
of low birth weight also include fetal, neonatal mortality and
morbidity, poor cognitive development [14-16] and an increased
risk of chronic diseases later in life .
A stillbirth is the birth of a newborn after 28th completed
week (weighing 1000g or more) when the baby does not breathe
or show any sign of life after delivery. Such deaths include
antepartum deaths (macerated) and intrapartum deaths . It is
a shocking event that has considerable impacts on those affected
[18-20]. In every year, 2.6 million Stillbirths occur worldwide
and 1.2 million occur after the onset of labour and congenital
anomalies accounts for 9% neonatal death . Furthermore,
the adverse birth outcomes can have significant emotional and
economic effects on the infant’s family [19,22,23].
There have been a number of previous studies trying to
identify associated factors of adverse birth outcome in several
countries. However, the factors associated with adverse
birth outcome are not the same across different cultures and
socioeconomic statuses within a society. Recognized sociodemographic
factors for adverse birth outcome rural resident
[24,25], low level of maternal education [7,26-28], age of the
mother less than 20 [24,28] and age of the mother (≥35) years
. Obstetric factors include primipara, unwanted pregnancy,
previous history of adverse birth outcome , pregnancy
complication [25,28,31-33], premature rupture of membrane
, induced onset of labor [9,30], no-antenatal care visit 
and incomplete antenatal visit. In addition, studies revealed that,
the presence of chronic disease/s [27,30], inadequate maternal
age gain during pregnancy [7,26,27] and maternal anemia 
were factors of adverse birth outcome. As studies indicated, the
prevalence of adverse birth outcome varies from place to place in
Ethiopia. Prevalence of adverse birth outcome in different towns
of Ethiopia is in a range of 18.3%-32.5% [29,31-34].
In Ethiopia, national reproductive health strategy 2014-
2018 are developed in 2014 and have implemented a number
of activities to improve birth outcomes are increased midwives
and emergency surgeons, equip health center with basic
obstetrics and newborn care equipments, equip all hospitals to
provide comprehensive obstetrics and newborn care, improving
antenatal care and promoting institutional delivery, ensure
availability of medicines, supplies and equipments for antenatal
care follow up, childbirth, postpartum and newborn care,
improving referral system and health care financing .
However, adverse birth outcome seems to be a common
cause of neonatal morbidity and mortality in Ethiopia. About
258 stillbirths (30 per 1,000 total births) occur every day 
and 320,000 babies are born too soon each year and 23,100
children under five die due to direct preterm birth complications
. Hospital based studies conducted in Ethiopia show a high
neonatal death due to preterm birth [38,39]. Furthermore,
congenital anomalies are also another major contributor of
neonatal death in Ethiopia (11.7%) . Therefore, the need
for further study is absolute to recognize the prevalence and
associated factors of adverse birth outcome.
It was an institution-based cross-sectional employed in
Butajira Zonal hospital from March 6-27, 2019. Butajira is located
at 135 Kms to south of Addis Ababa and 162kms from Hawassa. It
is arbitrarily bordered by Sodo District in the north, Silti District
in south, Mareko District in the east and Muhireaklil District in
the west. Butajira town covers a total area of 1854.24 hectares
and the total population is 49,121 people among them 24,069 are
male and 25,052 are female. The town has 7 health institutions,
including private clinics among them four are governmental
health institutions. The source populations for the study were
all cards for mothers who gave birth at Butajira hospital from
February 1, 2018 to February 1, 2019. Study populations were
randomly selected cards for mothers who gave birth at Butajira
hospital from February 1, 2018 to February 1, 2019.
The sample size was determined by using the single
population proportion formula. The following assumptions
were used to estimate the sample size; the proportion of
adverse birth outcome was taken from the study conducted at
Negest Elene Mohammed Memorial General Hospital in Hossana
Town (24.5%) (32), with 95% confidence interval and desired
precision 5% and 10% missed item rate, the final sample size
was 313 mothers’ cards. Three hundred thirteen mother’s cards
were obtained using the systematic sampling technique. First,
the sample frame was developed using maternity registration
numbers from February 1, 2018 to February 1, 2019. Then
interval was calculated by dividing total deliveries from February 1, 2018 to February 1, 2019. The first number was selected by
using a lottery method from the first 10 maternal registration
numbers. Finally, subjects (cards) were selected at every 10
interval and using selected card numbers of the mothers, the
card was retrieved from the card room. Data were collected by
using a pre-tested checklist from maternal cards. The checklist
was developed based on instruments that were applied in other
related studies [32-35]. The checklist was designed to collect data
on socio-demographic variables, Obstetric related characteristics
and medical illness. Data were collected by four clinical nurses.
To ensure the quality of data were collected from the mothers
card, first, a data collection instrument was pretested on 16
maternity records for the year 2017 and was modified to correct
observed inconsistencies. Also, data collectors were discussed on
procedures of data collection techniques before data collection
begun. In addition, at the end of each day collected data were
reviewed, and accuracy and consistency by the investigators and
corrective measure was undertaken.
Data were entered using Epi-data version 3.1 and exported
to Statistical Package social science (SPSS), version 21.0 software
for analyses. Descriptive statistics such as number, percent, mean
and standard deviation were used to summarize and present
major findings. Binary logistic regression analysis was used to
identify factors associated with adverse birth outcome. First a
bivariate logistic regression was carried out to select candidate
for multiple logistic regression analysis. Variable with p-value
less than 0.25 in the bivariate logistic regression was selected
for multiple logistic regression. Multiple logistic regression was
done for variables that has p-value <0.25 during the bivariate
logistic regression analyses to identify factors associated with
adverse birth outcome. The degree of association between
independent and dependent variables were assessed using
odds ratio with 95% confidence interval. The P-value <0.05 was
considered as statistically significant. The Hosmer-Lemeshow
statistic had significant value of 0.65 which shows that it is
not statistically significant so that the model was a good fit.
Formal letter of permission was obtained from the Wachemo
University College of medicine and Health sciences. In addition,
a letter of permission was secured from Butajira town health
office and Hospitals Management Committee. Confidentiality of
information was maintained.
Regarding to the Sociodemographic characteristics of
the mothers, 249(79.6%) were in the age group of 20-34.
The majority of them were urban 309(98.7%) and married
214(68.4%) by residence and marital status respectively (Table
Concerning gravidity, 223(71.2%) mothers were multigravida.
sixty-nine (22%) mothers had ever experienced abortion.
Most of mothers 294(93.9) gave birth within 18 hours while
19(6.1%) mothers stayed more than 18 hours on labor. Majority
of mothers had antenatal care follow-up while 56.4% had four or
above visits. Thirty five (11.2%) mothers faced the complications
during the pregnancy among which the leading cause was pregnancy
induced hypertension 17(48.6%) followed by pre-rupture
of fetal membranes 12(34.3%). Among all deliveries, 36(11.5%)
had experienced complications, of which prolonged labor accounting
13(36.2%), followed by malpresentation 12(33.3%)
and thirty-one (9%) women had ever experienced abortion.
About onset of labour, 305(97.2%) were spontaneous and thirty
five (11.2%) mothers gave birth via caesarean section (Table 2).
Regarding medical illness, 26(8.3%) mothers have a chronic
medical problem. According to reports in the mothers’ card,
7(2.2%) mothers were HIV positive, 18(5.8%) diagnosed UTI
during the pregnancy and, in 27(8.6%) of mothers, the hemoglobin
level was less than 11gm/dl (Table 3).
The prevalence of adverse birth outcome was 57(18.2%). Out
of these, 27(8.9%) live birth were low birth weight, 20(6.4%)
preterm birth, 11(3.5%) stillbirth, and 18(5.8%) babies were
with visible congenital malformation, respectively (Table 4).
In multiple logistic regression analysis, mothers aged 35 and
above, being rural residence, complication during the pregnancy
and history of abortion were found to be risk factors of adverse
birth outcome. Mothers aged 35 and above were nearly nine
times more likely experienced adverse birth outcome to
compared to women in the age group between 20-34 years old
[AOR=8.7; 95%CI (3.1,24.0)]. The occurrence of complication
during pregnancy was nearly thirteen times more likely to have
an adverse birth outcome than their counterparts [AOR=12.9,
95% CI (4.8,35.2)].
Also, mothers who were encountered pregnancy complication
during current pregnancy were nearly 3 times more likely to
deliver still birth compare to their counterparts (AOR=2. 9,
95%CI (1.2, 6.9). Similarly, mothers who lived in rural residence
were three or more times more likely to encounter adverse
birth outcomes compared to who was living in Urban residence
[AOR=3. 2, 95%CI (1.5, 7.7)]. In addition, those mothers who
had a history of abortion were more than two times [AOR=2.
4, 95%CI (1.1, 5.4)] more likely to experienced adverse birth
outcomes than their counterparts (Table 5).
The overall prevalence of adverse birth outcome was 18.2%.
The prevalence of adverse birth outcome found in the present
study is relatively similar to that reported in the Hospital based
study conducted at Hawassa and Nigeria were 18.3% and 19%
respectively (29,40). However, this study found out a lower
prevalence of adverse birth outcome compared to other Hospital
based study in Gondor, Hossana, Tigray, and Dessie where 23%,
24.5%, 22.6% and 32.5% respectively [31-34]. This variation may
be due to difference in study design, study setting, sociocultural
status, maternal and newborn health care services and various
interventions undertaken between these study times.
The study showed that mothers with history abortion was
found at more risk of adverse birth outcome than those who have
a history of bad obstetrics history. This finding was similar to
a previous study done in Brazil . Reason for such similarity
cannot be clarified. In this study, mothers aged 35 or above was
one of the risk factors for adverse birth outcome. This finding
was almost found as a universal fact, the mother’s age increases
the risk of obstetric complications also increases. Similar finding
was also reported from the study done in house  which
revealed that mothers aged.
As revealed by the present study, pregnancy complication
was found to have significant association with an adverse birth
outcome. Pregnancy complications that contributed to adverse
birth outcome in this study may have resulted from insufficient
antenatal care follow-up, and pregnancy related complications
decreased blood perfusion to uterus, which lead to low birth
weight, preterm delivery, and even fetal death. This finding was
almost found to be a universal fact and has been revealed in
many studies [25, 28, 31-33].
This study showed that mothers who have a history of
abortion were at a higher risk of having an adverse outcome
compared to mothers who had no bad obstetric history. Similar
findings were also reported from the study done in Brazil, which
revealed that mothers who had a bad obstetric history were
more likely to experience adverse birth outcome compared with
those mothers who had no bad obstetrics history .
Moreover, this study found that mothers who have been
living in rural residence was associated with adverse birth
outcome. It would have been more ideal, in developing country
like Ethiopia maternal health care service distribution were not
equal in the urban and rural residence. Also, the awareness of
the rural mothers about maternal care services is low compared
to the urban mothers. This is again supported by a research
done in Brazil , and Gambian . In this study, data were
collected from mothers card, in which some important variables
were missing these highlighted as risk factors of adverse birth
outcome in different studies. Regarding dependent variable,
different authors were defined in different way probable to
scientifically under or over classifying adverse birth outcome is
highly questionable .
Adverse birth outcome is quite common in the study area.
Mothers aged 35 and above, being rural residence, pregnancy
complication, and history of abortion were factors of adverse
birth outcome. Health education during antenatal care follow-up
of pregnant mothers about the need to attend maternity ward
early, as soon as possible in labor especially who are history of
abortion, and pregnancy complication recommended in order
to reduce adverse birth outcome. In addition, further study was
recommended in the study area to include some vital variables
and to develop an intervention plan.
Ritbano Ahmed Abdo participated in conceptualization
of the study design, participated in data collection, analyzed
the data, and interpretation, and also drafted the manuscript.
Lealem Zerihun Birhanu, Dejene Agero Defara conceived,
designed, wrote the study, participated in data collection, and
interpreted the data, and revised subsequent draft of the paper.
Hassen Mossa Halil and Biruk Assefa Kebede participated in
conceptualization of the study design and participated in data
collection. All authors read and approved the final manuscript.
Abdo RA, Tesso FY (2016) Prevalence and associated Factors of Adverse birth Outcomes among Women attended Maternity Ward at Negest Elene Mohammed Memorial General Hospital in Hosanna, SNNPR, Ethiopia. J Women’s Health Care 5(4).