One-sixth of women experienced obstructed labor among those delivered at public hospitals in Southern Ethiopia: A multicenter study

Abstract

Objective:

The study aimed to assess the prevalence of obstructed labor and associated factors among women delivered at public hospitals in Southern Ethiopia.

Methods:

Institution-based cross-sectional study was employed among 704 systematically selected postnatal women. The data were collected by the structured and pre-tested interviewer-administered questionnaire and analyzed by Statistical Package for Social Science version 20. Multivariable logistic regression with a 95% confidence level was used to determine the associated factors. Statistical significance was declared at p < 0.05.

Result:

The prevalence of obstructed labor was 15.8% (95% confidence interval: 13.1–18.5). Age (adjusted odds ratio = 5.23, 95% confidence interval: 2.98–11.12), antenatal care follow-up (adjusted odds ratio = 1.8, 95% confidence interval: 1.10–3.39), duration of labor (adjusted odds ratio = 4.41, 95% confidence interval: 2.56–7.67), and experiencing complications (adjusted odds ratio = 4.21, 95% confidence interval: 2.63–6.98) were significantly associated with obstructed labor.

Conclusion:

The study revealed that one-sixth of women experienced obstructed labor. Regional health sectors and non-governmental organizations need to collaborate with healthcare providers in providing improved maternal health services with special emphasis on teenage women with optimum and proper follow-up throughout the pregnancy, by early identifying complications during labor and delivery to manage the problem early.

Keywords

Cross-sectional studies Ethiopia maternal death obstructed labor prevalence

Introduction

Worldwide maternal mortality is the leading cause of death among females aged 15–49 years, an estimated 295,000 maternal deaths were reported in 2017; of this, 94% (277,300) of maternal deaths occur in developing countries and more than half of these deaths occurred in sub-Saharan Africa accounting 196,000 maternal death.¹ The approximate lifetime risk of maternal death in developed countries was 1 in 5400 as compared to 1 in 45 in low-income countries.¹

One of the main causes of maternal, and perinatal morbidity and mortality is delayed and neglected management of obstructed labor.² Globally, obstructed labor occurs in an estimated 5% of pregnancies and accounts for an estimated 9% of maternal deaths³ with a higher incidence in developing areas, which varies from region to region, with 4.1% of all maternal deaths in Africa, 9.4% in Asia, and 13.4% in Latin America and the Caribbean.⁴ Maternal mortality from obstructed labor is largely the result of hemorrhage due to ruptured uterus and puerperal infection, whereas prenatal mortality is mainly due to asphyxia.⁵ The most frequent cause of obstructed labor is a cephalo-pelvic disproportion—a mismatch between the fetal head and the mother’s pelvic brim,⁶ followed by mal-presentation or malposition of the fetus⁶ and it can be caused by locked twins or pelvic tumors in rare situations.⁷

Women in most sub-Saharan African countries are traditionally expected to give birth at home, and if complications arise, healthcare services are frequently delayed.⁸ This may be due to three delays: delay in deciding to seek medical care, delay in reaching the facility, or delay in the offering of medical services while the patients are already in the facility. Inadequately developed healthcare systems including poor infrastructure, poor transportation, and poor obstetrics care are also major contributors to obstructed labor.⁹

Ethiopia is one of the sub-Saharan African countries with the highest maternal death ratio, 871 per 100,000 live births in 2000 and now declined to 401 deaths per 100,000 live births in 2017,¹⁰ and also is one of the six countries that contribute about 50% of global maternal deaths.¹¹ The major causes of maternal deaths in Ethiopia are similar to most developing countries. The proportion of maternal deaths in Ethiopia is attributed to various causes’ changes from year to year. Overall the case fatality rates of the ruptured uterus/obstructed labor and preeclampsia/eclampsia indicate an increasing trend while that of abortion remains stable. Obstructed labor accounts for 36% of maternal deaths in Ethiopia, according to these figures.⁹ A systematic review and meta-analysis done in Ethiopia indicated that the prevalence of obstructed labor was 11.79%.¹² Another systemic review and meta-analysis showed that 14.4% pooled prevalence of maternal death incidence, 41.18% pooled prevalence of uterine rupture, 30.5% pooled prevalence of maternal near-miss, and 26.4% pooled prevalence of perinatal death in mothers faced obstructed labor.¹³ Other complications such as obstetric fistula, hysterectomy, bladder injury, sepsis, postpartum hemorrhage, perinatal asphyxia, and stillbirth were reported by systematic review and meta-analysis in Ethiopia.¹³

To bring a remarkable change to maternal mortality rate (MMR), countries targeted a new strategy called Sustainable Development Goals (SDGs) which targeted in reducing global maternal mortality to less than 70 deaths per 100,000 live births, and no country should have exceeded MMR of 140 maternal deaths per 100,000 live birth by 2030.¹⁴ Ethiopia was also striving to end preventable maternal mortality, including those caused by obstructed labor, and it accounted for 19.1% of maternal death in Ethiopia.^15,16

Even though obstructed labor in Ethiopia seems to be a common cause of maternal and prenatal morbidity and mortality, there is a dearth of evidence to increase the knowledge base for more successful intervention against obstructed labor, and understanding the factors associated with it is critical to take prompt action to prevent maternal and neonatal morbidity and mortality. Although the prevalence of obstructed labor remains high and a serious public health issue.¹² Most of the studies previously done were at a single public hospital,^17–23 and even though there was an attempt to determine the prevalence of obstructed labor with a small sample size (165) at a similar study area,²² it was not adequate. Thus, this study aimed to assess the prevalence and associated factors of obstructed labor among women delivered in public hospitals in southern Ethiopia.

Methods

Study area and period

This study was conducted in the western part of the Southern Nation, Nationalities, and People’s Region (SNNPR) from March 1 to 30, 2020. Hawasa was the capital city of SNNPR, which was located 284.8 km away from Addis Ababa, the center of Ethiopia, in the Southwest direction.²⁴ The study area includes four zones (Kaffa zone, Sheka zone, Bench-Sheko zone, and Debub mihrab Omo zone) with a total population of 1,355,422, 51% are female and 49% are male (population projection of Zonal Health Department).²⁵ It has 5 hospitals (two General, two primary hospitals, and one teaching hospital) and 96 health centers, all health facilities give delivery services; two Universities, one Health Sciences College, and 1 teaching college.^24,26

Study design and population

Institution-based cross-sectional study design was employed. The source population was all women who gave birth in public hospitals in the western part of the SNNP regional state, Ethiopia. Mothers who gave birth in selected public hospitals during the actual data collection period were included in the study. Mothers who were severely ill and unable to communicate during the data collection period were excluded.

Sample size determination ad sampling procedures

The sample size was calculated using a single population proportion formula with the assumptions of Zα/2 at 95% confidence level = 1.96, 5% level of significance, 2% margin of error (d = 0.02), and proportion of obstructed labor in Mizan Aman General Hospital in Southern Ethiopia (7.95%).²⁰ Therefore, the final sample size by considering 5% for non-response rate became 738. There are five public hospitals (two general hospitals, two primary hospitals, and one teaching hospital) found in the western part of the SNNP region and all hospitals were included in this study. The total sample size was proportionally allocated for each selected public hospital.

The total sample size was proportionally allocated to each selected health facility and became 199, 169, 155, 111, and 104 for Mizan Tepi University Hospital, Gebretsadik Shawo hospital (GSGH), Tepi General Hospital, Bachuma Primary Hospital, and Mizan Primary Hospital, respectively. Then eligible mothers in each facility were selected by a systematic random sampling technique with Kth value 2 which was calculated from the total average monthly delivery load and sample size (1481/738 = 2). The starting unit was selected using the lottery method among the first Kth units in each facility.

Data collection method and procedure

The data were collected by interviewer-administered structured questionnaire and review of secondary data. The questionnaire was developed based on the Ethiopian Demographic Health Survey data collection tool and other relevant works of literature.^17,19 The questionnaire contains two parts: the sociodemographic characteristics, health facility-related characteristics, and obstetric characteristics. Data collection was carried out by five BSc midwifery as data collectors while two MSc Midwifery were nominated as supervisors for 1 month. The questionnaires were initially prepared in English and then translated into Amharic and then back into English by a linguistic teacher to check their consistency. Cronbach’s alpha test was used to determine a tool’s reliability (0.83). A pilot test was done on 5% of the sample size, and based on its result ambiguous question was refined, and misunderstood question was modified. All information was collected from mothers who give birth in the hospital after their vital sign stability was confirmed and before their discharge. Maternal delivery records were reviewed at the same time before they left the health facilities. The diagnosis of obstructed labor is made by a physician or gynecology resident working in the hospital. Data collectors checked the cause by reviewing the client records.

Study variable

Dependent variable: Obstructed labor.

Independent variables: Sociodemographic characteristics (age, marital status, religion, residence, education level, occupation, and monthly income), health facility-related characteristics (distance from the healthcare facility, partograph utilization, and source of referral), and obstetric characteristics (parity, antenatal care (ANC) follow-up, number ANC visit time, gestational age, history of previous institutional delivery, duration of labor, mode of delivery, any complication during current childbirth, and birth weight).

Operational definition

Obstructed labor is considered as the failure of the presenting part to descend in the birth canal despite adequate uterine contractions for mechanical reasons.²³

Data quality control

To ensure the quality of the data, a structured and pretested questionnaire was used. Five percent of the questionnaires were pretested at the Tercha Primary Hospital (found in the nearby zone) before the actual data collection period. Then, further clarification and conceptuality of instruments were checked, data collectors familiarize themselves with the instrument, and the time needed was estimated. Based on the pretest result, ambiguous and unclear questions were modified accordingly. Two days of intensive training about instruments, ways of data collection, ethical issues, and the aims of the study were provided for data collectors and supervisors. To keep completeness and consistency, data collectors were closely supervised before and during the data collection process. The data were double-entered into Epi data version 4.2.0 by two different individuals.

Data processing and analysis

Data were checked for completeness, coded, and entered into Epi data version 4.2.0 software, and analyzed by SPSS version 20. Descriptive summaries such as frequency, prevalence, cross tabs, and graphical presentation were used. The association between independent and outcome variables (obstructed labor) was analyzed using bivariate and multivariable logistic regression. It was checked by crude odds ratio and 95% confidence level. The variables with p ⩽ 0.25 on bivariate logistic regression analysis were a candidate for multivariable logistic regression analysis. Lastly, model fitness was checked using the Hosmer–Lemeshow test (0.885) and no multi-collinearity was found when checked with variance inflation factors. With the multivariable analysis adjusted odd ratio with a 95% confidence level was used to determine factors that were associated significantly with obstructed labor at p < 0.05.

Results

Sociodemographic characteristics

Among 738 study participants, 704 women were participated in the study which made response rate 95.4%. The mean (±SD) age of the respondents was 28.5 (±5.8) and ranged from 18 to 45 years. Less than two-thirds of 451 (64.1%) of them were in the age group of 20–30 years. The majority, 587 (83.4%), of study participants were married. The mean monthly income of respondents was 1988.4 (±1817.7 SD) Ethiopian birr and 411(58.4%) of them had a monthly income of <2000 Ethiopian Birr (Table 1).

Table 1.

Sociodemographic characteristics of participants at the western part of SNNPR Public Hospitals, Ethiopia 2020 (n = 704).

Variables	Frequency	Percentage (%)
Age (years)
<20	24	3.4
20–30	451	64.1
>30	229	32.5
Marital status
Married	587	83.4
Single	45	6.4
Divorced	35	5.0
Widowed	37	5.3
Religion
Orthodox	262	37.2
Muslim	120	17.0
Protestant	258	36.6
*Other	64	9.1
Residence
Rural	322	45.7
Urban	382	54.3
Education level
No formal education	343	48.7
Primary school	158	22.4
Secondary school	109	15.5
College and above	94	13.4
Occupation
Governmental employee	117	16.6
Self-employee	152	21.6
Housewife	335	47.6
Student	83	11.8
Unemployment	17	2.5
Monthly income
⩾2000 ETB	293	41.6
<2000 ETB	411	58.4

Adventist and Catholic.

ETB, Ethiopian Birr; SNNPR, Southern Nation, Nationalities, and People’s Region.

Health facility-related characteristics

Among study participants, 403 (57.2%) of them seek a healthcare facility with no referral from another facility or individual. Of the study participants, 411 (58.4%) of them had lived within less than 10 km of distance from a nearby healthcare facility (Table 2).

Table 2.

Health facility-related characteristics at the western part of SNNPR Public Hospitals, Ethiopia 2020 (n = 704).

Variables	Frequency	Percentage (%)
Distance from the healthcare facility
<10 km	411	58.4
10–50 km	112	15.9
51–100 km	102	14.5
>100 km	44	6.2
Unknown/no data	35	5.0
Partograph utilization
Complete/correctly	413	58.7.
Partial	201	28.6
Not at all	47	6.7
Unknown/no data	36	5.1
Source of referral
Self	403	57.2
Hospital	35	5.0
Health center	191	27.1
TBA	38	5.4
Unknown/no data	37	5.3

SNNPR, Southern Nation, Nationalities, and People’s Region; TBA, traditional birth attendant.

Obstetric characteristics

Of the total study participants, 630 (89.5%) of them had 1–4 live births. About 595(84.5%) of them had ANC follow-up while 307(51.6%) of them had started ANC follow-up in the second trimester of their pregnancy. In all, 608 (86.4%) participants’ labor took 12–24 hours, and 105(14.9%) of the respondents were delivered through the cesarean section while almost one out of five (20.7%) of participants of the study encountered labor and delivery complications, the most common complication was postpartum hemorrhage 78 (53.4%) (Table 3).

Table 3.

Obstetric history of study participants at the western part of SNNPR Public Hospitals, Ethiopia 2020 (n = 704).

Variable	Frequency	Percent (%)
Parity
0	30	4.3
1–4	618	87.8
>5	56	7.9
ANC follow-up
Yes	595	84.5
No	109	15.5
If yes, ANC started time (n = 595)
First trimester	211	35.5
Second trimester	307	51.6
Third trimester	58	9.7
Don’t know	19	3.2
Number ANC visit time (n = 595)
Once	54	9.1
Twice	101	17.0
Three times	219	36.8
4 and above	221	37.1
Gestational age (weeks)
<37	96	13.6
37–42	501	71.2
>42	107	15.2
History of previous institutional delivery
Yes	446	63.4
No	258	36.6
Obstructed labor diagnosed
Yes	111	15.8
No	593	84.2
Underlying cause identified (n = 111)
Cephalo pelvic disproportion	47	42.3
Malposition	37	33.3
Mal-presentation	17	15.3
*Others	10	9.1
Mode of delivery for diagnosed with OL (n = 111)
Caesarian section	71	64.0
Instrumental delivery	25	22.5
Destructive delivery	15	13.5
Duration of labor
<24 hours	608	86.4
⩾24 hours	96	13.6
Mode of delivery
Normal delivery	514	73.0
Cesarean section	105	14.9
Instrumental delivery	85	12.1
Any complication during current childbirth
Yes	146	20.7
No	558	79.3
Types of complications (n = 146)
Rapture of uterus	13	8.9
Infection	52	35.6
Postpartum hemorrhage	78	53.4
Other	3	2.1
Birth weight (g)
⩽4000	656	93.2
>4000	48	6.8

Other: tight perineum, or hydrocephalus.

ANC, antenatal care; OL, obstructed labor; SNNPR, Southern Nation, Nationalities, and People’s Region.

Prevalence of obstructed labor

Among 704 completed maternal record reviews, the prevalence of obstructed labor was found to be 111 (15.8%) with 95% confidence interval (CI) (13.1%, 18.5%) (Figure 1).

Figure 1.

Prevalence of obstructed labor among participants in western SNNPR, Ethiopia 2020 (n = 704).

Factors associated with obstructed labor

To identify associated factors with obstructed labor, nine variables (age, have their source of income, parity, ANC follow-up, institutional delivery, complication during labor and delivery, birth weight, gestational age, and duration of labor) that had p < 0.25 in the bivariate logistic regression analysis were exported into the final model. Multivariable logistic regression analysis revealed that obstructed labor was significantly associated with age, ANC follow-up, duration of labor, and complications during labor and delivery.

The odds of obstructed labor were higher among women whose age was <20 years (adjusted odds ratio (AOR) = 5.23, 95% CI (2.98, 11.12)) as compared to their counterparts. Women who had no ANC follow-up were 1.8 times (AOR = 1.8 (1.10, 3.39)) greater likelihood of having obstructed labor than those who had at least one ANC follow-up. Women who were laboring for ⩾24 hours were 4.41 times (AOR = 4.41, 95% CI (2.56, 7.67)) more likely to experience obstructed labor than women whose labor persists <24 hours of duration. Those women who experienced any complications during their labor and delivery were 4.21 times (AOR = 4.21, 95% CI (2.63, 6.98)) had a greater likelihood of experiencing obstructed labor than their counterparts (Table 4).

Table 4.

Bivariate and multivariable logistic regression analyses for factors associated with obstructed labor at the western part of SNNPR Public Hospitals (n = 704).

Variables	Obstructed labor		COR (95% CI)	AOR (95% CI)	p-value
Variables	Yes	No	COR (95% CI)	AOR (95% CI)	p-value
Age (years)
<20	14	10	8.78 (3.73, 16.6)	5.23 (2.98, 11.12)	0.001**
20–30	62	389	1	1	1
>30	35	194	1.13 (0.88, 7.51)	1.05 (0.78, 6.52)	0.072
Monthly income
<2000 ETB	75	336	1.59 (1.03, 2.44)	1.32 (0.81, 2.17)	0.212
⩾2000 ETB	36	257	1	1	1
Parity
0	13	17	4.10 (1.11, 5.53)	1.8 (0.60, 5.63)	0.231
1–4	98	520	1	1	1
>5	12	44	0.69 (0.52, 10.28)	0.70 (0.50, 15.28)	0.110
ANC follow-up
No	20	89	1.10 (0.98, 2.12)	1.8 (1.10, 3.39)	0.006*
Yes	91	504	1	1	1
Previously delivered in institutional
No	53	205	1.72 (1.15, 2.61)	1.1 (0.65, 2.09)	0.590
Yes	58	388	1	1	1
Gestational age (weeks)
<37	14	82	0.91 (0.24, 1.13)	0.41 (0.20, 1.12)	0.090
37–42	79	422	1	1	1
>42	24	83	0.64 (1.01, 4.79)	1.24 (0.65, 3.90)	0.070
Duration of labor
>24 hours	41	55	5.73 (3.56, 9.21)	4.41 (2.56, 7.67)	0.001***
⩽24 hours	70	538	1	1	1
Birth weight (g)
>4000	12	36	1.88 (1.05, 3.72)	1.22 (0.96, 3.16)	0.990
⩽4000	99	557	1
Complications
Yes	56	90	5.69 (3.68, 8.78)	4.21 (2.63, 6.98)	0.001***
No	55	503	1	1	1

p < 0.05; *p < 0.01; ***p < 0.001.

ANC, antenatal care; AOR. adjusted odds ratio; ETB, Ethiopian Birr; SNNPR, Southern Nation, Nationalities, and People’s Region.

Discussion

Globally, up to 15% of pregnancies might develop a risk of complications and will be threatening the life of the mother and/ or newborn.²⁷ Obstructed labor is a risky pregnancy complication, which was rare in developed countries, but is still one of the leading causes of maternal and prenatal mortality in developing countries.²⁸ Obstructed labor contributed 4.1% (range: 0–10.3%) to all maternal deaths in Africa.²⁹

In this study, 15.8% of women experienced obstructed labor. This finding was in line with other institution-based studies conducted in Ethiopia: Mizan Tepi University Teaching Hospital (15.3%),²⁰ Halaba Kulito primary Hospital (18.6%),¹⁷ and Gimbi General Hospital (18.1%).²¹ But this study finding was higher than the prevalence reported in a facility-based study conducted at Mizan Aman General Hospital, Ethiopia (7.95%),²² Jimma University Specialized Hospital (12.2%),²³ Metu Karl Referal Hospital (4.1%),¹⁸ Adama Hospital Medical college (9.6%),¹⁹ systematic review and meta-analysis done in Ethiopia (11.79%),¹² Gombe State, Nigeria (1.1%),³⁰ and Maiduguri, Nigeria (2.13%),²⁸ Ebonyi, Nigeria (3.4%),³¹ Southwestern Uganda (10.5%),³² and India (8.9%).⁵ This might be due to the difference in the study setting, sample size, socioeconomic, and the difference in the time duration of the studies. For instance, a study conducted in 2015 in Mizan Aman General Hospital, Southwest Ethiopia had a small sample size (n = 165) and only being conducted in one hospital, unlike the current study which was conducted in multiple hospitals found in the study area and with relatively large sample size.

On the other hand, the prevalence of obstructed labor reported in this study is lower than the study conducted at Public Hospitals of Western Hararghe Zone, Oromia, Ethiopia in 2018 (34.3%),³³ Mojo Town, Oromia (22%),³⁴ and 20.5% prevalence of obstructed labor was reported in Nigeria.³⁵ The possible difference for this might be an improved healthcare system, proper care during pregnancy and delivery, and improved ANC follow-up in recent years than ever before. In addition to that improved referral linkage between the three-tier system of health care, primary levels of care (health post, health centers, and primary hospitals), the secondary level of care (general hospitals), and tertiary level of health care (specialized hospitals) than ever might be another reason.

Women below 20 years had higher odds to face obstructed labor. This is consistent with findings reported from Ethiopia: a hospital-based cross-sectional study conducted in Halab Kulito Primary Hospital in 2015,¹⁷ Gimbi General hospital in 2019,²¹ and Southwestern Uganda.³² This implies that pregnancy and related labor and delivery in teenagers are very risky for both maternal and fetal well-being secondary to her body not being well matured.

In this study, women who had no ANC follow-up had greater odds of having obstructed labor than those who had ANC follow-up. A similar finding was reported by another research in Southern Ethiopia.¹⁷ This could be because not having ANC during pregnancy may decrease women’s knowledge about risk factors of obstructed labor like multiple pregnancies, a big baby, and fetal anomalies. In addition, women who did not have ANC were prone to home delivery, have poor awareness about birth preparedness and complication readiness plan, and danger signs of pregnancy which might increase the risk of obstructed labor.³

Duration of labor that persists ⩾24 hours were significantly associated with experiencing obstructed labor. This is in line with a study conducted in Adigrat Zonal Hospital, Tigray Region, Ethiopia reported that obstructed labor was highly prevalent among women who are in labor for a long time,³⁶ Metu Referal Hospital, Ilu Ababora Zone, Southwest Ethiopia,¹⁸ Adama Hospital Medical College,¹⁹ Mojo Town, Oromia,³⁴ Hawasa Town³⁷ and also abroad study reported that prolonged labor and obstructed labor were significantly associated.^7,38 Therefore, proper follow-up of danger signs of obstructed labor to women in labor and delivery and appropriate utilization of partograph to follow labor progress will help reduce the occurrence of obstructed labor which, in turn, decreases maternal mortality.³⁹ Later, this will help in achieving SDG targeting the reduction of maternal morbidity and mortality related to labor and delivery.⁴⁰

Those women who experienced any complications during labor and delivery were more likely to encounter obstructed labor. This finding is consistent with the study finding done in Halaba Kulito primary Hospital, Southern Ethiopia,¹⁷ Mizan-Aman General Hospital, Ethiopia,²² Adama Hospital Medical College, Ethiopia,¹⁹ and in Southwestern Uganda.³² This might be due to complications like mal-presentation, cephalo-pelvic disproportion, and malposition left unidentified and managed early, they were at high risk for obstructed labor since their diameter was not competent to pass through the pelvic bone. Therefore, to avoid related problems and enhance maternal and fetal outcomes, early detection and prompt intervention are crucial.

If neglected in the early stages, obstructed labor can result in serious or life-threatening complications, including the death of the mother and/or the unborn child. Therefore, special attention coupled with optimum and timely care by advancing ANC follow-up, and easy access to labor and delivery service for those pregnant women would minimize maternal complications, so that it is possible to prevent morbidity and mortality secondary to obstructed labor.

This study utilized both primary and secondary data, all zonal public hospitals (multicenter study) were incorporated and a relatively large sample size was used. However, this study was Institution-based and it may not represent the proportion of obstructed labor in the community since many rural populations limited health service utilization.

Conclusion

The prevalence of obstructed labor was higher than in developed and even some developing countries. The main causes were cephalo-pelvic disproportion, malposition, and mal-presentation. Most obstructed labor was managed by the caesarian section. Maternal age, ANC follow-up, duration of labor ⩾ 24 hours, and any complications experienced during labor and delivery were significantly associated with obstructed labor. Regional and Zonal district health sectors and non-governmental organizations should work in collaboration with healthcare providers in providing improved maternal health services with special emphasis on teenage women with optimum and proper follow-up throughout the pregnancy, by early identifying complications during labor and delivery and properly managing them.

Supplemental Material

sj-pdf-1-smo-10.1177_20503121231164056 – Supplemental material for One-sixth of women experienced obstructed labor among those delivered at public hospitals in Southern Ethiopia: A multicenter study

Supplemental material, sj-pdf-1-smo-10.1177_20503121231164056 for One-sixth of women experienced obstructed labor among those delivered at public hospitals in Southern Ethiopia: A multicenter study by Yekatit Melesse, Tesfaye Assebe Yadeta, Magarsa Lami, Tamirat Getachew, Hanan Mohammed, Bekelu Berhanu and Merga Dheresa in SAGE Open Medicine

Footnotes

Acknowledgements

We would like to thank Haramaya University College of Health and Medical Sciences and Mizan Aman Medical and Health sciences. Also, we acknowledge the public health facilities of the region for giving us the necessary information. Finally, we would like to acknowledge the study participants, data collectors, and supervisors.

Authors’ contributions

All authors made a significant contribution to the work reported. YM, MD, ML, and TA contributed to the conceptualization, project administration, study design, and execution. YM, TG, ML, HM, and BB did the acquisition of data, methodology, formal analysis, interpretation, and writing—review & editing. In addition, YM, MD, TA, ML, TG, HM, and BB took part in writing the original draft, revising, or critically reviewing the article. All the authors read and approved the final version of the manuscript.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical approval and consent to participate

The ethical clearance was obtained from Haramaya University College of Health and Medical Sciences and the Institutional Health Research Ethical Review Committee (IHRERC) with ethical approval protocol: Ref. No. IHRERC/057/2020, and the official letter was sent to the four zonal Health bureaus (Bench Sheko, Debub mihrab Omo, Kaffa, and Sheka zones). An informed voluntary written consent was obtained from each study participant before the interview and those who had no formal education were signed with fingerprint after the informed consent was read to them before the interview. The entire study participants were informed that data were kept private and confidential and used only for research purposes. The participants were also assured that they had the right to refuse or withdraw at any time during or before the interview.

Trial registration

Not applicable.

Consent for publication

Not applicable.

ORCID iDs

Magarsa Lami

Tamirat Getachew

Availability of data and materials

Pertinent data were presented in this manuscript. Additional data can be requested from the corresponding author upon reasonable request.

Supplemental material

Supplemental material for this article is available online.

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