Mortality and its predictors among mothers diagnosed with Postpartum Hemorrhage in Public Hospitals in Harari Region, Ethiopia

Abstract Background: Despite hemorrhage being recognized as a top-ranked preventable obstetric complication that causes maternal mortality, its burden remains high. Furthermore, there is scarce information on the death contribution of postpartum hemorrhage in Eastern Ethiopia. Thus, this study aimed to assess the mortality and its predictors among mothers diagnosed with postpartum Hemorrhage in public Hospitals in Harari region, Eastern Ethiopia. Methods: We conducted a retrospective cohort among women with postpartum hemorrhage in public hospitals of Eastern Ethiopia. All women with postpartum hemorrhage were followed for 11 years (from October 1/ 2012 to October 1/ 2022) retrospectively. Statistical analysis was conducted with STATA version 14. Kaplan–Meier curves together with a log rank test were used to estimate the survival time and showed the presence of differences among groups. Cox Proportional Hazard (CPH) model was used to determine the association between independent predictors and mortality due to postpartum hemorrhage. Result: We found that the proportion of death among mothers with postpartum hemorrhage was 17.8 % (95%CI; 14.8%-21.3%). The median time to death was 2 days (IQR=1-3 days). The survival status of mothers diagnosed with postpartum hemorrhage declined to 75% on the 2nd day of admission, then after the survival chance remains relatively constant. Prolonged labor (AHR=19.16, 95%ci; 4.02-91.28), and being anemic (AHR=2.12; 95%CI; 1.10-4.09) were the predictors of mortality among mothers with postpartum hemorrhage. Conclusions: Around one out of five mothers died due to postpartum hemorrhage. Prolonged labor and the co-existence of anemia were significant predictors of mortality among mothers due to postpartum hemorrhage. Thus, emphasis has to be given to prevent and treat postpartum hemorrhage accordingly by improving the health care delivery system at all levels of health institutions, preventing prolonged labor, and working on the mothers to make them aware about the possible risk factors of postpartum hemorrhage.