Factors Associated with Childbirth Complications among Women of Reproductive Age (15-49 Years) in Mogadishu, Somalia

Abstract

Somalia has the highest adult lifetime risk of maternal mortality of 1 in 18. About 51% of pregnant women attended 3 antenatal care (ANC) and have access to emergency obstetric care services to detect and handle complications at childbirth. This study sought to determine the factors associated with childbirth complications among women of reproductive age (15-49 years) in two major maternal and child clinics in urban areas of Mogadishu, Somalia. This cross sectional study randomly enrolled 385 eligible women who had attended both Banadir Hospital and SOS Hospital in Mogadishu Somalia. Data were collected using structured questionnaire and in-depth interviews (IDIs) guides to gather information related to individual-level factors associated with child birth complications as well as selected facility level factors associated with childbirth complications. Influential and knowledgeable members of Mogadishu, Somalia were also conducted to gather qualitative data. Data were analyzed using bivariate and multivariable logistic regression to determine factors associated with obstetric complications using STATA version 11 at a significant level at p < 0.05. The thematic content analysis was used to analyze the qualitative data. A total of 203 out of 385 (52.7%) women had obstetric complications. This included 30% severe bleeding/post-partum hemorrhage, 29.6% obstructed labor, 23.6% hypertensive disorder and 14.3% cases of sepsis. Employment status (OR 0.6, 95% CI 0.4 to 0.9) monthly income (OR 1.7, 95% CI 1.1 to 3.2), antenatal care attendance (OR 0.7, 95% CI 0.5 to 0.9), ANC initiation in the first trimester (OR 0.7, 95% CI 0.5 to 0.9), home delivery assisted by Traditional Birth Attendance (TBA) (OR 1.7, 95% CI 1.7 to 2.4), worsening of past medical condition preceding the current birth (OR 1.6, 95% CI 1.2 to 2.3), current pregnancy termination (OR 1.9, 95% CI 1.1 to 3.4), vaginal delivery (OR 0.5, 95% CI 0.3 to 0.6), delivery assisted by a nurse (OR 0.4, 95% CI 0.3 to 0.6) were associated with obstetric complication. This data demonstrates high levels of obstetric complications among women of reproductive age (15-49 years) in Mogadishu Somalia. Economic status, social-cultural issues and current and past medical status were independently associated with obstetric complications among this population. The high proportion of obstetric complication especially hemorrhage among women in Mogadishu Somalia, requires that women be monitored closely during pregnancy and during delivery to reduce complications and death, in the absence of medical interventions. Economic empowerment, improved awareness of ANC, training of TBA would be key in reducing the obstetric complication in this region