The Cost of Maternal Complications and Its Associated Factors Among Mothers Attending Public Hospitals in Harari Region and Dire Dawa City Administration, Eastern Ethiopia: An Institution-Based Cross-Sectional Study

Figures & data

Table 1 Sampling Procedure for Selecting Mothers with a Complication Within Harari Regional State and Dire Dawa City Administration, Eastern Ethiopia 2022

Regions	Study Area	Total Number of Expected Maternal Complication	Number of Randomly Selected Women from Which Data was Collected
Harari regional state	Hiwot Fana specialized university Hospital	209	185
	Jugel general Hospital	38	34
Dire Dawa city administration	Dil-chora hospital	142	123
	Sabian general hospital	93	83

Table 2 Socio-Demographic Characteristics of Mothers with Complications Attending Public Hospitals in the Harari Region and Dire Dawa City Administration July 1–31, 2022 (n = 425)

Variables	Category	Frequency	Percent
Age in years*	15–24	176	41.2
	25–34	222	52.2
	35–44	27	6.6
Residence	Urban	231	54.4
	Rural	194	45.6
Referral	Other facility	240	56.5
	Self-referral	185	43.5
Religion	Orthodox	102	24
	Muslim	298	70.1
	Protestant	25	5.9
Current marital status	Single	3	0.7
	Married	420	98.8
	Widowed	2	0.5
Educational status	No formal education	122	28.7
	Primary level (1–8)	119	28
	Secondary (9–12)	114	26.8
	College/University	70	16.5
Husband educational status	No formal education	64	15.1
	Primary level (1–8)	102	24
	Secondary level (9–12)	137	32.2
	College/university	122	28.7
	Government employee	74	17.4
Occupation	Merchant	51	12
	House wife	286	67.3
	Farmer	4	0.9
	Private employees	10	2.35
	Government employee	123	28.9
Husband occupation	Merchant	67	15.8
	Farmer	106	24.9
	Private employee	113	26.6
	Daily laborer	16	3.76
Total money earning family members** Working family members**	<5	328	77.2
	≥5	97	22.8
	≤2	419	98.6
	>2	6	1.4
Total number of children**	<4	371	87.3
	≥4	54	12.7
Total family monthly income***	<1000	2	0.5
	1001–3000	81	19
	≥3001	342	80.5
Total family monthly expenditure***	<1000	5	1.2
	1001–3000	114	26.8
	≥3001	306	72

Notes: *Abadi and Mebratie.⁸ **Statistical method (Mean) was used to classify as cutoff point. ***Classified using terciles 1st terciles being 1000, 2nd 2000, 3rd terciles 3000, the baseline was average household income which was around (926 USD) 4012 birr in 2022 world bank report and also Merga et al.⁷

Table 3 Institutional Factors Related with Cost of Maternal Complications Attending Public Hospitals in the Harari Region and Dire Dawa City Administration July 1–31, 2022 (n = 425)

Variables	Category	Frequency	Percent
Distance from hospital*	≤20 km	255	60
	>20 km	170	40
Method of transport	Ambulance	143	33.7
	Private car	43	10.1
	Bajaj	165	38.8
	Public transport	69	16.2
	On foot	5	1.2
Total time to reach hospital*	<30min	241	56.7
	≥30min	184	43.3
Total admission day*	≤4 days	348	81.9
	>4 days	77	18.1
Accompanied by relatives besides their husbands	No	14	3.3
	Yes	411	96.7
Days stayed with the mother*	≤4 days	349	82.1
	>4 days	76	17.9

Notes: *Statistical method (mean) was used as cut off point to classify the category.

Table 4 Clinical Characteristics Related with Mothers with Complications Attending Public Hospitals in the Harari Region and Dire Dawa City Administration July 1–31, 2022 (n = 425)

Variables	Category	Frequency	Percent
Gravida	Primigravida	118	27.8
	Multigravida	238	56
	Grand multigravida	69	16.2
Parity	Nulliparous	17	4
	Multiparous	353	83.1
	Grand multipara	55	12.9
Method of delivery	SVD	112	26.4
	Cesarean section	278	65.4
	Assisted Vaginal delivery	35	8.2
Admission reason	Hemorrhage	27	6.3
	Obstructed labor	186	43.8
	Preeclampsia	102	24
	APH	42	9.9
	PPH	34	8
	Sepsis	10	2.4
	Abortion	9	2.1
	PROM	15	3.5
Neonatal outcome	Normal	339	79.8
	Dead	50	11.8
	Asphyxia	10	2.3
	Low birth weight	15	3.5
	Preterm	2	0.5
	Low APGAR score	3	0.7
	Birth defect	6	1.4

Table 5 The Costs of Maternal Complication in Mothers with Complications Attending Public Hospitals in the Harari Region and Dire Dawa City Administration July 1–31, 2022 (n = 425)

Cost Category	ETB		Median		Min/Max Cost
	Mean	SD	ETB	USD	ETB	USD
Direct medical cost (n = 425)	1475.6	981.6	1300	24.9	0–9000	0–172.2
Drugs	1475.6	981.6	1300	24.9	0–9000	0–172.2
Direct non-medical cost (n = 425)	2030.9	1648.8	1560	29.8	25–8730	0.45–167
Food expenses	972.8	950.4	800	15.3	0–5400	0–103.3
Drinking expenses	387.3	311.1	300	5.7	0–2500	0–47.8
Transport expenses	608.2	930.4	300	5.7	0–6000	0–114.8
Lodging expenses	4.9	59.5	0	0	0–1000	0–19.1
Communication	58.8	49.4	50	0.96	0–300	0–5.7
Indirect cost (n = 425)	1145.7	1086.4	800	15.3	0–6667	0–127.5
Mother productivity loss	209.6	425.5	0	0	0–3267	0–62.5
Care giver productivity loss	936.1	795.4	700	13.4	0–5000	0–95.6

Note: 1USD= 52.27 ETB.

Table 6 The Cost of Maternal Complication by Mode of Delivery and by Reason for Admission in Mothers with Complications Attending Public Hospitals in the Harari Region and Dire Dawa City Administration July 1–31, 2022 (n = 425)

Variables	Median		IQR	Min/Max Cost
	ETB	USD		ETB	USD
Mode of delivery
SVD (n = 112)	4050	77.48	(2887.5–5591.7)	(1275–14,846.7)	(24.39–284.04)
Cesarean section (n = 278)	4485	85.80	(3070–6083.3)	(610–15,040)	(11.67–287.73)
Assisted delivery (n = 35)	2940	56.25	(2218.3–4400)	(1436.7–6695)	(27.5–128.08)
Reason for admission
Hemorrhage (n = 27)	3810	72.9	(3175–5833.3)	(2158.3–8241.7)	(41.29–157.7)
Obstructed Labor (n = 186)	4105	78.5	(2900–5585)	(610–12,753.3)	(11.7–243.98)
Preeclampsia (n = 102)	4348.3	83.19	(2638.3–5908.3)	(1025–15,040)	(19.61–287.74)
APH (n = 42)	5470	104.65	(3305–7250)	(1637–13,520)	(31.32–258.66)
PPH (n = 34)	3795	72.6	(2700–5650)	(1798.3–7833.3)	(34.4–149.86)
Sepsis (n = 10)	5248.7	100.4	(3800–6356.7)	(2625–9840)	(50.22–188.25)
Abortion (n = 9)	4210	80.5	(3900–5140)	(2510–8123.3)	(48.02–155.4)
PROM (n = 15)	4616.7	88.3	(3334.3–5556.7)	(1555–9463.3)	(29.75–181.05)

Note: 1USD = 52.27 Birr.

Table 7 Factors Predicting the Cost of Maternal Complication Among Admitted Mothers Attending Public Hospitals in the Harari Region and Dire Dawa City Administration July 1–31, 2022 (n = 425)

Variables	Unadjusted exp.a Coefficient (95% CI)	Adjusted exp.b Coefficient (95% CI)	T	Significance
Residence
Urban	−0.08 (−0.05–0.22)	1.09 (0.95–1.24)	1.24	0.21
Referral
By themselves	− 0.01 (−0.11–0.08)	0.99 (0.90–1.24)	−0.29	0.77
Marital status
Married	− 0.03 (−0.43–0.35)	0.97 (0.65–1.44)	−0.15	0.88
Education status of the mother
No formal education	− 0.09 (−0.21–0.03)	0.92 (0.81–1.03)	−1.44	0.15
Husband education
Primary education	− 0.05 (−0.15–0.06)	0.96 (0.86–1.06)	−0.82	0.41
Husband occupation
Government employee	0.09 (−0.02–0.19)	1.09 (0.98–1.21)	1.62	0.11
Total family size
<5	− 0.06 (−0.20–0.08)	0.94 (0.82–1.09)	−0.81	0.42
Working family members
≤2	− 0.11 (−0.48–0.6)	0.89 (0.62–1.30)	−0.57	0.57
Number of children
<4	0.01 (−0.26–0.28)	1.01 (0.77–1.32)	0.05	0.96
Income
≥3001	0.12 (0.00–0.23)	1.13 (1.00–1.26)	2.02	0.04*
Distance from the Hospital
≤30km	− 0.05 (−0.17–0.07)	0.95 (0.84–1.07)	−0.86	0.39
Method of transportation
Bajaj	− 0.07 (−0.18–0.04)	0.93 (0.83–1.04)	−1.26	0.21
Time it takes to reach hospital
<30min	− 0.32 (−0.45- −0.19)	0.73 (0.64–0.83)	−4.84	< 0.00*
Total admission days
≤4 days	− 0.50 (−0.64- −0.37)	0.60 (0.53–0.69)	−7.45	< 0.00*
Accompanied by relatives other than the husband
Yes	0.66 (0.42–0.89)	1.93 (1.52–2.46)	5.41	< 0.00*
Gravida
Multigravida	− 0.07 (−0.17–0.03)	0.93 (0.85–1.03)	−1.39	0.17
Parity
Multiparity	0.01 (−0.21–0.23)	1.01 (0.81–1.26)	0.08	0.94
Mode of delivery
Cesarean section	0.15 (0.04–0.27)	1.17 (1.04–1.31)	2.67	0.01*
Admission reason
Obstructed labor	− 0.08 (−0.19–0.03)	0.92 (0.82–1.03)	−1.47	0.14
Neonatal outcome
Normal	− 0.15 (−0.26- −0.31)	0.86 (0.77–0.97)	−2.50	0.01*

Note: *Statistically significant at (p < 0.05).

Abadi T, Mebratie AD. Cost of treating maternal complications and associated factors in Mekelle general hospital, Northern Ethiopia. Risk Manag Healthc Policy. 2021;2021:87–95.

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