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Background: In developing countries, adverse pregnancy outcomes are major public health issues. It is one of the leading causes of neonatal morbidity and mortality worldwide. Despite the fact that ending prenatal mortality and morbidity is one of the third Sustainable Development Goals (SDG), the burden of the problem continues to be a huge concern in developing countries, including Ethiopia. Hence, this study aimed to determine the prevalence and associated factors of lifetime adverse pregnancy outcomes among antenatal care (ANC) booked women in Northwest Ethiopia. Methods: An institutional-based cross-sectional study design was conducted in Northwest Ethiopia, between March 2021 and June 2021. A multi-stage stratified random sampling technique was employed to recruit participants. An interviewer-administered and checklist questionnaire were used to collect the data. The data were entered into Epi-data version 4.6 software and exported to Stata version 16 for analysis. The binary logistic regression model was fitted to identify an association between associated factors and the outcome variable. Variables with a p-value of < 0.05 in the multivariable logistic regression model were declared as statistically significant. Results: In this study, the lifetime prevalence of adverse pregnancy outcome among study participants was 14.53% (95%CI: 11.61, 18.04). Road access to the health facilities (AOR = 2.62; 95% CI: 1.14, 6.02) and husband-supported pregnancy (AOR = 2.63; 95 CI: 1.46, 4.72) were significantly associated with adverse pregnancy outcomes. Conclusions: More than one in 10 reproductive age women had adverse pregnancy outcome throughout their life. Road access to health facilities and husband-supported pregnancy were statistically significant factors for adverse events in pregnancy. Therefore, it is better to give more attention to expanding infrastructure like road accessibility and increasing husband-supported pregnancy to reduce adverse pregnancy outcomes.
An institutional-based cross-sectional study design was applied. The study was performed in central Gondar (Central Gondar zone and Gondar city administration), Northwest Ethiopia, from the period of March 2021 to June 2021. The Central Gondar zone is located 738 km northwest of Addis Ababa. The central Gondar includes the Central Gondar Zone with 15 districts and the Gondar City administration. According to the national reports conducted by the Central Statistical Agency of Ethiopia, Central Gondar has a total population of 2,711,329, of which 91,372 pregnancies were projected for 2020/21 by the zonal statistical agency. In the study area, maternal health services like antenatal care (ANC), skilled delivery, and postnatal care (PNC) services are freely available for women without any cost. All health centers and hospitals give maternal and neonatal health services. All ANC booked pregnant women in the central Gondar zone and Gondar City were the source population. All ANC booked pregnant women in the selected health facilities were the study population. All women who had at least one normal live birth or adverse pregnancy outcome history before and were booked for ANC at the selected health facilities were included in our study. All women who had at least one normal live birth or adverse pregnancy outcome history before and were booked for ANC at the selected health facilities with mothers who died and critically ill were excluded. The sample size for the present study was calculated using a single population proportion formula by considering the following assumptions: 95% level of confidence, 18% proportion of adverse pregnancy outcome (19), and 5% margin of error. Where, n = required sample size, α = level of significant, z = standard normal distribution curve value for 95% confidence level = 1.96, p = proportion of adverse pregnancy outcome, and d = margin of error. After considering a non-response rate of 10% and a design effect of 2, we obtained a total sample size of 500. A multistage stratified sampling technique was used to select the study participants. At the first stage, three districts ( Gondar zuria, West Dembia and Wogera) and one city administration were selected by using lottery methods, and from each district, 20% of the health facilities were selected. From the selected districts and Gondar city, five health facilities (160 participants), four health facilities (145 participants), two health facilities (75 participants), and three health facilities (88 participants) were selected from Gondar zuria district, Gondar city, West Dembia district, and Wogera district, respectively. The dependent variable was life time adverse pregnancy outcome whereas the independent variables were age, marital status, education, residence, religion, occupation, and parity, number of living children, insurance membership, distance to the nearest health facility, pregnancy wontedness, pregnancy supported by the husband, the reason for the first ANC, and history of chronic illness. Adverse pregnancy outcome: was considered as “yes,” if women had at least one of the following before her current pregnancy: still birth, abortion, intrauterine growth restriction, congenital anomalies, gestational hypertension disorders, gestational diabetes, and preterm birth (2). If born before 37 completed weeks of gestation but after 28 weeks of gestation or low birth weight (24). It defined as any abnormality of physical structure found at birth or during the first few weeks of life; or any irreversible condition existing in a child before birth in which there is sufficient deviation in the usually number, size, shape, location of any part, organ, and cell to warrant its designation as abnormal (25). If the infant died in the womb or during the intrapartum period after 28 weeks of gestation (26). Fetus removed or expelled from the uterus before 28 weeks or weighing < 500 g (27). The data collection tool was developed by reviewing the literature (13, 17–19, 28–30). A structured, interviewer-administered and checklist questionnaire were employed to collect the data through face-to-face interviews and observing charts. The questionnaire was developed in English first, then translated to Amharic (the local language), and re-translated back to the English language to check its consistency. The questionnaire contains socio-demographic characteristics, maternity health services, and reproductive-related characteristics of the participants. A total of 18-trained midwives collected the data under the supervision of six MSc holders. Data collectors and supervisors were oriented and trained for 1 day, focusing on how to select and interview the participants. The questionnaires were pretested on 24 study participants (5%) and modifications were made according to the results of the pretest. Data were checked for completeness and entered into Epi-data version 4.6 Statistical software and transferred to the Stata version 16 for further cleaning and analysis. Descriptive statistics were described using frequencies, percentages, mean and standard deviation, which were further presented using tables, and texts. Normality tests such as kurtosis and skewness were employed to see the normal distribution of the variables and to identify which summary measures were appropriate to use. A binary logistic regression model was used with a cut-off P-value <0.25 and <0.05 in the bi-and multi-variable analysis respectively. Adjusted odds ratio with 95% confidence intervals was computed to see the presence of an association between dependent and independent variables. The 95% CI was used to declare the statistical association. We tested the chi-square assumption and model goodness of fit was tested using the Hosmer Lemeshow test. Besides, the multi-collinearity assumption was tested using pseudo variance inflation factor (VIF), and standard error. Thus, parity was excluded from the final analysis because of the significant multi-collinearity effect.
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