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Safe Motherhood: Severe maternal morbidity and mortality in eastern Ethiopia

PhD ceremony:A.K. (Abera) Tura
When:June 24, 2019
Supervisors:prof. dr. S.A. Scherjon, prof. dr. J. (Jelle) Stekelenburg, prof. dr. J.J.M. van Roosmalen
Co-supervisor:dr. T.H. van den Akker
Where:Academy building RUG
Faculty:Medical Sciences / UMCG

The objective of this thesis was to assess the frequency of and factors associated with severe maternal morbidity and mortality in eastern Ethiopia. It included studies reviewing applicability of the World Health Organization (WHO) criteria for identifying severe maternal morbidity, and suggest adaptations to increase its applicability in sub-Saharan Africa. Moreover, it contains findings about the performance of the adapted tool in eastern Ethiopia. With the global reduction in number of maternal deaths, the need to study woman who with severe complications during pregnancy and childbirth has emerged. Such studies suffered from lack of uniform identification criteria until the publication of the 2009 WHO MNM tool. Unfortunately, these criteria were difficult for use in several low-resource settings and a need to adapt the criteria to the local context emerged. From a consultation of experts in the field, a new tool was suggested. The adapted tool functioned well in identifying cases of severe morbidity and deaths in two hospitals in eastern Ethiopia. The tool also captured significant number of cases not identified by the WHO criteria. In addition, proportion of stillbirth and early neonatal deaths was high among woman in the WHO group. This implies that strategies for improving maternal and child health should use the adapted criteria. In addition to studying the magnitude of severe maternal morbidity and deaths, it is important to thoroughly evaluate care provided to these women if meaningful improvement in quality of care is to be achieved.