Determinants of Premature Rupture of Membranes Among Pregnant Women Admitted to Public Hospitals in Southern Ethiopia, 2020: A Hospital-Based Case–Control Study

Figures & data

Table 1 Socio-Demographic and Economic Characteristics of Respondents Admitted to Public Hospitals in Guraghe Zone, Southern Ethiopia, 2020

Variables	Categories	Cases=93	Controls=186	Total =279	X^2	P-value
		n (%)	n (%)	n (%)
Age of mother in years	15–19	10 (10.8)	15 (8.1)	25 (8.9)	16.49	<0.001
	20–34	59 (63.4)	155 (83.3)	214 (76.7)
	≥35	24 (25.8)	16 (8.6)	40 (14.4)
Residence	Urban	44 (47.3)	118 (63.4)	162 (58.1)	6.624	0.007
	Rural	49 (52.7)	68 (36.6)	117 (41.9)
Marital status	In marital union	85 (91.4)	175 (94.1)	260 (93.2)	0.401	0.452
	Not in marital relation	8 (8.6)	11 (5.9)	19 (6.8)
Religion	Orthodox	38 (40.9)	84 (45.2)	122 (43.7)	0.692	0.875
	Muslim	31 (33.3)	54 (29.0)	85 (30.5)
	Protestant	20 (21.5)	41 (22.0)	61 (21.9)
	Catholic	4 (4.3)	7 (3.8)	11 (3.9)
Ethnicity	Guraghe	77 (82.8)	162 (87.1)	239 (85.7)	1.705	0.426
	Amhara	10 (10.8)	18 (9.7)	28 (10.0)
	Others*	6 (6.4)	6 (3.2)	12 (4.3)
Mother’s Educational level	No formal education	46 (49.5)	65 (34.9)	111 (39.8)	11.696	0.009
	Primary education (1–8th)	23 (24.7)	35 (18.8)	58 (20.8)
	Secondary(9–12th)	12 (12.9)	53 (28.5)	65 (23.3)
	College and above	12 (12.9)	33 (17.8)	45 (16.1)
Husband’s Education	No formal education	26 (27.9)	66 (35.5)	92 (33.0)	1.877	0.598
	Primary education (1–8th)	33 (35.5)	62 (33.3)	95 (34.0)
	Secondary(9–12th)	19 (20.4)	35 (18.8)	54 (19.4)
	College and above	15 (16.2)	23 (12.4)	38 (13.6)
Wealth index	Highest	13 (14.0)	43 (23.1)	56 (20.1)	10.058	0.039
	Fourth	16 (17.2)	40 (21.5)	56 (20.1)
	Middle	16 (17.2)	39 (21.0)	55 (19.7)
	Second	21 (22.6)	36 (19.4)	57 (20.4)
	Lowest	27 (29.0)	28 (15.0)	55 (19.7)
Family size	<5	45 (48.4)	101 (54.3)	146 (52.3)	0.869	0.351
	≥5	48 (51.6)	85 (45.7)	133 (47.7)

Note: *Tigri, Oromo.

Table 2 Obstetric Characteristics of Respondents Admitted to Public Hospitals in Guraghe Zone, Southern Ethiopia, 2020

Variables	Categories	Cases=93	Controls=186	Total =279	X^2	P-value
		n(%)	n(%)	n (%)
Gestational age in weeks	<37(Preterm)	23 (24.7)	42 (22.6)	65 (23.3)	0.208	0.901
	37–42(Term)	55 (59.2)	115 (61.8)	170 (60.9)
	>42(Post-term)	15 (16.1)	29 (15.6)	44 (15.8)
Gravidity	1	10 (10.7)	23 (12.4)	33 (11.8)	0.455	0.797
	2–4	50 (53.8)	104 (55.9)	154 (55.2)
	≥5	33 (35.5)	59 (32.3)	92 (33.0)
Parity	0(Nulliparous)	15 (16.1)	35 (18.8)	50 (17.9)	5.369	0.147
	1(Primiparous)	11 (11.8)	23 (12.3)	34 (12.2)
	2–4(Multiparous)	43 (46.2)	101 (54.4)	144 (51.6)
	≥5(Grand multiparous)	24 (25.8)	27 (14.5)	51 (18.3)
Desire on the last pregnancy	Planned	60 (64.5)	130 (69.9)	190 (68.1)	0.825	0.364
	Not planned	33 (35.5)	56 (30.1)	89 (31.9)
History of multiple pregnancies(n=246)	Yes	7 (8.4)	10 (6.1)	17 (6.9)	0.452	0.502
	No	76 (91.6)	153 (93.9)	229 (93.1)
Ever had abortion	Yes	27 (29.1)	21 (11.3)	48 (17.2)	13.701	<0.001
	No	66 (70.9)	165 (88.7)	231 (82.8)
Frequency of abortion (n=48)	1	22 (81.5)	14 (66.7)	36 (75.0)
	2 times	4 (14.8)	6 (28.6)	10 (20.8)
	3 times	1 (3.7)	1 (4.7)	2 (4.2)
Types of abortion(n=48)	Spontaneous	21 (77.8)	13 (61.9)	34 (70.8)
	Induced	5 (18.5)	7 (33.3)	12 (25.0)
	Both	1 (3.7)	1 (4.8)	2 (4.2)
Previous history PROM	Yes	35 (37.6)	20 (10.8)	55 (19.7)	28.308	<0.001
	No	58 (62.4)	166 (89.2)	224 (80.3)
Previous history of preterm birth	Yes	19 (20.4)	16 (8.6)	35 (12.6)	7.906	0.005
	No	74 (79.6)	170 (91.4)	244 (87.4)
Previous history of C/S	Yes	24 (25.8)	19 (10.2)	43 (15.4)	11.560	0.001
	No	69 (74.2)	167 (89.8)	236 (84.6)

Table 3 Maternal Health Service-Related Characteristics of Respondents Admitted to Public Hospitals in Guraghe Zone, Southern Ethiopia, 2020

Variables	Categories	Cases=93	Controls=186	Total =279	X^2	P-value
		n(%)	n(%)	n (%)
ANC visit	≥4	17 (18.3)	54 (29.0)	71 (25.5)	16.129	0.001
	2–3	19 (20.4)	64 (34.4)	83 (29.8)
	1	31 (33.4)	42 (22.6)	73 (26.1)
	No	26 (27.9)	26 (14.0)	52 (18.6)
Place of ANC	Health center	38 (57.6)	110 (68.3)	148 (65.2)	2.150	0.670
	Hospital	28 (42.4)	51 (31.7)	79 (34.8)
ANC providers	Midwives	30 (45.5)	87 (38.3)	117 (51.5)	1.229	0.724
	Public health officers	24 (36.4)	50 (22.1)	74 (32.6)
	Nurses	7 (10.6)	14 (6.2)	21 (9.3)
	Doctors	5 (7.6)	10 (4.4)	15 (6.6)
Place of last delivery (n=247)	Health center	57 (68.7)	114 (69.9)	171 (69.5)	0.179	0.915
	Hospital	16 (19.3)	28 (17.2)	44 (17.9)
	Home	10 (12.0)	21 (12.9)	31 (12.6)
Mode of delivery for the last birth (n=246)	SVD	38 (45.8)	87 (53.4)	125 (50.8)	1.311	0.519
	Instrumental delivery	33 (39.8)	57 (35.0)	90 (36.6)
	C/S	12 (14.4)	19 (11.6)	31 (12.6)
Cervical cerclage	Yes	5 (5.4)	5 (2.7)	10 (3.6)	1.296	0.255
	No	88 (94.6)	181 (97.3)	269 (96.4)
Use of modern contraceptives	Yes	56 (60.2)	111 (59.7)	167 (59.9)	0.007	0.931
	No	37 (39.8)	75 (40.3)	112 (40.1)
Last used Contraceptive method (n=167)	Oral contraceptives	14 (25.0)	24 (21.6)	38 (22.8)	2.344	0.504
	Injectables	19 (33.9)	49 (44.2)	68 (40.7)
	Implants	18 (32.1)	26 (23.4)	44 (26.3)
	IUCD	5 (9.0)	12 (10.8)	17 (10.2)
Time spent to reach the nearby Health Facility	<1hr	43 (46.2)	84 (45.2)	127 (45.5)	0.029	0.865
	≥1hr	50 (53.8)	102 (54.8)	152 (54.5)
Using maternal waiting room	No	72 (77.4)	121 (65.1)	193 (69.2)	4.446	0.039
	Yes	21 (22.5)	65 (34.9)	86 (30.8)

Table 4 Clinical and Medical Conditions of Respondents Admitted to Public Hospitals in Guraghe Zone, Southern Ethiopia, 2020

Variables	Categories	Cases=93	Controls=186	Total =279	X^2	P-value
		n(%)	n(%)	n (%)
Having a chronic cough	Yes	20 (21.5)	32 (17.2)	52 (18.6)	1.341	0.251
	No	73 (78.5)	154 (82.8)	227 (81.4)
Having abnormal vaginal discharge during this pregnancy	Yes	19 (20.4)	22 (11.8)	41 (14.7)	3.660	0.056
	No	74 (79.6)	164 (88.2)	238 (85.3)
History of Genital ulcer during this pregnancy	Yes	5 (5.4)	6 (3.2)	11 (3.9)	0.293	0.588
	No	88 (94.6)	180 (96.8)	268 (96.1)
Diagnosed polyhydramnios	Yes	8 (8.6)	14 (7.5)	22 (7.9)	0.099	0.753
	No	85 (91.4)	172 (92.5)	257 (92.1)
Hemoglobin(gm/dl)	<11	18 (19.4)	24 (12.9)	42 (15.1)	2.018	0.160
	≥11	75 (80.6)	162 (87.1)	237 (84.9)
MUAC(Cm)	<23	29 (31.2)	18 (9.7)	47 (16.8)	20.470	<0.001
	≥23	64 (68.8)	168 (90.3)	232 (83.2)
Having a Pregnancy-induced hypertension(PIH)	Yes	16 (17.2)	21 (11.3)	37 (13.3)	1.885	0.170
	No	77 (82.8)	165 (88.7)	242 (86.7)

Table 5 Risky Physical Activities and Habits Among Respondents Admitted to Public Hospitals in Guraghe Zone, Southern Ethiopia, 2020

Variables	Categories	Cases=93	Controls=186	Total =279	X^2	P-value
		n(%)	n(%)	n (%)
Accidental fall during pregnancy	Yes	21 (22.6)	21 (11.3)	42 (15.1)	6.180	0.013
	No	72 (77.4)	165 (88.7)	237 (84.9)
Smoking	Yes	4 (4.3)	5 (2.7)	9 (3.2)	0.517	0.472
	No	89 (95.7)	181 (97.3)	270 (96.8)
Heavy load lifting	Yes	27 (29.1)	41 (22.0)	68 (24.4)	1.643	0.200
	No	66 (70.9)	145 (78.0)	211 (75.6)
Sleeping hours/day	<8hr	25 (26.9)	54 (29.1)	79 (28.3)	0.141	0.707
	≥8hr	68 (73.1)	132 (70.1)	200 (71.7)
Alcohol consumption	Yes	10 (10.8)	13 (7.0)	23 (8.2)	1.160	0.281
	No	83 (89.2)	173 (93.0)	256 (91.8)
Having help at home	No	30 (32.3)	43 (23.1)	73 (26.2)	2.681	0.102
	Yes	63 (67.7)	143 (76.9)	206 (73.8)
Who help you?	Husband	49 (77.8)	106 (74.1)	155 (75.2)	2.985	0.394
	Maid	12 (19.0)	32 (22.4)	44 (21.4)
	Family	2 (3.2)	5 (3.5)	7 (3.4)
Having sexual intercourse in 3rd trimester	Yes	17 (18.3)	28 (15.0)	45 (16.1)	0.477	0.490
	No	76 (81.7)	158 (84.9)	234 (83.9)

Table 6 Determinants of PROM Among Women Admitted to Public Hospitals in Guraghe Zone, Southern Ethiopia, 2020

Variable	Categories	PROM		COR(95% CI)	AOR(95% CI)	p-value
		Cases (%)	Controls (%)
Age of mother in years	15–19	10 (10.8)	15 (8.1)	1	1	1
	20–34	59 (63.4)	155 (83.3)	0.57 (0.24,1.34)	0.41 (0.12,1.39)	0.166
	≥35	24 (25.8)	16 (8.6)	2.25 (0.81,6.24)*	1.01 (0.23, 4.41)	0.887
Residence	Urban	44 (47.3)	118 (63.4)	1	1	1
	Rural	49 (52.7)	68 (36.6)	1.93 (1.17,3.20)*	1.84 (0.94,3.59)	0.074
Marital status	In marital union	85 (91.4)	175 (94.1)	1
	Not in marital relation	8 (8.6)	11 (5.9)	0.67 (0.26,1.72)
Mother’s Educational level	College and above	12 (12.9)	33 (17.8)	1	1	1
	Secondary(9–12th)	12 (12.9)	53 (28.5)	0.62 (0.25,1.55)	0.76 (0.25,2.33)	0.629
	Primary education (1–8th)	23 (24.7)	35 (18.8)	1.81 (0.78,4.21)	1.30 (0.44,3.79)	0.631
	No formal education	46 (49.5)	65 (34.9)	1.95 (0.91,4.17)*	1.78 (0.68,4.64)	0.237
Family size	<5	45 (48.4)	101 (54.3)	1
	≥5	48 (51.6)	85 (45.7)	1.27 (0.77,2.09)
Husband’s Education	College and above	15 (16.2)	23 (12.4)	1
	Secondary(9–12th)	19 (20.4)	35 (18.8)	0.83 (0.35,1.96)
	Primary education (1–8th)	33 (35.5)	62 (33.3)	0.82 (0.38,1.77)
	No formal education	26 (27.9)	66 (35.5)	0.60 (0.27,1.34)
Wealth index	Highest	13 (14.0)	43 (23.1)	1	1	1
	Fourth	16 (17.2)	40 (21.5)	1.32 (0.57,3.09)	1.34 (0.47,3.83)	0.587
	Middle	16 (17.2)	39 (21.0)	1.36 (0.58,3.18)	1.44 (0.52,3.99)	0.479
	Second	21 (22.6)	36 (19.4)	1.93 (0.85,4.38)*	1.72 (0.62,4.77)	0.296
	Lowest	27 (29.0)	28 (15.0)	3.19 (1.41,7.20)*	2.52 (0.93,6.84)	0.069
Gravidity	1	10 (10.7)	23 (12.4)	1
	2–4	50 (53.8)	104 (55.9)	1.11 (0.49,2.49)
	≥5	33 (35.5)	59 (32.3)	1.28 (0.55,3.03)
Parity	0(Nulliparous)	15 (16.1)	35 (18.8)	1	1	1
	1(Primiparous)	11 (11.8)	23 (12.3)	1.12 (0.44,2.85)	1.29 (0.36,3.66)	0.700
	2–4(Multiparous)	43 (46.2)	101 (54.4)	0.99 (0.49,2.00)	1.66 (0.61,4.53)	0.319
	≥5(Grand multiparous)	24 (25.8)	27 (14.5)	2.07 (0.91,4.69)*	2.25 (0.68,6.46)	0.184
Desire on the last pregnancy	Planned	60 (64.5)	130 (69.9)	1
	Not planned	33 (35.5)	56 (30.1)	1.28 (0.75,2.16)
History of multiple pregnancy(n=246)	No	76 (91.6)	153 (93.9)	1
	Yes	7 (8.4)	10 (6.1)	1.41 (0.52,3.85)
Ever had abortion	No	66 (70.9)	165 (88.7)	1	1	1
	Yes	27 (29.1)	21 (11.3)	3.21 (1.69,6.08)*	4.14 (1.70,9.07)^s	0.002
Previous history PROM	No	58 (62.4)	166 (89.2)	1	1	1
	Yes	35 (37.6)	20 (10.8)	5.01 (2.68.9.36)*	4.91 (2.23,9.82)^s	<0.001
Previous history of C/S	No	69 (74.2)	167 (89.8)	1	1	1
	Yes	24 (25.8)	19 (10.2)	3.06 (1.57,5.94)*	3.02 (1.24,7.40)^s	0.015
ANC visit	≥4	17 (18.3)	54 (29.0)	1	1	1
	2–3	19 (20.4)	64 (34.4)	0.94 (0.45,1.99)	0.80 (0.31,2.10)	0.652
	1	31 (33.4)	42 (22.6)	2.34 (1.15,4.79)*	1.58 (0.63,3.97)	0.332
	No	26 (27.9)	26 (14.0)	3.17 (1.47,6.86)*	3.51 (1.33,8.27)^s	0.011
Mode of delivery for the last birth (n=246)	SVD	38 (45.8)	87 (53.4)	1
	Instrumental delivery	33 (39.8)	57 (35.0)	1.32 (0.75,2.35)
	C/S	12 (14.4)	19 (11.6)	1.45 (0.64,3.27)
Using maternal waiting room	No	72 (77.4)	121 (65.1)	1	1	1
	Yes	21 (22.5)	65 (34.9)	0.54 (0.31,0.96)*	0.33 (0.15,0.74)^s	0.007
Having a chronic cough	No	73 (78.5)	154 (82.8)	1
	Yes	20 (21.5)	32 (17.2)	1.32 (0.71,2.46)
Abnormal vaginal discharge during this pregnancy	No	74 (79.6)	164 (88.2)	1	1	1
	Yes	19 (20.4)	22 (11.8)	1.91 (0.98,3.75)*	2.26 (0.86,5.93)	0.096
Diagnosed polyhydramnios	No	85 (91.4)	172 (92.5)	1
	Yes	8 (8.6)	14 (7.5)	1.16 (0.47,2.86)
Hemoglobin(gm/dl)	≥11	75 (80.6)	162 (87.1)	1	1	0.677
	<11	18 (19.4)	24 (12.9)	1.62 (0.83,3.16)*	1.23 (0.47,3.19)
MUAC(Cm)	≥23	64 (68.8)	168 (90.3)	1	1	1
	<23	29 (31.2)	18 (9.7)	4.23 (2.19,8.14)*	3.69 (1.58,8.64)^s	0.003
Having Pregnancy-induced hypertension(PIH)	No	77 (82.8)	165 (88.7)	1
	Yes	16 (17.2)	21 (11.3)	1.63 (0.81,3.30)
Having sexual intercourse in 3rd trimester	No	76 (81.7)	158 (84.9)	1
	Yes	17 (18.3)	28 (15.0)	1.26 (0.65,2.45)
Lifting Heavyweight	No	66 (70.9)	145 (78.0)	1	1	1
	Yes	27 (29.1)	41 (22.0)	1.45 (0.82,2.55)*	1.94 (0.94,3.98)	0.074

Notes: 1: Reference category. *Statistically significant at p-value<0.25, ^sStatistically significant at p-value <0.05.

Abbreviations: AOR, adjusted odds ratio; COR, crude odds ratio.