Joint MPH Program Arba Minch University and Addis Continental Institute of Public Health MATERNAL COMPLICATION AND ASSOCIATED FACTORS AMONG WOMEN WHO GAVE BIRTH BY CAESARIAN SECTION DELIVERY AT GAMO GOFFA ZONE AND BASKETO SPECIAL WOREDA, SOUTHERN ETHIOPIA BY: ZILLO ZIDDA (BSC) A THESIS SUBMITTED TO COLLEGE OF MEDICINE & HEALTH SCIENCES, ARBAMINCH UNIVERSITY, IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER’S IN PUBLIC HEALTH ARBA MINCH, ETHIOPIA June 2015 JOINT MPH PROGRAM ARBA MINCH UNIVERSITY AND ADDIS CONTINENTAL INSTITUTE OF PUBLIC HEALTH MATERNAL COMPLICATION AND ASSOCIATED FACTORS AMONG WOMEN WHO GAVE BIRTH BY CAESARIAN SECTION DELIVERY AT GAMO GOFFA ZONE AND BASKETO SPECIAL WOREDA, SOUTHERN ETHIOPIA BY: ZILLO ZIDDA (BSC) ADVISOR: HONELIGN NAHUSENAY, HO, MPH A THESIS SUBMITTED TO COLLEGE OF MEDICINE & HEALTH SCIENCES, ARBAMINCH UNIVERSITY, IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER’S IN PUBLIC HEALTH ARBA MINCH, ETHIOPIA June 2015 i Acknowledgment I would like to express my deepest gratitude and appreciation to my advisor M/r Honelgn Nahusenay for his unreserved, continuous support, generous assistance, constructive criticism, guidance, and valuable comments in each & every steps of this thesis work. Without his support this work has been impossible. I am greatly thankful to Norwegian Lutheran Mission-Reduction of Maternal Mortality Project for providing me with financial support to conduct this research. And also, I extend my deepest gratitude and appreciation to Professor Bernt Lindtjørn (RMMP advisor) for his relentless support to my thesis and has been generous with his time and knowledge constrictive comments and suggestion in this thesis. I also acknowledge my wife w/rAbebechAnjuloand my children Baslel, Natinale, Dina and Bereket Zillo. Without your unreserved love, support and courage this thesis would not be possible. My acknowledgment also goes to Gamo Goffa zone Health Department Arba Minch ,Chencha & Sawula Hospital, & Kemba, Laha, Gezesso, Beto,Selamber health center and Basketo special woreda health office Laska health center for your significant support and contribution in this work. ii Table of Contents Acknowledgment .................................................................................................................................. i ABBREVIATIONS ............................................................................................................................. v TABLES ............................................................................................................................................ vi FIGURES ........................................................................................................................................... vi ABSTRACT ...................................................................................................................................... vii 1. INTRODUCTION ......................................................................................................................... 1 1.1 Back ground of the study ....................................................................................................... 1 1.2 Statement of the Problem ....................................................................................................... 2 1.3 Significance of the study ........................................................................................................ 3 2. LITERATURE REVIEW .............................................................................................................. 4 2.1 Caesarian Delivery ................................................................................................................. 4 2.2 The magnitude of caesarian delivery complications ............................................................. 5 2.3 Factors associated with caesarian delivery complications .................................................... 5 3. OBJECTIVE .................................................................................................................................. 8 4. METHOD ...................................................................................................................................... 9 4.1 Study Area .............................................................................................................................. 9 4.2 Study Design and Period ...................................................................................................... 10 4.3 Study population .................................................................................................................. 10 4.4 Inclusion and Exclusion criteria .......................................................................................... 10 4.5 Sample size ........................................................................................................................... 10 4.6 Sampling Procedure ............................................................................................................. 11 4.7 Data collection procedures ................................................................................................... 12 4.8 Operational definitions ........................................................................................................ 13 4.9 Study Variables .................................................................................................................... 13 4.10 Data Management /Processing/ ............................................................................................ 14 4.11 Data Analysis Procedures .................................................................................................... 14 4.12 Data quality assurance ......................................................................................................... 14 4.13 Ethical consideration ............................................................................................................ 14 5. RESULTS .................................................................................................................................... 15 5.1 Socio-demographic characteristics of study participants ................................................... 15 iii 5.2 Obstetric characteristics of study participants .................................................................... 15 5.3 The prevalence of maternal complication ........................................................................... 17 5.4 Factors associated with maternal complication .................................................................. 18 6. DISCUSSION ............................................................................................................................... 23 7. CONCLUSION ............................................................................................................................ 26 8. RECOMMENDATION ............................................................................................................... 27 9.REFERENCES ........................................................................................ Error! Bookmark not defined. ANNEXS .............................................................................................................................................. 31 Annex 1.Data Retrieving Form .......................................................................................................... 31 Annex 2. Information Sheet (For Hospital and health centers) ............................................................ 35 Annex 3. ½ ......................................................................................................................... 37 Annex 4. Consent .............................................................................................................................. 39 Annex 5. የስምምነት ቅጽ ......................................................................................................................... 40 Declarations .......................................................................................................................................... 41 iv ABBREVIATIONS ANC Antenatal Care APH Ante Partum Hemorrhage APGAR Appearance, Pulse, Grimace, Activity, Respiration CI Confidence Interval C/S Cesarean Section DHS Demographic and Health Survey DVT Deep Venous Thrombosis E.C Ethiopian Calendar EMNOC Emergency Obstetric and Neonatal Care FMOH Federal Ministry of Health GA Gestational Age GP General Practitioner HCT Hematocrit HEW Health Extension Worker HIV Human Immunodeficiency Virus Hgb Hemoglobin HO Health Officer IESO Integrated Emergency Surgery Gynecology/Obstetrics MC Maternal Complication MD Medical Doctor MDG Millennium Development Goal MMR Maternal Mortality Rate/ratio NIC National Institute of International Excellence NLM Norwegian Lutheran mission RHB Regional Health Bureau RMMP Reduction of Maternal and infant Mortality Project SNNPR South Nation Nationality Peoples of Republic SPSS Statistical Packages for Social Science SAMM Severe Acute Maternal Morbidity VVF VesicoVaganl Fistula v TABLES Table 1 Sample size calculated by Open Epi version 2.3.1 for second specific objective of the study .............................................................................................................................................. 11 Table 2 Socio-demographic characteristics of mothers delivered by CS in Gamo Gofa zone and Basketo special woreda, 2012-2014 ............................................................................................