Determinants of adverse birth outcome among newborn deliveries in Addis Ababa City, Ethiopia: Unmatched Case Control Study

Abstract

Background: Adverse birth outcomes, including preterm birth, low birth weight, and stillbirth, remain major public health challenges worldwide, particularly in low- and middle-income countries. Despite advances in maternal health services in Ethiopia, evidence on factors associated with birth outcomes in public hospitals in Addis Ababa remains limited. This study aimed to identify factors associated with adverse birth outcomes among mothers who gave birth in selected public hospitals.

Methods: An institution-based, unmatched case-control study was conducted among mothers who gave birth in selected public hospitals in Addis Ababa, Ethiopia, from March 1 to June 30, 2022. Four hospitals were randomly selected from the 12 public hospitals offering delivery services. A total of 465 mothers (155 cases and 310 controls) were enrolled. Cases were mothers who delivered newborns with adverse birth outcomes (preterm birth <37 weeks, low birth weight <2500 g, or stillbirth). Controls were mothers who delivered normal live newborns. Cases were selected consecutively; controls were selected by systematic sampling (sampling interval k was calculated for each hospital based on delivery load). Data were collected using a structured pretested questionnaire, entered into Epi Data 3.1, and exported to SPSS 25 for analysis. Bivariable and multivariable binary logistic regression analyses were performed. Variables with p ≤ 0.25 in bivariable analysis were entered into the multivariable model. Adjusted odds ratios (AORs) with 95% confidence intervals were calculated, and statistical significance was declared at p < 0.05.

Result: Pregnancy-induced hypertension (defined as new-onset hypertension ≥140/90 mmHg after 20 weeks of gestation) (AOR=2.99; 95% CI: 1.79-4.99), maternal HIV infection (AOR=3.04; 95% CI: 2.09-7.81), history of adverse birth outcome (AOR=3.07; 95% CI: 1.39-6.78), hemoglobin level <11 g/dL during labor (AOR=4.15; 95% CI: 1.80-6.53), and fewer than four ANC visits (AOR=4.29; 95% CI: 2.20-5.42) were independently associated with adverse birth outcomes.

Conclusions: This study identified pregnancy-induced hypertension, maternal HIV infection, previous adverse birth outcomes, maternal anemia, and inadequate antenatal care attendance as key factors associated with adverse birth outcomes. To reduce adverse birth outcomes in hospital settings in Ethiopia, there is a need to improve the quality of ANC and address maternal anemia and hypertension through early detection and treatment. HIV services should be integrated into maternal health. Updated WHO guidance recommends 8+ ANC contacts; health facilities should work toward this standard while maintaining the minimum of four visits as an initial target.