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Postpartum hemorrhage and associated factors among mothers who delivered at public health institutions in Ethiopia: A systematic review and meta-analysis.

Yoseph Merkeb Alamneh*,Fentahun Adane

Background: Despite postpartum hemorrhage is a preventable and manageable condition; it remains the leading cause of maternal morbidity and mortality worldwide. In Ethiopia, there is a scarcity and high variability of information regarding the magnitude and associated factors of postpartum hemorrhage. Thus, this study was aimed to assess the pooled prevalence and associated factors of postpartum hemorrhage among mothers at public health institutions in Ethiopia. Methods: The universal databases include MEDLINE/PubMed, EMBASE, Scopus, and Grey literature databases, Google Scholar, Science Direct and Cochrane library were extensively searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2009 guidelines have pursued this review. STATA version 14 with 95% CI was used to analyze the data and I2 test was used to assess the heterogeneity between the studies. Egger's test was used to assess publication bias. The quality of each study was assessed using the Newcastle- Ottawa quality assessment tool and metaanalysis was conducted using a random-effects model. Result: Eleven studies with a total of 16, 416 delivered women were included in this meta-analysis. The pooled national level prevalence of postpartum hemorrhage among mothers who delivered at public health institutions in Ethiopia was12.50% (95% CI: 9.4, 15.27). Mothers aged 35and above (OR: 2.40, 95% CI: 1.41-4.09), Living in rural (OR: 3.08, 95% CI: 1.52-6.25), grand multi-parity (OR: 3.73, 95% CI: 1.32-6.55), antenatal care follows up (OR: 4.82, 95% CI: 3.43-8.71), Previous history of postpartum hemorrhage (OR: 3.22, 95% CI: 2.02-5.15), cesarean section and instrumental delivery (OR: 6.67, 95% CI: 2.92-6.23) were independent risk factors. Conclusions and Recommendation: The pooled national level prevalence of postpartum hemorrhage among mothers who delivered at public health institutions in Ethiopia was relatively high despite the government launches different strategies to prevent postpartum hemorrhage. Older age, residency, grand multi-parity, antenatal care follows up, the previous history of postpartum hemorrhage and mode of delivery were the major predictor variables. Hence, appropriate intervention on potential determinates could be addressed by extra vigilance during labor and preparedness for PPH management in all women giving birth.