Determinants of Birth Asphyxia Among Newborns in Debre Berhan Referral Hospital, Debre Berhan, Ethiopia: a Case-control Study

Determinants of Birth Asphyxia Among Newborns in Debre Berhan Referral Hospital, Debre Berhan, Ethiopia: a Case-control Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Birth Asphyxia Among Newborns in Debre Berhan Referral Hospital, Debre Berhan, Ethiopia: a Case-control Study Sisay Shine Tegegnework, Yeshfanos Tekola Gebre, Sindew Mahmud Ahmed, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-870893/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: Birth asphyxia is the major public health problem in the world. It is estimated that around 23% of all newborn deaths are caused by birth asphyxia worldwide. Birth asphyxia is the top three causes of newborn deaths in sub-Saharan Africa and more than one-third of deaths in Ethiopia. Therefore, the aim of this study was to identify determinants of birth asphyxia which can play a crucial role to decrease the death of newborns. Methods: Unmatched case-control study design was implemented among 276 (92 cases and 184 controls) newborns from January 1st to March 30th, 2020. A systematic sampling technique was used to select the study participants. Data were collected by using a semi-structured interviewer-administered questionnaire and document review by trained nurses and midwives who work at the delivery ward of the hospitals. Bivariate logistic regression analysis was done to identify determinants of birth asphyxia. Adjusted odds ratios with 95% confidence intervals and p-value less than 0.05 were used to assess the level of significance. Results: In this study, maternal education of being can’t read & write [AOR = 4.7, 95% CI: (1.2, 11.9)], ante-partum hemorrhage [AOR = 7.7, 95% CI: (1.5, 18.5)], prolonged labor [AOR =13.5, 95% CI: (2.0, 19.4)], meconium stained amniotic fluid [AOR = 11.3, 95% CI: (2.7, 39.5)], breech fetal presentation [AOR = 4.5, 95% CI: (2.0, 8.4)] and preterm birth [AOR: 4.1, 95% CI: (1.8, 9.2)] were factors which showed significantly associated with birth asphyxia among newborns. Conclusions: In this study, maternal education can’t read & write, antepartum hemorrhage, prolonged labour, stained amniotic fluid, breech fetal presentation, preterm birth were significantly associated with birth asphyxia. So, educating mothers to have continuous follow-up during the pregnancy period and provide quality care to the women in labour through close monitoring of the fetus presentation were recommended to reduce birth asphyxia. Pediatrics Birth asphyxia Determinant Newborn Debre Berhan Ethiopia Introduction Birth asphyxia is defined as the failure of the newborn to initiate and sustain adequate respiration after delivery [ 1 ]. It is existence of three factors like metabolic or mixed academia (Ph < 7) which is determined by umbilical cord arterial blood samples; APGAR score of < 3 for longer than 5 minute; neurological manifestations and multisystem organ dysfunction [ 2 ]. It is the major public health problem among under-five children in the world. Globally, 4 million or 23.0% of newborn deaths occur yearly due to birth asphyxia, representing the fifth (38.0%) largest cause of under-5 year’s children deaths [ 3 ]. The problem is severe in developing countries at which 120 million newborns develop birth asphyxia and the cause for 900,000 deaths every year. In sub-Saharan African countries 24.0% of newborn deaths were due to birth asphyxia [ 4 ]. In Ethiopia, birth asphyxia is the cause of more than one-third of newborn deaths [ 5 ]. The effect of birth asphyxia is not limited only to death but also has a short and long-term neurodevelopment squeal including cognitive and motor disabilities which are almost untreatable [ 6 , 7 ]. In order to alleviate this problem, national newborn training and guidelines are well established for those health professionals who were attending labor at any health facility level. There is also a child survival strategy in Ethiopia that connects essential maternal, newborn, and child health packages throughout adolescence, pregnancy, childbirth, postnatal and newborn periods, and into childhood building upon their natural interactions throughout life. Even if such strategies were applied by Ethiopian health policy the problem of newborn death was still high in the country [ 5 , 8 ]. Many studies in different parts of Ethiopia showed that parity [ 9 ], anemia [ 10 , 11 ], antepartum hemorrhage [ 12 ], prolonged labor [ 9 ], preterm birth [ 12 ], meconium-stained liquor [ 12 , 13 ], pregnancy-induced hypertension [ 10 ], and mode of delivery [ 14 ] were significant predictors of birth asphyxia. However, information related to determinants of newborn asphyxia in Debre Berhan referral hospitals is limited. Therefore, the aim of this study was to identify determinants of birth asphyxia among newborns in Debre Berhan Referral Hospital, Debre Behan, Ethiopia. The findings will help to improve health care providers' and women’s knowledge on birth asphyxia during labor. In addition, the information will also give a guide for policymakers and stakeholders with updated information for future planning and interventions. Methods Study area and period: The study was conducted in Debre Berhan referral hospital at Debre Berhan town. It is located in North Shoa Zone, Amara regional state, North East part of Ethiopia. It is 130 km far from the capital city Addis Ababa, and 695 km far from the regional city Bahir Dar. It is one of the largest public referral hospitals in the zone, providing preventive, curative and rehabilitative services to about more 3 million people in the catchment area. It also provides delivery service 24 hours a day, 7days a week by 24 midwives, 3 general practitioners and 4 gynecologists who assist about 3366 deliveries annually. In NICU ward there are 22 nurses, 3 general practitioners and 2 pediatricians. The total admission of NICU wards from 2019 report 1056 neonates 313 by birth asphyxia. The study was conducted from January 1st to March 30th, 2020. Study design: An institution-based unmatched case-control study design was employed to assess determinants of birth asphyxia among newborns in Debre Berhan Referral Hospital. Population: All newborns delivered in Debre Berhan referral hospital were the source population and all newborns delivered in the hospital during the study period were the study population. Newborns who had heart deformity and more than one malformation were excluded from the study. Sample size determination: The sample size was determined by Epi Info 7 version software package for the unmatched case control study. By considering, 29.4% proportion of controls exposed and odds ratio of 2 for low gestational age from a previous study conducted in Ethiopia Tigray region [ 12 ], with an assumption of, 95% confidence interval, 80% power of the study, two- to- one control to cases ratio, and 5% non-response rate. The final sample size was 276 (92 cases and 184 controls). Sampling procedure: A systematic random sampling technique was used to select the study participants. Every third study subjects were included for both cases and controls. On the first day of data collection the first study participant was taken by using simple random sampling technique from the registration book. Data collection tools and procedure: The data were collected by using interviewer administered structured questionnaire adapted from different literatures [ 7 , 12 ], and document review. The questionnaire was first prepared in English and translated to local language Amhric and back translates to English to keep its consistency. The questionnaire was pre-tested in another health facilities and essential amendment were made based on the results. Data were collected by four midwives and two supervisors who have en experience of work on neonatal intensive care unit of the hospital. Operational definition: C ases: When the newborn has at least one of the following signs, not breathing, gasping, < 30 breaths per minute or < 7 APGAR score [ 15 ]. Outcome variable: Birth asphyxia Independent variable Socio demographic determinants : age, marital status, residence, educational status, maternal occupation Ante partum determinants : parity, pregnancy induced hypertension, anemia, ante-partum hemorrhage, ANC follow up, chronic disease Intra-partum determinants : fetal presentation, duration of labor, amniotic fluid, type of labor, mode of delivery, labor attendant, PROM Neonatal determinants : Sex, birth weight, gestational age Data quality control: The quality of data was assured by using properly designed and validated questionnaire by expertise. Training was given for the data collectors and supervisors on how to collect the data for three days. Pre-testing was performed in another health facility and essential amendment was made on the questionnaire. The principal investigator and supervisors were made a day to day on site supervision and check the collected data for completeness, clarity and consistency. Data processing and analysis: The data was coded and entered to Epi-data version 3.1 and exported to SPSS Version 21 for data analysis. Descriptive statistics were performed and presented in the form of means, standard deviations, frequencies and percentages. Binary logistic regression was computed to identify determinates of birth asphyxia. Variable which have p-value less than 0.25 in binary logistic regression analysis were transferred to multiple logistic regression model to see the relative effect of the confounder. Model goodness of fit test was checked by using Hosmer Lemeshow goodness of fit and Multicolinearity was assessed by variance inflation factor (VIF) among variables. Adjusted odd ratios with 95% confidence interval and P-value less than 0.05 was used to identify determinates of birth asphyxia. Results Socio-demographic characteristics of the study participants A total of 276 (92 cases and 184 controls) were participated in the study with a response rate of 100%. About 52.2% of cases and 42.4% controls were live in rural resident and 42.4% of the mother of the cases and 6.0% controls were can’t read and write in their educational status. More mother of cases (48.9%) than controls (19.0%) were house wife by their occupational status. The majority of mother of cases (80.4%) and controls (95.1%) were married in their marital status (Table 1 ). Table 1 Socio demographic characteristics of the study participants in Debre Berhan referral hospital, Debre Berhan, Ethiopia, 2020 Variable Cases (%) Controls (%) Total (%) Age of the mother (year) =35 12 (13.1) 34 (18.5) 46 (16.7) Residence Urban 44 (47.8) 106 (57.6) 150 (54.3) Rural 48 (52.2) 78 (42.4) 126 (45.7) Marital status Married 74 (80.4) 175 (95.1) 249 (90.2) Single 18 (19.6) 9 (4.9) 27 (9.8) Maternal education Can’t read and write 39 (42.4) 11 (6.0) 50 (18.1) Primary school 22 (23.9) 27 (14.7) 49 (17.8) Secondary school 13 (14.1) 71(38.6) 84 (30.4) College/university 18 (19.6) 75 (40.7) 93 (33.7) Maternal occupation House wife 45 (48.9) 35 (19.0) 80 (29.0) Merchant 13 (14.1) 16 (8.7) 29 (10.5) Farmer 8 (8.7) 11 (6.0) 19 (6.9) Private employee 11 (12.0) 69 (37.5) 80 (29.0) Government employee 15 (16.3) 53 (28.8) 68 (24.6) Ante partum related characteristics of the study participants From the total study participants,46 (55.4%) mothers of the cases and 37 (44.6%) mothers of the controls were premipara, 39 (61.9%) mothers of the cases and 24 (38.1%) mothers of the controls were less than or equals to two ANC visits, 25 (78.1%) of the mothers of the cases and 7 (21.9%) mothers of the controls were APH during pregnancy, 21 (77.8%) mothers of the cases and 6 (22.2%) of the controls had anemia and 19 (73.1%) mothers of the cases and 7 (26.9%) of the controls were PIH during pregnancy (Table 2 ). Table 2 Ante partum characteristics of the study participants in Debre Berhan referral hospital, Debre Berhan, Ethiopia, 2020 Variable Cases (%) Controls (%) Total (%) Parity 1(premipara) 2–4(multipara) >=5(grand multipara) 46 (50.0) 29 (31.5) 17 (18.5) 37 (20.1) 129 (70.1) 18 (9.8) 83 (30.1) 158 (57.2) 35 (12.7) ANC follow up <= two Three Four and above 39 (42.3) 20 (21.7) 33 (36.0) 24 (13.0) 19 (10.3) 141 (76.7) 63 (22.8) 39 (14.1) 174 (63.1) APH Yes No 25 (27.2) 67 (72.8) 7 (3.8) 177 (96.2) 32 (11.6) 244 (88,4) PIH Yes No 19 (20.7) 73 (79.3) 7 (3.8) 177 (96.8) 26 (9.4) 250 (90.6) Anemia Yes No 21 (22.8) 71 (77.2) 6 (3.3) 178 (96.7) 27 (9.8) 249 (90.2) Chronic disease Yes No 13 (14.1) 79 (85.9) 14 (7.6) 170 (92.4) 27 (9.8) 249 (90.2) Intra partum related characteristics of the study participants About 43.4% of the cases and 23.9% of the controls mother labor were attended by midwives. Majority 54.3% of the cases and 84.8% of the controls mother had spontaneous type labor and 50.0% of cases and 7.6% of controls mother delivered with stained amniotic fluid. Majority 73.9% of cases and 88.0% of controls were cephalic fetal presentation. About 14.1% of the cases and only 1.1% of controls were delivered with cored prolapsed (Table 3 ). Table 3 Intra partum related characteristics of the study participants in Debre Berhan referral hospital, Debre Berhan, Ethiopia, 2020 Variable Cases (%) Controls (%) Total (%) Labor attendant Midwives General practitioner Gynecologist 39 (43.4) 30 (36.6) 23 (25.0) 44 (23.9) 92 (50.0) 48 (26.1) 83 (30.1) 122 (44.2) 71 (25.7) Type of labor Spontaneous Induced 50 (54.3) 42 (45.7) 156 (84.8) 28 (15.2) 206 (74.6) 70 (25.4) Duration of labor Normal Prolonged 24 (20.1) 68 (79.9) 151 (82.1) 33 (17.9) 175 (63.4) 101 (36.6) Mode of delivery SVD Instrumental CS 37 (40.2) 26 (28.3) 29 (31.5) 131 (71.2) 23 (12.5) 30 (16.3) 168 (60.9) 49 (17.7) 59 (21.4) Amniotic fluid Stained Non stained 46 (50.0) 46 (50.0) 14 (7.6) 170 (92.4) 60 (21.7) 216 (78.3) PROM Yes No 39 (42.4) 53 (57.6) 25 (13.6) 159 (86.4) 64 (23.2) 212 (76.8) Obstructed labor Yes No 27 (29.3) 65 (70.7) 16 (8.7) 168 (91.3) 43 (15.6) 233 (84.4) Fetal presentation Cephalic Not cephalic 68 (73.9) 24 (26.1) 162 (88.0) 22 (12.0) 230 (83.3) 46 (16.7) Cord prolapse Yes No 13 (14.1) 79 (85.9) 2 (1.1) 182 (98.9) 15 (5.4) 261 (94.6) Newborn related characteristics of the study participants This study revealed that 54 (58.7%) of cases and 107 (58.2%) of controls were male neonates. Twenty two (23.9%) of cases and only 6 (3.3%) of controls were preterm neonates. It was also observed that 39 (42.4%) of the cases and 34 (18.5%) of the controls were low birth weight (Table 4 ). Table 4 Neonatal related characteristics of the study participants in Debre Berhan referral hospital, Debre Berhan, Ethiopia, 2020 Variable Cases (%) Controls (%) Total (%) Sex of new born Male Female 54 (58.7) 38 (41.3) 107 (58.2) 77 (41.8) 161 (58.3) 115 (41.7) Gestational age Pre-term Term Post-term 22 (23.9) 38 (41.3) 32 (34.8) 6 (3.3) 166 (90.2) 12 (5.5) 28 (10.1) 204 (73.9) 44 (16.0) Birth weight =2500 39 (42.4) 53 (57.6) 34 (18.5) 150 (81.5) 73 (26.4) 203 (73.6) Determinants of birth asphyxia among newborns In bivariate analysis eleven variables showed significantly associated with birth asphyxia. After controlling the possible confounders in multivariate logistic regression analysis maternal education, ANC follow up, presence APH, prolonged labor, stained amniotic fluid, not cephalic fetal presentation and gestational age less than 37 weeks were identified as determinants of birth asphyxia among newborns. This study revealed that mother who can’t read and write [AOR = 4.7; 95%CI (1.2, 11.9)] were 4.7 times higher to develop birth asphyxia compared from mother who have college diploma and above. The odds of developing birth asphyxia among mothers who faced antepartum hemorrhage was 7.7 times higher compared from the counterparts [AOR = 7.7; 95%CI (1.5, 18.5)]. This study revealed that prolonged labor was the main predictor of birth asphyxia. A mother who had prolonged labor was more than 13 time higher risk compared from normal labor on the outcome of birth asphyxia [AOR = 13.5; 95%CI (2.0, 19.4)]. Preterm babies were 4.1 times higher risk than term babies to development birth asphyxia [AOR = 4.1; 95%CI (1.8, 9.2)] (Table 5 ). Table 5 Bivariate and Multivariate logistic regression analysis on the determinants of birth asphyxia among newborns in Debre Berhan Referral hospital, Debre Berhan, Ethiopia 2020 Variable Asphyxia status COR (95%CI) AOR (95%CI) Cases (%) Controls (%) Maternal education Can’t read & write Primary school Secondary school Diploma & above 39 (42.4) 22 (23.9) 13 (14.1) 18 (19.6) 11 (6.0) 27 (14.6) 71 (38.6) 75 (40.8) 14.8 (6.4, 34.4) 3.4 (1.6, 7.3) 0.8 (0.4, 1.7) 1.0 4.7 (1.2, 11.9)* 0.5 (0.1, 2.2) 0.5 (0.4, 2.4) 1.0 ANC follow up < Two Three Four and above 39 (42.4) 20 (21.7) 33 (35.9) 24 (13.1) 19 (10.3) 141 (76.6) 6.9 (3.7, 13.1) 4.5 (2.2, 9.4) 1.0 4.6 (1.1, 9.5)* 2.4 (0.5, 11.4) 1.0 APH Yes No 25 (27.2) 67 (72.8) 7 (3.8) 177 (96.2) 9.4 (3.9, 22.8) 1.0 7.7 (1.5, 18.5)* 1.0 Type of labor Spontaneous Induced 50 (54.3) 42 (45.7) 156 (84.8) 28 (15.2) 1.0 4.7 (1.1, 7.4) 1.0 6.4 (0.7, 37.2) Duration of labor Normal Prolonged 24 (26.1) 68 (73.9) 151 (82.1) 33 (13.9) 1.0 13.0 (2.4, 18.1) 1.0 13.5 (2.0, 19.4)* Amniotic fluid Stained Non stained 46 (50.0) 46 (50.0) 14 (7.6) 170 (92.4) 12.1 (6.2, 24.0) 1.0 11.3 (2.7, 39.5)* 1.0 PROM Yes No 39 (42.4) 53 (57.6) 25 (13.6) 159 (86.4) 4.7 (2.6, 8.5) 1.0 6.1 (0.7, 8.5) 1.0 Obstructed labor Yes No 27 (29.3) 65 (70.7) 16 (8.7) 168 (91.3) 4.4 (2.2, 8.6) 1.0 1.2 (0.1, 2.0) 1.0 Fetal presentation Cephalic presentation Breech presentation 68 (73.9) 24 (26.1) 162 (88.0) 22 (12.0) 1.0 2.6 (2.0, 7.3) 1.0 4.5 (2.0, 8.4)* Gestational age Pre-term (=40) 22 (23.9) 38 (41.3) 32 (34.8) 6 (3.3) 166 (90.2) 12 (6.5) 1.4 (1.2, 6.1) 0.2 (0.1, 1.3) 1.0 4.1 (1.8, 9.2)* 0.1 (0.01, 0.5) 1.0 Birth weight =2500 39 (42.4) 53 (57.6) 34 (18.5) 150 (81.5) 3.3 (1.9, 5.7) 1.0 2.7 (0.9, 8.5) 1.0 Discussion This study tried to identify the determinants of birth asphyxia among newborns in Debre Berhan referral hospital by including number of variables from different categories like socio-demographic, antepartum, intra partum and neonatal related characteristics of the newborns. This study revealed that mothers who can’t read and write were 4.7 times higher risk to have asphyxiated newborns compared to mothers who have a college diploma and above. This finding was consistent with the study conducted in Pakistan [ 16 ] and Ethiopia [ 7 , 12 , 17 ]. This could indicate that poor literacy limits mothers from having independent decisions and good access to family resources that could restrict their health-seeking behavior during the antepartum period and also it is an indicator of poor socio-economic status of the community and unplanned pregnancy. Gestational age was significantly associated with birth asphyxia. Preterm (< 37wks) was 4.1 times more likely asphyxiated than the term newborns. This finding was consistent with those of previous studies conducted in Pakistan [ 16 ], Nepal [ 18 ], and Ethiopia [ 9 , 12 , 19 ]. This may be due to the fact that preterm babies face multiple morbidities including organ system, immaturity especially lung immaturities causing respiratory failure. Newborns with the breech presentation were 4.5 times the odds of developing birth asphyxia than the cephalic presentation. This finding was consistent with previous studies conducted in Uganda [ 20 ], Cameron [ 21 ], and Ethiopia [ 22 ]. Mal-presentation of foetus is associated with premature rupture of membrane; this premature rupture of membrane could leads to umbilical cord accidents occur with sub sequent asphyxia at birth [ 14 ]. But, the finding was inconsistent with previous studies conducted in Ethiopia [ 13 , 23 ]. This difference might be due to the difference in the study population and the study design. Prolonged labour was significantly associated with birth asphyxia. This finding was consistent with studies conducted in Cameron [ 21 ], Pakistan [ 16 ], and Ethiopia [ 11 , 24 – 26 ]. This could be due to primary, secondary, or tertiary dalliance. This is in fact that, when labour is prolonged there was a high probability for the foetus to become distressed which can lead to birth asphyxia [ 26 ]. Less than or equals to two ANC follow up by the mothers were 4.6 times higher odds of developing asphyxiated newborns than mothers who have more than four ANC follow up. This finding was inconsistent with the study conducted in Ethiopia [ 13 , 23 , 25 ]. This difference may be due to the number of health facilities included in the study and study period. This ANC visit of the pregnant mother are very important to minimize adverse pregnancy outcomes including birth asphyxia as they provide chance for evaluating the foetal wellbeing and permit management soon by improving the health and wellbeing of the mother and preventing further complications by early detection and treatment of diseases. In this study, we have limitations that should be noted. The study was done in single health facility therefore; it is difficult to generalize for the whole country with this small sample. This study also subjected to recalling bias of mothers when they remembered their previous history. Conclusions In this study, maternal education can’t read & write, antepartum hemorrhage, prolonged labour, stained amniotic fluid, breech fetal presentation, preterm birth were significantly associated with birth asphyxia. So, educating mothers to have continuous follow-up during the pregnancy period and provide quality care to the women in labour through close monitoring of the fetus presentation were recommended to reduce birth asphyxia. Abbreviations ANC - Antenatal Care, AOR – Adjusted Odd Ratio, DDS – Dietary Diversity Score, FAO - Food and Agriculture Organization, NNP - National Nutritional Program, SD - Standard Deviation, SPSS - Statistical Package for Social Science, WHO - World Health Organization Declarations Ethical approval and consent to participate This study was carried out after getting ethical clearance from Debre Berhan University, Institute of medicine and Health Science, College of Health Science, Department of Public Health research ethics review committee Ref. No./IOMHS/029/201/10/2020. Data collection was carried out after receiving ethical clearance letter from the district administrative health bureau. Informed written consent was obtained from each study participant prior to data collection. Each participant read the letter and explained further by the data collectors for easily understands the objective of the research. Finally, the consent form was signed by each participant. Consent to publication Not applicable. Availability of data and material The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request. Competing interests The Authors declare that we do not have any financial or non-financial competing interests in reference to this article for its publication. Funding Not applicable Authors’ contributions SST supervised the design of the study, writing and critically reviewed the drafts. YTG conceptualized and designed the study, obtain fund for the study, coordinate, and monitor the overall implementation of the project. She also participated in data extraction and analysis, interpreted the results and wrote the initial draft. SMA and AST contributed to the design and write of subsequent drafts of the study. All authors read and approved the final manuscript. Acknowledgements We would like to thank Debre Berhan Referral hospital medical directors for their collaboration during conducting this research. Our gratitude also goes to our data collectors and study participants for their willingness to participate in the study. At last but not least, we would like to forward our special thank and sincere appreciations to our friends who gave advice and comment throughout the whole research project activities. References Spector JM, Daga S: Preventing those so-called stillbirths. Bulletin of the World Health Organization 2008, 86:315-316. Solnes Miltenburg A: Quality of Maternity Care in Rural Tanzania: Understanding Local Realities and Identification of Opportunities for Improvement. 2019. Organization WH: Newborn death and illness. Millennium Development goal (mdg) 2011, 4. 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Kune G, Oljira H, Wakgari N, Zerihun E, Aboma M: Determinants of birth asphyxia among newborns delivered in public hospitals of West Shoa Zone, Central Ethiopia: A case-control study. PloS one 2021, 16(3):e0248504. Woday A, Muluneh A, St Denis C: Birth asphyxia and its associated factors among newborns in public hospital, northeast Amhara, Ethiopia. PloS one 2019, 14(12):e0226891. Kibret Y, Hailu G, Angaw K: Determinants of Birth-Asphyxia among Newborns in Dessie Town Hospitals, North-Central Ethiopia, 2018. 2017. Meshesha AD, Azage M, Worku E, Bogale GG: Determinants of Birth asphyxia among newborns in referral hospitals of Amhara National Regional State, Ethiopia. Pediatric Health, Medicine and Therapeutics 2020, 11:1. Sendeku FW, Azeze GG, Fenta SL: Perinatal asphyxia and its associated factors in Ethiopia: a systematic review and meta-analysis. BMC pediatrics 2020, 20(1):1-11. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 31 Dec, 2021 Reviews received at journal 22 Nov, 2021 Reviewers agreed at journal 15 Nov, 2021 Reviewers invited by journal 15 Nov, 2021 Editor assigned by journal 15 Nov, 2021 Editor invited by journal 06 Sep, 2021 Submission checks completed at journal 06 Sep, 2021 First submitted to journal 02 Sep, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-870893","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":50295301,"identity":"dad41b99-1a0c-4c32-a191-b0a439d12e0b","order_by":0,"name":"Sisay Shine Tegegnework","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYDACZghlwA8iEwpI0SLZANJiQIJlBgYHwBQRSuXb2R9+5qmpMzY+vzrxwwMDBnl+sQMETD/MYyzNc+ywmdmNt5slgA4znDk7gYAWZh4GaR62AzZmN85uAGlJMLhNQIt8M/vj3zz/6myMZ5zd/IMoLQyHGcykeduYzQz4e7cRZwvQL2aWc/sOG0vc4N1mkWAgQdgv8v3HH994863OsL//7OabPyps5PmlCTkMCJh4QKQEWKUEYeUgwPgDRPIfIE71KBgFo2AUjDwAANSKQLxDLhRhAAAAAElFTkSuQmCC","orcid":"","institution":"Debre Berhan University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Sisay","middleName":"Shine","lastName":"Tegegnework","suffix":""},{"id":50295302,"identity":"90bd5fd1-7fb4-4616-ad7d-8b0c05546a8e","order_by":1,"name":"Yeshfanos Tekola Gebre","email":"","orcid":"","institution":"Debre Berhan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yeshfanos","middleName":"Tekola","lastName":"Gebre","suffix":""},{"id":50295303,"identity":"29dfe04e-9eca-4260-b5a1-8fddd59df80b","order_by":2,"name":"Sindew Mahmud Ahmed","email":"","orcid":"","institution":"Kotebe Metropolitan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sindew","middleName":"Mahmud","lastName":"Ahmed","suffix":""},{"id":50295304,"identity":"4f48bd4f-ed44-4ad0-86d7-ec713842f20e","order_by":3,"name":"Abrham Shitaw Tewachew","email":"","orcid":"","institution":"Debre Berhan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abrham","middleName":"Shitaw","lastName":"Tewachew","suffix":""}],"badges":[],"createdAt":"2021-09-02 13:14:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-870893/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-870893/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13713313,"identity":"0191d780-baa1-4ea1-9bdf-2605edb6a509","added_by":"auto","created_at":"2021-09-17 14:32:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":427713,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-870893/v1/538b6d4e-598b-4e34-8270-c9880d7b6cb4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDeterminants of Birth Asphyxia Among Newborns in Debre Berhan Referral Hospital, Debre Berhan, Ethiopia: a Case-control Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBirth asphyxia is defined as the failure of the newborn to initiate and sustain adequate respiration after delivery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is existence of three factors like metabolic or mixed academia (Ph\u0026thinsp;\u0026lt;\u0026thinsp;7) which is determined by umbilical cord arterial blood samples; APGAR score of \u0026lt;\u0026thinsp;3 for longer than 5 minute; neurological manifestations and multisystem organ dysfunction [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is the major public health problem among under-five children in the world. Globally, 4\u0026nbsp;million or 23.0% of newborn deaths occur yearly due to birth asphyxia, representing the fifth (38.0%) largest cause of under-5 year\u0026rsquo;s children deaths [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The problem is severe in developing countries at which 120\u0026nbsp;million newborns develop birth asphyxia and the cause for 900,000 deaths every year. In sub-Saharan African countries 24.0% of newborn deaths were due to birth asphyxia [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Ethiopia, birth asphyxia is the cause of more than one-third of newborn deaths [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The effect of birth asphyxia is not limited only to death but also has a short and long-term neurodevelopment squeal including cognitive and motor disabilities which are almost untreatable [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In order to alleviate this problem, national newborn training and guidelines are well established for those health professionals who were attending labor at any health facility level. There is also a child survival strategy in Ethiopia that connects essential maternal, newborn, and child health packages throughout adolescence, pregnancy, childbirth, postnatal and newborn periods, and into childhood building upon their natural interactions throughout life. Even if such strategies were applied by Ethiopian health policy the problem of newborn death was still high in the country [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany studies in different parts of Ethiopia showed that parity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], anemia [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], antepartum hemorrhage [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], prolonged labor [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], preterm birth [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], meconium-stained liquor [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], pregnancy-induced hypertension [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and mode of delivery [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] were significant predictors of birth asphyxia. However, information related to determinants of newborn asphyxia in Debre Berhan referral hospitals is limited. Therefore, the aim of this study was to identify determinants of birth asphyxia among newborns in Debre Berhan Referral Hospital, Debre Behan, Ethiopia. The findings will help to improve health care providers' and women\u0026rsquo;s knowledge on birth asphyxia during labor. In addition, the information will also give a guide for policymakers and stakeholders with updated information for future planning and interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy area and period:\u0026nbsp;\u003c/strong\u003eThe study was conducted in Debre Berhan referral hospital at Debre Berhan town. It is located in North Shoa Zone, Amara regional state, North East part of Ethiopia. It is 130 km far from the capital city Addis Ababa, and 695 km far from the regional city Bahir Dar. It is one of the largest public referral hospitals in the zone, providing preventive, curative and rehabilitative services to about more 3\u0026nbsp;million people in the catchment area. It also provides delivery service 24 hours a day, 7days a week by 24 midwives, 3 general practitioners and 4 gynecologists who assist about 3366 deliveries annually. In NICU ward there are 22 nurses, 3 general practitioners and 2 pediatricians. The total admission of NICU wards from 2019 report 1056 neonates 313 by birth asphyxia. The study was conducted from January 1st to March 30th, 2020.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design:\u0026nbsp;\u003c/strong\u003eAn institution-based unmatched case-control study design was employed to assess determinants of birth asphyxia among newborns in Debre Berhan Referral Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation:\u0026nbsp;\u003c/strong\u003eAll newborns delivered in Debre Berhan referral hospital were the source population and all newborns delivered in the hospital during the study period were the study population. Newborns who had heart deformity and more than one malformation were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size determination:\u0026nbsp;\u003c/strong\u003eThe sample size was determined by Epi Info 7 version software package for the unmatched case control study. By considering, 29.4% proportion of controls exposed and odds ratio of 2 for low gestational age from a previous study conducted in Ethiopia Tigray region [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e], with an assumption of, 95% confidence interval, 80% power of the study, two- to- one control to cases ratio, and 5% non-response rate. The final sample size was 276 (92 cases and 184 controls).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling procedure:\u0026nbsp;\u003c/strong\u003eA systematic random sampling technique was used to select the study participants. Every third study subjects were included for both cases and controls. On the first day of data collection the first study participant was taken by using simple random sampling technique from the registration book.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tools and procedure:\u0026nbsp;\u003c/strong\u003eThe data were collected by using interviewer administered structured questionnaire adapted from different literatures [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e], and document review. The questionnaire was first prepared in English and translated to local language Amhric and back translates to English to keep its consistency. The questionnaire was pre-tested in another health facilities and essential amendment were made based on the results. Data were collected by four midwives and two supervisors who have en experience of work on neonatal intensive care unit of the hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definition: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC\u003cstrong\u003eases:\u0026nbsp;\u003c/strong\u003e\u003c/strong\u003eWhen the newborn has at least one of the following signs, not breathing, gasping, \u0026lt; 30 breaths per minute or \u0026lt;\u0026thinsp;7 APGAR score [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome variable:\u0026nbsp;\u003c/strong\u003eBirth asphyxia\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variable\u003c/strong\u003e\u003c/p\u003e\n\u003col style=\"list-style-type: upper-roman;\"\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003eSocio demographic determinants\u003c/span\u003e: age, marital status, residence, educational status, maternal occupation\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003eAnte partum determinants\u003c/span\u003e: parity, pregnancy induced hypertension, anemia, ante-partum hemorrhage, ANC follow up, chronic disease\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003eIntra-partum determinants\u003c/span\u003e: fetal presentation, duration of labor, amniotic fluid, type of labor, mode of delivery, labor attendant, PROM\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003eNeonatal determinants\u003c/span\u003e: Sex, birth weight, gestational age\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eData quality control:\u0026nbsp;\u003c/strong\u003eThe quality of data was assured by using properly designed and validated questionnaire by expertise. Training was given for the data collectors and supervisors on how to collect the data for three days. Pre-testing was performed in another health facility and essential amendment was made on the questionnaire. The principal investigator and supervisors were made a day to day on site supervision and check the collected data for completeness, clarity and consistency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and analysis:\u0026nbsp;\u003c/strong\u003eThe data was coded and entered to Epi-data version 3.1 and exported to SPSS Version 21 for data analysis. Descriptive statistics were performed and presented in the form of means, standard deviations, frequencies and percentages. Binary logistic regression was computed to identify determinates of birth asphyxia. Variable which have p-value less than 0.25 in binary logistic regression analysis were transferred to multiple logistic regression model to see the relative effect of the confounder. Model goodness of fit test was checked by using Hosmer Lemeshow goodness of fit and Multicolinearity was assessed by variance inflation factor (VIF) among variables. Adjusted odd ratios with 95% confidence interval and P-value less than 0.05 was used to identify determinates of birth asphyxia.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics of the study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 276 (92 cases and 184 controls) were participated in the study with a response rate of 100%. About 52.2% of cases and 42.4% controls were live in rural resident and 42.4% of the mother of the cases and 6.0% controls were can\u0026rsquo;t read and write in their educational status. More mother of cases (48.9%) than controls (19.0%) were house wife by their occupational status. The majority of mother of cases (80.4%) and controls (95.1%) were married in their marital status (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSocio demographic characteristics of the study participants in Debre Berhan referral hospital, Debre Berhan, Ethiopia, 2020\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCases (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eControls (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge of the mother (year)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;=19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e8 (8.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e5 (2.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (4.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u0026ndash;24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e30 (32.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e38 (20.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68 (24.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25\u0026ndash;29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e28 (30.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e74 (40.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e102 (36.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u0026ndash;34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e14 (15.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e33 (17.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47 (17)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;=35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e12 (13.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e34 (18.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46 (16.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eResidence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUrban\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e44 (47.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e106 (57.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e150 (54.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRural\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e48 (52.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e78 (42.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e126 (45.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e74 (80.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e175 (95.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e249 (90.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e18 (19.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e9 (4.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27 (9.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMaternal education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCan\u0026rsquo;t read and write\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e39 (42.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e11 (6.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50 (18.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary school\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e22 (23.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e27 (14.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49 (17.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary school\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e13 (14.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e71(38.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84 (30.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCollege/university\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e18 (19.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e75 (40.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e93 (33.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMaternal occupation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHouse wife\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e45 (48.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e35 (19.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80 (29.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMerchant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e13 (14.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e16 (8.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (10.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFarmer\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e8 (8.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e11 (6.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (6.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate employee\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e11 (12.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e69 (37.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80 (29.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGovernment employee\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e15 (16.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e53 (28.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68 (24.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnte partum related characteristics of the study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the total study participants,46 (55.4%) mothers of the cases and 37 (44.6%) mothers of the controls were premipara, 39 (61.9%) mothers of the cases and 24 (38.1%) mothers of the controls were less than or equals to two ANC visits, 25 (78.1%) of the mothers of the cases and 7 (21.9%) mothers of the controls were APH during pregnancy, 21 (77.8%) mothers of the cases and 6 (22.2%) of the controls had anemia and 19 (73.1%) mothers of the cases and 7 (26.9%) of the controls were PIH during pregnancy (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eAnte partum characteristics of the study participants in Debre Berhan referral hospital, Debre Berhan, Ethiopia, 2020\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 84px;\" align=\"left\"\u003e\n\u003cp\u003eCases (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003eControls (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 98px;\" align=\"left\"\u003e\n\u003cp\u003eTotal (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003eParity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003e1(premipara)\u003c/p\u003e\n\u003cp\u003e2\u0026ndash;4(multipara)\u003c/p\u003e\n\u003cp\u003e\u0026gt;=5(grand multipara)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\n\u003cp\u003e46 (50.0)\u003c/p\u003e\n\u003cp\u003e29 (31.5)\u003c/p\u003e\n\u003cp\u003e17 (18.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003e37 (20.1)\u003c/p\u003e\n\u003cp\u003e129 (70.1)\u003c/p\u003e\n\u003cp\u003e18 (9.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\n\u003cp\u003e83 (30.1)\u003c/p\u003e\n\u003cp\u003e158 (57.2)\u003c/p\u003e\n\u003cp\u003e35 (12.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003eANC follow up\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;= two\u003c/p\u003e\n\u003cp\u003eThree\u003c/p\u003e\n\u003cp\u003eFour and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\n\u003cp\u003e39 (42.3)\u003c/p\u003e\n\u003cp\u003e20 (21.7)\u003c/p\u003e\n\u003cp\u003e33 (36.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003e24 (13.0)\u003c/p\u003e\n\u003cp\u003e19 (10.3)\u003c/p\u003e\n\u003cp\u003e141 (76.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\n\u003cp\u003e63 (22.8)\u003c/p\u003e\n\u003cp\u003e39 (14.1)\u003c/p\u003e\n\u003cp\u003e174 (63.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003eAPH\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\n\u003cp\u003e25 (27.2)\u003c/p\u003e\n\u003cp\u003e67 (72.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003e7 (3.8)\u003c/p\u003e\n\u003cp\u003e177 (96.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\n\u003cp\u003e32 (11.6)\u003c/p\u003e\n\u003cp\u003e244 (88,4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003ePIH\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\n\u003cp\u003e19 (20.7)\u003c/p\u003e\n\u003cp\u003e73 (79.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003e7 (3.8)\u003c/p\u003e\n\u003cp\u003e177 (96.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\n\u003cp\u003e26 (9.4)\u003c/p\u003e\n\u003cp\u003e250 (90.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003eAnemia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\n\u003cp\u003e21 (22.8)\u003c/p\u003e\n\u003cp\u003e71 (77.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003e6 (3.3)\u003c/p\u003e\n\u003cp\u003e178 (96.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\n\u003cp\u003e27 (9.8)\u003c/p\u003e\n\u003cp\u003e249 (90.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003eChronic disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 173px;\" align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 84px;\" align=\"left\"\u003e\n\u003cp\u003e13 (14.1)\u003c/p\u003e\n\u003cp\u003e79 (85.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003e14 (7.6)\u003c/p\u003e\n\u003cp\u003e170 (92.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 98px;\" align=\"left\"\u003e\n\u003cp\u003e27 (9.8)\u003c/p\u003e\n\u003cp\u003e249 (90.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntra partum related characteristics of the study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbout 43.4% of the cases and 23.9% of the controls mother labor were attended by midwives. Majority 54.3% of the cases and 84.8% of the controls mother had spontaneous type labor and 50.0% of cases and 7.6% of controls mother delivered with stained amniotic fluid. Majority 73.9% of cases and 88.0% of controls were cephalic fetal presentation. About 14.1% of the cases and only 1.1% of controls were delivered with cored prolapsed (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\u003ccaption\u003e\n\u003cp\u003eTable 3\u003c/p\u003e\n\u003cp\u003eIntra partum related characteristics of the study participants in Debre Berhan referral hospital, Debre Berhan, Ethiopia, 2020\u003c/p\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003eVariable \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003eCases (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eControls (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eTotal (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003eLabor attendant\u003c/p\u003e\n\u003cp\u003eMidwives\u003c/p\u003e\n\u003cp\u003eGeneral practitioner\u003c/p\u003e\n\u003cp\u003eGynecologist\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e39 (43.4)\u003c/p\u003e\n\u003cp\u003e30 (36.6)\u003c/p\u003e\n\u003cp\u003e23 (25.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e44 (23.9)\u003c/p\u003e\n\u003cp\u003e92 (50.0)\u003c/p\u003e\n\u003cp\u003e48 (26.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e83 (30.1)\u003c/p\u003e\n\u003cp\u003e122 (44.2)\u003c/p\u003e\n\u003cp\u003e71 (25.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003eType of labor\u003c/p\u003e\n\u003cp\u003eSpontaneous\u003c/p\u003e\n\u003cp\u003eInduced\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e50 (54.3)\u003c/p\u003e\n\u003cp\u003e42 (45.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e156 (84.8)\u003c/p\u003e\n\u003cp\u003e28 (15.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e206 (74.6)\u003c/p\u003e\n\u003cp\u003e70 (25.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003eDuration of labor\u003c/p\u003e\n\u003cp\u003eNormal\u003c/p\u003e\n\u003cp\u003eProlonged\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e24 (20.1)\u003c/p\u003e\n\u003cp\u003e68 (79.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e151 (82.1)\u003c/p\u003e\n\u003cp\u003e33 (17.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e175 (63.4)\u003c/p\u003e\n\u003cp\u003e101 (36.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003eMode of delivery\u003c/p\u003e\n\u003cp\u003eSVD\u003c/p\u003e\n\u003cp\u003eInstrumental\u003c/p\u003e\n\u003cp\u003eCS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e37 (40.2)\u003c/p\u003e\n\u003cp\u003e26 (28.3)\u003c/p\u003e\n\u003cp\u003e29 (31.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e131 (71.2)\u003c/p\u003e\n\u003cp\u003e23 (12.5)\u003c/p\u003e\n\u003cp\u003e30 (16.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e168 (60.9)\u003c/p\u003e\n\u003cp\u003e49 (17.7)\u003c/p\u003e\n\u003cp\u003e59 (21.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003eAmniotic fluid\u003c/p\u003e\n\u003cp\u003eStained\u003c/p\u003e\n\u003cp\u003eNon stained\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e46 (50.0)\u003c/p\u003e\n\u003cp\u003e46 (50.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e14 (7.6)\u003c/p\u003e\n\u003cp\u003e170 (92.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e60 (21.7)\u003c/p\u003e\n\u003cp\u003e216 (78.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003ePROM\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e39 (42.4)\u003c/p\u003e\n\u003cp\u003e53 (57.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e25 (13.6)\u003c/p\u003e\n\u003cp\u003e159 (86.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e64 (23.2)\u003c/p\u003e\n\u003cp\u003e212 (76.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003eObstructed labor\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e27 (29.3)\u003c/p\u003e\n\u003cp\u003e65 (70.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16 (8.7)\u003c/p\u003e\n\u003cp\u003e168 (91.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e43 (15.6)\u003c/p\u003e\n\u003cp\u003e233 (84.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003eFetal presentation\u003c/p\u003e\n\u003cp\u003eCephalic\u003c/p\u003e\n\u003cp\u003eNot cephalic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e68 (73.9)\u003c/p\u003e\n\u003cp\u003e24 (26.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e162 (88.0)\u003c/p\u003e\n\u003cp\u003e22 (12.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e230 (83.3)\u003c/p\u003e\n\u003cp\u003e46 (16.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003eCord prolapse\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e13 (14.1)\u003c/p\u003e\n\u003cp\u003e79 (85.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2 (1.1)\u003c/p\u003e\n\u003cp\u003e182 (98.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e15 (5.4)\u003c/p\u003e\n\u003cp\u003e261 (94.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNewborn related characteristics of the study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study revealed that 54 (58.7%) of cases and 107 (58.2%) of controls were male neonates. Twenty two (23.9%) of cases and only 6 (3.3%) of controls were preterm neonates. It was also observed that 39 (42.4%) of the cases and 34 (18.5%) of the controls were low birth weight (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eNeonatal related characteristics of the study participants in Debre Berhan referral hospital, Debre Berhan, Ethiopia, 2020\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth style=\"width: 121px;\" align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 92px;\" align=\"left\"\u003e\n\u003cp\u003eCases (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 94px;\" align=\"left\"\u003e\n\u003cp\u003eControls (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 88px;\" align=\"left\"\u003e\n\u003cp\u003eTotal (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 121px;\" align=\"left\"\u003e\n\u003cp\u003eSex of new born\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 92px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 94px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 88px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 121px;\" align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 92px;\" align=\"left\"\u003e\n\u003cp\u003e54 (58.7)\u003c/p\u003e\n\u003cp\u003e38 (41.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 94px;\" align=\"left\"\u003e\n\u003cp\u003e107 (58.2)\u003c/p\u003e\n\u003cp\u003e77 (41.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 88px;\" align=\"left\"\u003e\n\u003cp\u003e161 (58.3)\u003c/p\u003e\n\u003cp\u003e115 (41.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 121px;\" align=\"left\"\u003e\n\u003cp\u003eGestational age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 92px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 94px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 88px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 121px;\" align=\"left\"\u003e\n\u003cp\u003ePre-term\u003c/p\u003e\n\u003cp\u003eTerm\u003c/p\u003e\n\u003cp\u003ePost-term\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 92px;\" align=\"left\"\u003e\n\u003cp\u003e22 (23.9)\u003c/p\u003e\n\u003cp\u003e38 (41.3)\u003c/p\u003e\n\u003cp\u003e32 (34.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 94px;\" align=\"left\"\u003e\n\u003cp\u003e6 (3.3)\u003c/p\u003e\n\u003cp\u003e166 (90.2)\u003c/p\u003e\n\u003cp\u003e12 (5.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 88px;\" align=\"left\"\u003e\n\u003cp\u003e28 (10.1)\u003c/p\u003e\n\u003cp\u003e204 (73.9)\u003c/p\u003e\n\u003cp\u003e44 (16.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 121px;\" align=\"left\"\u003e\n\u003cp\u003eBirth weight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 92px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 94px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 88px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 121px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;2500gm\u003c/p\u003e\n\u003cp\u003e\u0026gt;=2500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 92px;\" align=\"left\"\u003e\n\u003cp\u003e39 (42.4)\u003c/p\u003e\n\u003cp\u003e53 (57.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 94px;\" align=\"left\"\u003e\n\u003cp\u003e34 (18.5)\u003c/p\u003e\n\u003cp\u003e150 (81.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 88px;\" align=\"left\"\u003e\n\u003cp\u003e73 (26.4)\u003c/p\u003e\n\u003cp\u003e203 (73.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeterminants of birth asphyxia among newborns\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn bivariate analysis eleven variables showed significantly associated with birth asphyxia. After controlling the possible confounders in multivariate logistic regression analysis maternal education, ANC follow up, presence APH, prolonged labor, stained amniotic fluid, not cephalic fetal presentation and gestational age less than 37 weeks were identified as determinants of birth asphyxia among newborns. This study revealed that mother who can\u0026rsquo;t read and write [AOR\u0026thinsp;=\u0026thinsp;4.7; 95%CI (1.2, 11.9)] were 4.7 times higher to develop birth asphyxia compared from mother who have college diploma and above. The odds of developing birth asphyxia among mothers who faced antepartum hemorrhage was 7.7 times higher compared from the counterparts [AOR\u0026thinsp;=\u0026thinsp;7.7; 95%CI (1.5, 18.5)]. This study revealed that prolonged labor was the main predictor of birth asphyxia. A mother who had prolonged labor was more than 13 time higher risk compared from normal labor on the outcome of birth asphyxia [AOR\u0026thinsp;=\u0026thinsp;13.5; 95%CI (2.0, 19.4)]. Preterm babies were 4.1 times higher risk than term babies to development birth asphyxia [AOR\u0026thinsp;=\u0026thinsp;4.1; 95%CI (1.8, 9.2)] (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\u003ccaption\u003e\n\u003cp\u003eTable 5\u003c/p\u003e\n\u003cp\u003eBivariate and Multivariate logistic regression analysis on the determinants of birth asphyxia among newborns in Debre Berhan Referral hospital, Debre Berhan, Ethiopia 2020\u003c/p\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"170\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"208\"\u003e\n\u003cp\u003eAsphyxia status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCOR (95%CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAOR (95%CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eCases (%) \u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eControls (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eMaternal education\u003c/p\u003e\n\u003cp\u003eCan\u0026rsquo;t read \u0026amp; write\u003c/p\u003e\n\u003cp\u003ePrimary school\u003c/p\u003e\n\u003cp\u003eSecondary school\u003c/p\u003e\n\u003cp\u003eDiploma \u0026amp; above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e39 (42.4)\u003c/p\u003e\n\u003cp\u003e22 (23.9)\u003c/p\u003e\n\u003cp\u003e13 (14.1)\u003c/p\u003e\n\u003cp\u003e18 (19.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e11 (6.0)\u003c/p\u003e\n\u003cp\u003e27 (14.6)\u003c/p\u003e\n\u003cp\u003e71 (38.6)\u003c/p\u003e\n\u003cp\u003e75 (40.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e14.8 (6.4, 34.4)\u003c/p\u003e\n\u003cp\u003e3.4 (1.6, 7.3)\u003c/p\u003e\n\u003cp\u003e0.8 (0.4, 1.7)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.7 (1.2, 11.9)*\u003c/p\u003e\n\u003cp\u003e0.5 (0.1, 2.2)\u003c/p\u003e\n\u003cp\u003e0.5 (0.4, 2.4)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eANC follow up\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u0026lt;\u003c/u\u003e Two\u003c/p\u003e\n\u003cp\u003eThree\u003c/p\u003e\n\u003cp\u003eFour and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e39 (42.4)\u003c/p\u003e\n\u003cp\u003e20 (21.7)\u003c/p\u003e\n\u003cp\u003e33 (35.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e24 (13.1)\u003c/p\u003e\n\u003cp\u003e19 (10.3)\u003c/p\u003e\n\u003cp\u003e141 (76.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e6.9 (3.7, 13.1)\u003c/p\u003e\n\u003cp\u003e4.5 (2.2, 9.4)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.6 (1.1, 9.5)*\u003c/p\u003e\n\u003cp\u003e2.4 (0.5, 11.4)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eAPH\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e25 (27.2)\u003c/p\u003e\n\u003cp\u003e67 (72.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7 (3.8)\u003c/p\u003e\n\u003cp\u003e177 (96.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e9.4 (3.9, 22.8)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e7.7 (1.5, 18.5)*\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eType of labor\u003c/p\u003e\n\u003cp\u003eSpontaneous\u003c/p\u003e\n\u003cp\u003eInduced\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e50 (54.3)\u003c/p\u003e\n\u003cp\u003e42 (45.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e156 (84.8)\u003c/p\u003e\n\u003cp\u003e28 (15.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003cp\u003e4.7 (1.1, 7.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003cp\u003e6.4 (0.7, 37.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eDuration of labor\u003c/p\u003e\n\u003cp\u003eNormal\u003c/p\u003e\n\u003cp\u003eProlonged\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e24 (26.1)\u003c/p\u003e\n\u003cp\u003e68 (73.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e151 (82.1)\u003c/p\u003e\n\u003cp\u003e33 (13.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003cp\u003e13.0 (2.4, 18.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003cp\u003e13.5 (2.0, 19.4)*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eAmniotic fluid\u003c/p\u003e\n\u003cp\u003eStained\u003c/p\u003e\n\u003cp\u003eNon stained\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e46 (50.0)\u003c/p\u003e\n\u003cp\u003e46 (50.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e14 (7.6)\u003c/p\u003e\n\u003cp\u003e170 (92.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e12.1 (6.2, 24.0)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e11.3 (2.7, 39.5)*\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003ePROM\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e39 (42.4)\u003c/p\u003e\n\u003cp\u003e53 (57.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e25 (13.6)\u003c/p\u003e\n\u003cp\u003e159 (86.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.7 (2.6, 8.5)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e6.1 (0.7, 8.5)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eObstructed labor\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e27 (29.3)\u003c/p\u003e\n\u003cp\u003e65 (70.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16 (8.7)\u003c/p\u003e\n\u003cp\u003e168 (91.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.4 (2.2, 8.6)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.2 (0.1, 2.0)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eFetal presentation\u003c/p\u003e\n\u003cp\u003eCephalic presentation\u003c/p\u003e\n\u003cp\u003eBreech presentation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e68 (73.9)\u003c/p\u003e\n\u003cp\u003e24 (26.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e162 (88.0)\u003c/p\u003e\n\u003cp\u003e22 (12.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003cp\u003e2.6 (2.0, 7.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003cp\u003e4.5 (2.0, 8.4)*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eGestational age\u003c/p\u003e\n\u003cp\u003ePre-term (\u0026lt;37)\u003c/p\u003e\n\u003cp\u003eTerm (37-39)\u003c/p\u003e\n\u003cp\u003ePost-term (\u0026gt;=40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e22 (23.9)\u003c/p\u003e\n\u003cp\u003e38 (41.3)\u003c/p\u003e\n\u003cp\u003e32 (34.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e6 (3.3)\u003c/p\u003e\n\u003cp\u003e166 (90.2)\u003c/p\u003e\n\u003cp\u003e12 (6.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.4 (1.2, 6.1)\u003c/p\u003e\n\u003cp\u003e0.2 (0.1, 1.3)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.1 (1.8, 9.2)*\u003c/p\u003e\n\u003cp\u003e0.1 (0.01, 0.5)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eBirth weight\u003c/p\u003e\n\u003cp\u003e\u0026lt;2500gm\u003c/p\u003e\n\u003cp\u003e\u0026gt;=2500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e39 (42.4)\u003c/p\u003e\n\u003cp\u003e53 (57.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e34 (18.5)\u003c/p\u003e\n\u003cp\u003e150 (81.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.3 (1.9, 5.7)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.7 (0.9, 8.5)\u003c/p\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study tried to identify the determinants of birth asphyxia among newborns in Debre Berhan referral hospital by including number of variables from different categories like socio-demographic, antepartum, intra partum and neonatal related characteristics of the newborns.\u003c/p\u003e \u003cp\u003eThis study revealed that mothers who can\u0026rsquo;t read and write were 4.7 times higher risk to have asphyxiated newborns compared to mothers who have a college diploma and above. This finding was consistent with the study conducted in Pakistan [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and Ethiopia [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This could indicate that poor literacy limits mothers from having independent decisions and good access to family resources that could restrict their health-seeking behavior during the antepartum period and also it is an indicator of poor socio-economic status of the community and unplanned pregnancy.\u003c/p\u003e \u003cp\u003eGestational age was significantly associated with birth asphyxia. Preterm (\u0026lt;\u0026thinsp;37wks) was 4.1 times more likely asphyxiated than the term newborns. This finding was consistent with those of previous studies conducted in Pakistan [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], Nepal [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and Ethiopia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This may be due to the fact that preterm babies face multiple morbidities including organ system, immaturity especially lung immaturities causing respiratory failure.\u003c/p\u003e \u003cp\u003eNewborns with the breech presentation were 4.5 times the odds of developing birth asphyxia than the cephalic presentation. This finding was consistent with previous studies conducted in Uganda [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], Cameron [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and Ethiopia [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Mal-presentation of foetus is associated with premature rupture of membrane; this premature rupture of membrane could leads to umbilical cord accidents occur with sub sequent asphyxia at birth [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. But, the finding was inconsistent with previous studies conducted in Ethiopia [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This difference might be due to the difference in the study population and the study design.\u003c/p\u003e \u003cp\u003eProlonged labour was significantly associated with birth asphyxia. This finding was consistent with studies conducted in Cameron [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], Pakistan [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and Ethiopia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This could be due to primary, secondary, or tertiary dalliance. This is in fact that, when labour is prolonged there was a high probability for the foetus to become distressed which can lead to birth asphyxia [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLess than or equals to two ANC follow up by the mothers were 4.6 times higher odds of developing asphyxiated newborns than mothers who have more than four ANC follow up. This finding was inconsistent with the study conducted in Ethiopia [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This difference may be due to the number of health facilities included in the study and study period. This ANC visit of the pregnant mother are very important to minimize adverse pregnancy outcomes including birth asphyxia as they provide chance for evaluating the foetal wellbeing and permit management soon by improving the health and wellbeing of the mother and preventing further complications by early detection and treatment of diseases.\u003c/p\u003e \u003cp\u003eIn this study, we have limitations that should be noted. The study was done in single health facility therefore; it is difficult to generalize for the whole country with this small sample. This study also subjected to recalling bias of mothers when they remembered their previous history.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, maternal education can\u0026rsquo;t read \u0026amp; write, antepartum hemorrhage, prolonged labour, stained amniotic fluid, breech fetal presentation, preterm birth were significantly associated with birth asphyxia. So, educating mothers to have continuous follow-up during the pregnancy period and provide quality care to the women in labour through close monitoring of the fetus presentation were recommended to reduce birth asphyxia.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eANC\u003c/strong\u003e - Antenatal Care, \u003cstrong\u003eAOR\u003c/strong\u003e\u0026ndash; Adjusted Odd Ratio, \u003cstrong\u003eDDS\u003c/strong\u003e \u0026ndash; Dietary Diversity Score, \u003cstrong\u003eFAO\u003c/strong\u003e- Food and Agriculture Organization, \u003cstrong\u003eNNP\u003c/strong\u003e- National Nutritional Program, \u003cstrong\u003eSD\u003c/strong\u003e - Standard Deviation, \u003cstrong\u003eSPSS\u003c/strong\u003e - Statistical Package for Social Science, \u003cstrong\u003eWHO\u003c/strong\u003e - World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out after getting ethical clearance from Debre Berhan University, Institute of medicine and Health Science, College of Health Science, Department of Public Health research ethics review committee Ref. No./IOMHS/029/201/10/2020. Data collection was carried out after receiving ethical clearance letter from the district administrative health bureau. Informed written consent was obtained from each study participant prior to data collection. Each participant read the letter and explained further by the data collectors for easily understands the objective of the research. Finally, the consent form was signed by each participant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Authors declare that we do not have any financial or non-financial competing interests in reference to this article for its publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSST\u003c/strong\u003e supervised the design of the study, writing and critically reviewed the drafts. \u003cstrong\u003eYTG\u003c/strong\u003e conceptualized and designed the study, obtain fund for the study, coordinate, and monitor the overall implementation of the project. She also participated in data extraction and analysis, interpreted the results and wrote the initial draft. \u003cstrong\u003eSMA\u003c/strong\u003e and \u003cstrong\u003eAST\u003c/strong\u003e contributed to the design and write of subsequent drafts of the study. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Debre Berhan Referral hospital medical directors for their collaboration during conducting this research. Our gratitude also goes to our data collectors and study participants for their willingness to participate in the study. At last but not least, we would like to forward our special thank and sincere appreciations to our friends who gave advice and comment throughout the whole research project activities.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSpector JM, Daga S: Preventing those so-called stillbirths. \u003cem\u003eBulletin of the World Health Organization\u0026nbsp;\u003c/em\u003e2008, 86:315-316.\u003c/li\u003e\n \u003cli\u003eSolnes Miltenburg A: Quality of Maternity Care in Rural Tanzania: Understanding Local Realities and Identification of Opportunities for Improvement. 2019.\u003c/li\u003e\n \u003cli\u003eOrganization WH: Newborn death and illness. \u003cem\u003eMillennium Development goal (mdg)\u0026nbsp;\u003c/em\u003e2011, 4.\u003c/li\u003e\n \u003cli\u003eFekede A: Knowledge, Attitude and Practice Towards Management of Birth Asphyxia among Nurses and Midwives Working In Labour Ward and Nicu in Governmental Hospitals, Addis Ababa, Ethiopia, 2017. Addis Ababa University; 2017.\u003c/li\u003e\n \u003cli\u003eEDHS: Demographic and health survey key indicators 2016.\u003c/li\u003e\n \u003cli\u003eKiyani AN, Arshad Khushdil AE: Perinatal factors leading to birth asphyxia among term newborns in a tertiary care hospital. \u003cem\u003eIranian journal of pediatrics\u0026nbsp;\u003c/em\u003e2014, 24(5):637.\u003c/li\u003e\n \u003cli\u003eWosenu L, Worku AG, Teshome DF, Gelagay AA: Determinants of birth asphyxia among live birth newborns in University of Gondar referral hospital, northwest Ethiopia: A case-control study. \u003cem\u003ePloS one\u0026nbsp;\u003c/em\u003e2018, 13(9):e0203763.\u003c/li\u003e\n \u003cli\u003eMoH F: National strategy for child survival in Ethiopia. \u003cem\u003eAddis Ababa, Ethiopia\u0026nbsp;\u003c/em\u003e2005.\u003c/li\u003e\n \u003cli\u003eAbdo RA, Halil HM, Kebede BA, Anshebo AA, Gejo NG: Prevalence and contributing factors of birth asphyxia among the neonates delivered at Nigist Eleni Mohammed memorial teaching hospital, Southern Ethiopia: a cross-sectional study. \u003cem\u003eBMC pregnancy and childbirth\u0026nbsp;\u003c/em\u003e2019, 19(1):1-7.\u003c/li\u003e\n \u003cli\u003eAlemu A, Melaku G, Abera GB, Damte A: Prevalence and associated factors of perinatal asphyxia among newborns in Dilla University referral hospital, Southern Ethiopia\u0026ndash;2017. \u003cem\u003ePediatric Health, Medicine and Therapeutics\u0026nbsp;\u003c/em\u003e2019, 10:69.\u003c/li\u003e\n \u003cli\u003eGebregziabher GT, Hadgu FB, Abebe HT: Prevalence and associated factors of perinatal asphyxia in neonates admitted to ayder comprehensive specialized hospital, Northern Ethiopia: a cross-sectional study. \u003cem\u003eInternational journal of pediatrics\u0026nbsp;\u003c/em\u003e2020, 2020.\u003c/li\u003e\n \u003cli\u003eTasew H, Zemicheal M, Teklay G, Mariye T, Ayele E: Risk factors of birth asphyxia among newborns in public hospitals of Central Zone, Tigray, Ethiopia 2018. \u003cem\u003eBMC research notes\u0026nbsp;\u003c/em\u003e2018, 11(1):1-7.\u003c/li\u003e\n \u003cli\u003eMulugeta T, Sebsibe G, Fenta FA, Sibhat M: Risk factors of perinatal asphyxia among newborns delivered at public hospitals in Addis Ababa, Ethiopia: case\u0026ndash;control study. \u003cem\u003ePediatric Health, Medicine and Therapeutics\u0026nbsp;\u003c/em\u003e2020, 11:297.\u003c/li\u003e\n \u003cli\u003eBayih WA, Yitbarek GY, Aynalem YA, Abate BB, Tesfaw A, Ayalew MY, Belay DM, Hailemeskel HS, Alemu AY: Prevalence and associated factors of birth asphyxia among live births at Debre Tabor General Hospital, North Central Ethiopia. \u003cem\u003eBMC pregnancy and childbirth\u0026nbsp;\u003c/em\u003e2020, 20(1):1-12.\u003c/li\u003e\n \u003cli\u003eABABA A: Federal Democratic Republic of Ethiopia Ministry of Health CLTSH Verification and Certification Protocol. \u003cem\u003eFederal Democratic Republic of Ethiopia Ministry of Health CLTSH Verification and Certification Protocol\u0026nbsp;\u003c/em\u003e2012.\u003c/li\u003e\n \u003cli\u003eTabassum F, Rizvi A, Ariff S, Soofi S, Bhutta ZA: Risk factors associated with birth asphyxia in rural district Matiari, Pakistan: a case control study. \u003cem\u003eInternational Journal of Clinical Medicine\u0026nbsp;\u003c/em\u003e2014, 5(21):1430.\u003c/li\u003e\n \u003cli\u003eDesalew A, Semahgn A, Tesfaye G: Determinants of birth asphyxia among newborns in Ethiopia: A systematic review and meta-analysis. \u003cem\u003eInternational journal of health sciences\u0026nbsp;\u003c/em\u003e2020, 14(1):35.\u003c/li\u003e\n \u003cli\u003eLee AC, Mullany LC, Tielsch JM, Katz J, Khatry SK, LeClerq SC, Adhikari RK, Shrestha SR, Darmstadt GL: Risk factors for neonatal mortality due to birth asphyxia in southern Nepal: a prospective, community-based cohort study. \u003cem\u003ePediatrics\u0026nbsp;\u003c/em\u003e2008, 121(5):e1381-e1390.\u003c/li\u003e\n \u003cli\u003eYeshaneh A, Kassa A, Kassa ZY, Adane D, Fikadu Y, Wassie ST, Alemu BW, Tadese M, Shitu S, Abebe H: The determinants of 5th minute low Apgar score among newborns who delivered at public hospitals in Hawassa City, South Ethiopia. \u003cem\u003eBMC pediatrics\u0026nbsp;\u003c/em\u003e2021, 21(1):1-10.\u003c/li\u003e\n \u003cli\u003eKaye D: Antenatal and intrapartum risk factors for birth asphyxia among emergency obstetric referrals in Mulago Hospital, Kampala, Uganda. \u003cem\u003eEast african medical journal\u0026nbsp;\u003c/em\u003e2003, 80(3):140-143.\u003c/li\u003e\n \u003cli\u003eChiabi A, Nguefack S, Evelyne M, Nodem S, Mbuagbaw L, Mbonda E, Tchokoteu P-F: Risk factors for birth asphyxia in an urban health facility in Cameroon. \u003cem\u003eIranian journal of child neurology\u0026nbsp;\u003c/em\u003e2013, 7(3):46.\u003c/li\u003e\n \u003cli\u003eKune G, Oljira H, Wakgari N, Zerihun E, Aboma M: Determinants of birth asphyxia among newborns delivered in public hospitals of West Shoa Zone, Central Ethiopia: A case-control study. \u003cem\u003ePloS one\u0026nbsp;\u003c/em\u003e2021, 16(3):e0248504.\u003c/li\u003e\n \u003cli\u003eWoday A, Muluneh A, St Denis C: Birth asphyxia and its associated factors among newborns in public hospital, northeast Amhara, Ethiopia. \u003cem\u003ePloS one\u0026nbsp;\u003c/em\u003e2019, 14(12):e0226891.\u003c/li\u003e\n \u003cli\u003eKibret Y, Hailu G, Angaw K: Determinants of Birth-Asphyxia among Newborns in Dessie Town Hospitals, North-Central Ethiopia, 2018. 2017.\u003c/li\u003e\n \u003cli\u003eMeshesha AD, Azage M, Worku E, Bogale GG: Determinants of Birth asphyxia among newborns in referral hospitals of Amhara National Regional State, Ethiopia. \u003cem\u003ePediatric Health, Medicine and Therapeutics\u0026nbsp;\u003c/em\u003e2020, 11:1.\u003c/li\u003e\n \u003cli\u003eSendeku FW, Azeze GG, Fenta SL: Perinatal asphyxia and its associated factors in Ethiopia: a systematic review and meta-analysis. \u003cem\u003eBMC pediatrics\u0026nbsp;\u003c/em\u003e2020, 20(1):1-11.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Birth asphyxia, Determinant, Newborn, Debre Berhan, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-870893/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-870893/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eBirth asphyxia is the major public health problem in the world. It is estimated that around 23% of all newborn deaths are caused by birth asphyxia worldwide. Birth asphyxia is the top three causes of newborn deaths in sub-Saharan Africa and more than one-third of deaths in Ethiopia. Therefore, the aim of this study was to identify determinants of birth asphyxia which can play a crucial role to decrease the death of newborns.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eUnmatched case-control study design was implemented among 276 (92 cases and 184 controls) newborns from January 1st to March 30th, 2020. A systematic sampling technique was used to select the study participants. Data were collected by using a semi-structured interviewer-administered questionnaire and document review by trained nurses and midwives who work at the delivery ward of the hospitals. Bivariate logistic regression analysis was done to identify determinants of birth asphyxia. Adjusted odds ratios with 95% confidence intervals and p-value less than 0.05 were used to assess the level of significance.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIn this study, maternal education of being can’t read \u0026amp; write [AOR = 4.7, 95% CI: (1.2, 11.9)],\u0026nbsp;ante-partum hemorrhage [AOR = 7.7, 95% CI: (1.5, 18.5)], prolonged labor [AOR =13.5, 95% CI: (2.0, 19.4)], meconium stained amniotic fluid [AOR = 11.3, 95% CI: (2.7, 39.5)], breech fetal presentation [AOR = 4.5, 95% CI: (2.0, 8.4)] and preterm birth [AOR: 4.1, 95% CI: (1.8, 9.2)]\u0026nbsp;were factors which showed significantly associated with birth asphyxia among newborns.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eIn this study, maternal education can’t read \u0026amp; write, antepartum hemorrhage, prolonged labour, stained amniotic fluid, breech fetal presentation, preterm birth were significantly associated with birth asphyxia. So, educating mothers to have continuous follow-up during the pregnancy period and provide quality care to the women in labour through close monitoring of the fetus presentation were recommended to reduce birth asphyxia.\u003c/p\u003e","manuscriptTitle":"Determinants of Birth Asphyxia Among Newborns in Debre Berhan Referral Hospital, Debre Berhan, Ethiopia: a Case-control Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-09-08 17:24:55","doi":"10.21203/rs.3.rs-870893/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-12-31T10:23:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-11-22T22:31:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164dc995-7922-4ffd-84f9-d2638c044e3e","date":"2021-11-15T20:44:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-11-15T18:47:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-11-15T18:44:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-09-06T12:32:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-09-06T12:31:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2021-09-02T13:02:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cf46f23c-6039-4c83-900d-b4899e380990","owner":[],"postedDate":"September 8th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":7050488,"name":"Pediatrics"}],"tags":[],"updatedAt":"2022-03-14T11:39:16+00:00","versionOfRecord":[],"versionCreatedAt":"2021-09-08 17:24:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-870893","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-870893","identity":"rs-870893","version":["v1"]},"buildId":"369fNeqWncA4NS6XSWjrt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}