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Meta-Analysis
. 2022 Sep 21;19(1):194.
doi: 10.1186/s12978-022-01498-4.

Magnitude of postpartum hemorrhage and associated factors among women who gave birth in Ethiopia: a systematic review and meta-analysis

Tadesse Tolossa  1 , Getahun Fetensa  2   3 , Edgeit Abebe Zewde  4 , Merga Besho  5 , Tafese Dejene Jidha  6
Affiliations
Meta-Analysis

Magnitude of postpartum hemorrhage and associated factors among women who gave birth in Ethiopia: a systematic review and meta-analysis

Tadesse Tolossa et al. Reprod Health. .

Abstract

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and morbidity worldwide, particularly in resource-limited countries such as Ethiopia. Findings from a few studies were inconsistent and inconclusive. Therefore, this study aimed to estimates the pooled magnitude of PPH and factors associated with PPH among women who gave birth in Ethiopia.

Methods: Electronic databases such as Medline, Pub Med, Cochrane library, the Web of Science, and Google Scholar were used to search for articles. The search period for articles was conducted from 15th August 2021 to 15th November 2021. Data were extracted using a standardized data extraction checklist and the analyses were conducted using Stata version 14. The Cochrane Q test statistic and I2 statistics were used to assessing heterogeneity. To estimate the pooled magnitude of postpartum hemorrhage, a random-effects model was fitted. Association between PPH and independent variables was reported in odds ratio (OR) with 95% confidence interval (CI). Visual assessment of publication bias was assessed using a funnel plot and Egger's test was used to check the significant presence of publication bias.

Results: A total of 876 studies were identified from several databases and nine studies fulfilled eligibility criteria and were included in the meta-analysis. The pooled magnitude of PPH in Ethiopia was 11.14% (95% CI 7.21, 15.07). The current meta-analysis revealed that lack of antenatal care follow-up (ANC) (OR = 6.52, 95% CI 2.87, 14.81), being multipara (OR = 1.88, 95% CI 1.25, 2.85), and having the previous history of PPH (OR = 7.59, 95% CI 1.88, 30.55) were found to be significantly associated with PPH.

Conclusion: In Ethiopia the magnitude of PPH was high, and lack of ANC up follow-up, being multipara, and having a previous history of PPH were risk factors for postpartum hemorrhage. Thus, improving antenatal care follow-up is needed to decrease the magnitude of postpartum hemorrhage.

Keywords: Associated systematic factors; Ethiopia; Postpartum hemorrhage; Systematic review.

Plain language summary

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and morbidity worldwide, particularly in resource-limited countries such as Ethiopia. Findings from a few studies were inconsistent and inconclusive. Therefore, this study aimed to estimate the pooled magnitude of PPH and factors associated with PPH among women who gave birth in Ethiopia.Electronic databases such as Medline, Pub Med, Cochrane library, the Web of Science, and Google Scholar were used to search for articles. Data were extracted using a standardized data extraction checklist and the analyses were conducted using Stata version 14. The Cochrane Q test statistic and I2 statistics were used to assessing heterogeneity. To estimate the pooled magnitude of postpartum hemorrhage, a random-effects model was fitted. Association between PPH and independent variables was reported in odds ratio (OR) with 95% confidence interval (CI).The pooled magnitude of PPH in Ethiopia was 11.14% (95% CI 7.21, 15.07). The current meta-analysis revealed that lack of antenatal care follow-up (ANC) (OR = 6.52, 95% CI 2.87, 14.81), being multipara (OR = 1.88, 95% CI 1.25, 2.85), and having the previous history of PPH (OR = 7.59, 95% CI 1.88, 30.55) were found to be significantly associated with PPH.In Ethiopia the magnitude of PPH was high, and lack of ANC follow-up, being multipara, and having the previous history of PPH were risk factors for postpartum hemorrhage. Thus, improving antenatal care follow-up is needed to decrease the magnitude of postpartum hemorrhage.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of included studies in the systematic review and meta-analysis of the magnitude of postpartum hemorrhage and associated factors in Ethiopia, 2020
Fig. 2
Fig. 2
Forest plot of the pooled estimate of magnitude of postpartum hemorrhage in Ethiopia, 2020
Fig. 3
Fig. 3
Sub group analysis of magnitude of postpartum hemorrhage among women gave birth in Ethiopia based on the region, 2020
Fig. 4
Fig. 4
Sub group analysis of magnitude of postpartum hemorrhage among women gave birth in Ethiopia based on the timing of the study, 2020
Fig. 5
Fig. 5
Funnel plot with 95% confidence limit of the magnitude of postpartum hemorrhage in Ethiopia, 2020
Fig. 6
Fig. 6
Result of trim and fill analysis for adjusting publication bias of the 9 studies, 2020
Fig. 7
Fig. 7
Result of sensitivity analysis of PPH in Ethiopia, 2020
Fig. 8
Fig. 8
Forest plot of the pooled estimate of association between maternal age and PPH in Ethiopia, 2020
Fig. 9
Fig. 9
Forest plot of the pooled estimate of association between antenatal care follow up and PPH in Ethiopia, 2020
Fig. 10
Fig. 10
Forest plot of the pooled estimate of association between number of delivery and PPH in Ethiopia, 2020
Fig. 11
Fig. 11
Forest plot of the pooled estimate of association between previous history of PPH and PPH in Ethiopia, 2020
Fig. 12
Fig. 12
Forest plot of the pooled estimate of association between duration of labour and PPH in Ethiopia, 2020
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