Determinants of puerperal sepsis among mothers who give birth at Jigjiga public hospitals, Somali Regional State, Eastern Ethiopia

Determinants of puerperal sepsis among mothers who give birth at Jigjiga public hospitals, Somali Regional State, Eastern Ethiopia | 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 Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of puerperal sepsis among mothers who give birth at Jigjiga public hospitals, Somali Regional State, Eastern Ethiopia Hassan Nur Ali, Abdullahi Ahmed Tahlil, Mahad Ali Mohamud, Fuad Ismail Daud, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4970368/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Sep, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 12 You are reading this latest preprint version Abstract Introduction: Puerperal sepsis is a significant public health concern in low-resource settings, including Ethiopia, where it is a major contributor to maternal mortality, accounting for 13% of maternal deaths. We investigated the determinants of puerperal sepsis among mothers who give birth at Jigjiga Public Hospitals, Somali Regional State, Eastern Ethiopia. Methods: A facility-based unmatched case-control design was employed, with a sample size of 227 (76 cases and 151 controls). The study was conducted at two public hospitals in Jigjiga, Eastern Ethiopia, from January 2022 to December 2022. Data was collected using a standardized structured questionnaire and medical record review. Data were analyzed using SPSS software version 26. Multivariate logistic regression analysis was used to identify the determinants of puerperal sepsis. The level of significance was set at 0.05. Results: The mean age of the mothers was 30.2±10.2 years for cases and 31.5±6.7 years for controls. The results showed that not attending antenatal care regularly (aOR: 3.2, 95% CI: 1.483-6.940), having fewer antenatal care follow-ups (aOR: 3.3, 95% CI: 1.608-6.589), membranes rupturing for less than 24 hours (aOR: 4.6, 95% CI: 1.933-11.028), and having fewer pelvic examinations (aOR: 12.1, 95% CI: 2.873-19.131) were determinants of puerperal sepsis. Conclusion: The study found that several factors were associated with puerperal sepsis, including irregular antenatal care attendance, fewer antenatal follow-ups, delayed membrane rupture, and fewer pelvic examinations. To address this issue, healthcare providers and policymakers should prioritize improving access to quality antenatal care, empowering mothers through education and enhancing maternal education, and implementing evidence-based guidelines for managing obstetric complications. Case-control Determinants Eastern Ethiopia Mothers Puerperal sepsis Somali Regional State INTRODUCTION Puerperal sepsis remains a serious and life-threatening infection that impacts women during the postpartum period, especially in low-resource settings such as Ethiopia [ 1 ]. It is a major contributor to maternal morbidity and mortality worldwide, accounting for around 11% of maternal deaths, with the highest incidence in developing countries where access to quality maternal healthcare is limited [ 2 ]. It is estimated that there are between 15 to 19 million cases of maternal sepsis annually, resulting in approximately 75,000 maternal deaths, making it a significant public health concern [ 3 – 5 ]. In Africa, the prevalence of puerperal sepsis is higher than the global average, ranging from 8–15% [ 6 , 7 ]. In Ethiopia, where maternal mortality rates remain high despite recent improvements in healthcare access and quality, puerperal sepsis is the fourth leading cause of maternal mortality, contributing for 13% of all maternal death [ 8 , 9 ]. According to the 2016 Ethiopia Demographic and Health Survey (EDHS) report, the maternal mortality ratio was 412 per 100,000 live births. Therefore, four women died during pregnancy, childbirth, or within two months of giving birth for every 1,000 live births [ 10 ]. Puerperal sepsis is a significant public health concern in Jigjiga Public hospitals, Somali Regional State, Eastern Ethiopia, where it is associated with high maternal morbidity and mortality rates. Despite this, there is limited understanding of the determinants of puerperal sepsis in this setting. Identifying the determinants of puerperal sepsis is crucial for the development of targeted interventions to reduce its incidence and improve maternal outcomes. This study investigated the determinants of puerperal sepsis among mothers who give birth at Jigjiga Public Hospitals in Jigjiga, Somali Regional State, eastern Ethiopia. METHODS Study Design, Period and Setting This study employed a facility-based unmatched case-control design to investigate the determinants of puerperal sepsis among mothers who delivered at Jigjiga public hospitals between January 2022 and December 2022. The Somali Regional State is a regional state located in eastern Ethiopia, which holds the second-largest territory in the country after the Oromia Region. It is bordered by the Ethiopian regions of Afar and Oromia to the west, Djibouti to the north, Somalia to the northeast, east, and south, and Kenya to the southwest. Jigjiga is the capital city, located 621 kilometers from Addis Ababa, Ethiopia's capital city. The city has a population of approximately 304,400 people, comprising 151,422 males and 153,578 females [ 11 ]. The study was conducted at two public hospitals in Jigjiga, specifically Sultan Sheikh Hassan Yabare Comprehensive Specialized Hospital and Karamara General Hospital. These hospitals provide health services to the local community as well as serving an estimated population of more than 7 million people living in the region, including neighboring districts of the Oromia region, region in northern Somalia (approximately 3.5-5 million according to the standard). The hospitals are responsible for training, teaching, and research for Jigjiga University's College of Medicine and Health Sciences, as well as internship training for students from other health science colleges in the region. Study Population The study population comprised all postpartum mothers who delivered at Jigjiga Public hospitals over a 12-month period. The case group consisted of mothers who were admitted with puerperal sepsis, while the control group comprised mothers who did not develop puerperal sepsis and remained hospitalized for more than 24 hours. Eligibility Criteria Cases Postpartum mothers who developed puerperal sepsis within 24 hours after delivery or within 42 days after delivery admitted to Jigjiga Public hospitals during the data collection period were included in the study. Postpartum mothers who had a history of previous puerperal sepsis, who had pre-existing medical conditions, and who had incomplete or inaccurate medical records admitted to Jigjiga Public hospitals during the data collection period were excluded from the study. Controls Postpartum mothers who did not develop puerperal sepsis within 24 hours after delivery or within 42 days after delivery, gave birth normally, had a normal pregnancy outcome admitted to Jigjiga Public hospitals during the data collection period were included in the study. Sample Size Determination The sample size was determined using the double population proportion formula, with Epi Info 7, taking into account the prevalence of puerperal sepsis based on a previous study in West Ethiopia [ 12 ], the desired level of precision (5%), a power of 80%, and an expected odds ratio of 3.4. Therefore, the calculated sample size was calculated to be 216 (72 cases and 144 controls), and considering a 5% non-response rate, the final sample size for this study was 227 (76 cases and 151 controls). Sampling Procedure Consecutive sampling was used to select cases from postpartum mothers with puerperal sepsis admitted to the maternity wards of the two public hospitals Sultan Sheikh Hassan Yabare Comprehensive Specialized Hospital and Karamara General Hospital. The total sample size was allocated proportionally to each hospital based on the number of registered puerperal sepsis cases in each hospital. Cases were selected from the medical records of mothers who had developed puerperal sepsis during their postpartum stay. Controls were selected from the same population, but were mothers who did not develop puerperal sepsis during their postpartum stay. Every third case of puerperal sepsis and every third mother without puerperal sepsis were selected from the hospital records until the desired sample size was reached. Data Collection Tool and Procedure A standardized questionnaire was utilized to collect data for this study, which was adapted from a previous study conducted in Ethiopia [ 4 , 8 , 13 ]. The questionnaire was initially developed in English and subsequently translated into Somali language, followed by a back-translation into English by independent language experts to ensure consistency between the two versions. The questionnaire comprehensively covers all relevant information necessary to meet the objectives of the study, categorized into the following sections: socio-demographic characteristics, obstetric factors, and maternal and co-morbidities. All collected data were recorded on a specially designed data collection sheet for the study. A team of trained data collectors and supervisors was recruited for this study. Two midwives and two nurses served as data collectors, while a health officer acted as a supervisor. Prior to data collection, a comprehensive one-day training session was conducted by the principal investigator, emphasizing the study's objectives, data recording methods, data quality control measures, and confidentiality protocols. The training also covered the contents of the questionnaire and the approach to be taken when interacting with study participants (cases and controls), with the aim of minimizing information bias and ensuring high-quality data collection. Data Quality Control To assure the quality of data, adequate training was given to data collectors and supervisor for one-day duration, the objective of the training is to clearly explain data collectors and supervisor the objective of the study to strengthen their skills about how to interview and approach with the study participants during the actual data collection. The questioners were pre-tested on 5% (4 Cases and 8 Controls) of the total sample size at Jigjiga public hospitals. The Questionnaires were checked for their completeness, validity and consistency by the principal investigator. Data Analysis The collected and cleaned data were subsequently entered into Epi data version 3.1 and exported to SPSS version 26 for analysis. Descriptive statistics were performed to examine the distribution of variables, and the results were presented in text, frequency tables, and proportion formats. The Pearson Chi-square test was employed to identify the determinants of puerperal sepsis among mothers who gave birth in Jigjiga public hospitals. Binary logistic regression analysis was conducted to investigate the relationship between puerperal sepsis and the explanatory variables. Variables with a p-value less than 0.25 in the bivariate analysis were selected as candidate variables for multivariate logistic regression modeling to account for confounding variables. The model fitness was subsequently assessed using the Hosmer-Lemeshow test. The strength of the associations between independent and dependent variables was evaluated using odds ratios with 95% confidence intervals. Finally, a statistically significant level was declared at a p-value less than 0.05. RESULTS Sociodemographic Characteristics of the Study Participants A total of 227 participants were included in the study, with 76 cases and 151 controls. The mean age of the mothers was 30.2 ± 10.2 years for cases and 31.5 ± 6.7 years for controls. A majority of mothers, 37 (16.3%) of cases and 86 (37.9%) of controls were between the ages of 25–34 years. A significant proportion, 62 (27.3%) of cases and about half, 123 (54.2%), of controls, were married. Most of the participants, 32 (14.1%) of cases and 55 (24.2%) of controls, had no formal education. The majority of the participants, 43 (19.0%) cases and 87 (38.3%) controls, resided in urban areas. ( Table 1 ) Table 1 Socio-demographic characteristics of mothers who gave birth in Jigjiga public hospitals, Eastern Ethiopia, 2023 (n = 227) Variables Puerperal sepsis status Total N (%) Cases N (%) Controls N (%) Age of the mother (In years) 15–24 18 (7.9%) 19 (8.4%) 37 (16.3%) 25–34 37 (16.3%) 86 (37.9%) 123 (54.2%) 35–44 19 (8.4%) 43 (18.9%) 62 (27.3%) > 44 2 (0.9%) 3 (1.35%) 5 (2.2%) Marital Status Married 62 (27.3%) 123 (54.2%) 185 (81.5%) Divorced 10 (4.4%) 18 (7.9%) 28 (12.3%) Widowed 4 (2.5%) 10 (4.4%) 14 (6.2%) Educational Level No Formal 32 (14.1%) 55 (24.2%) 87 (38.3%) Primary 15 (6.6%) 36 (15.9%) 51 (22.5%) Secondary 16 (7.0%) 32 (14.1%) 48 (21.1%) University/tertiary 13 (5.8%) 28 (12.3%) 41 (18.2%) Residence Urban 43 (19.0%) 87 (38.3%) 130 (57.3%) Rural 33 (14.5%) 64 (28.2%) 97 (42.7%) Obstetric Characteristics of the Study Participants Around a quarter of the cases 54 (23.8%) and nearly half of the controls 108 (47.6%) were grand multiparous. Approximately one-quarter of cases 59 (26.0%) and more than half of controls 117 (51.5%) had received antenatal care (ANC) services. Of those who received ANC follow-up, in most cases 22 (9.7%) and controls 72 (31.7%) visited ANC three or more times. Regarding the duration of labor, 41 (18.0%) of cases and 76 (33.5%) of controls had experienced labor lasting 24 hours or more. The majority of mothers, 59 (26.0%) of cases and 83 (36.6%) of controls, had a duration of rupture of membrane of less than 24 hours. Most cases (71, 31.3%) and controls (116, 51.1%) had pelvic examinations performed fewer than five times. The majority of mothers, 49 (21.6%) of cases and 115 (50.6%) of controls, had spontaneous vaginal deliveries. 49 (21.6%) of cases and 54 (23.8%) of controls underwent episiotomy. A significant proportion of mothers, 62 (27.3%) of cases and 134 (59.0%) of controls, delivered in hospitals. Regarding previous obstetric history, 18 (7.9%) of cases and 28 (12.4%) of controls had a history of bad obstetric outcomes. Additionally, 14 (6.2%) of cases and 24 (10.5%) of controls were referred from other healthcare facilities before giving birth. Among the study population, the majority of cases 56 (24.7%) and controls 123 (54.2%) did not have hypertension. Similarly, most cases 51 (22.5%) and controls 130 (57.2%) did not have diabetic mellitus. Additionally, nearly one-third of the cases 29 (12.8%) and half of the controls 114 (50.2%) had a history of sexually transmitted infections. Furthermore, 58 (25.5%) of the cases and 63 (27.8%) of the controls had anemia. ( Table 2 ). Table 2 Obstetric characteristics among mothers who gave birth in Jigjiga public hospitals, Eastern Ethiopia, 2023 (n = 227) Variables Puerperal sepsis status Total N (%) Cases N (%) Controls N (%) Parity Primiparous 9 (4.0) 14 (6.1) 23 (10.1) Multiparous 13 (5.7) 29 (12.8) 42 (18.5) Grand Multiparous 54 (23.8) 108 (47.6) 162 (71.4) ANC follow up Yes 59 (26.0) 117 (51.5) 176 (77.5) No 17 (7.5) 34 (15.0) 51 (22.5) Number of ANC follow up (n = 176) ≤ 2 times 37 (16.3) 45 (19.8) 82 (36.1) ≥ 3 times 22 (9.7) 72 (31.7) 94 (41.4) Duration of labor < 24 hours 35 (15.4) 75 (33.1) 110 (48.5) ≥ 24 hours 41 (18.0) 76 (33.5) 117 (51.5) Duration of rupture of membrane < 24 hours 59 (26.0) 83 (36.6) 142 (62.6) ≥ 24 hours 17 (7.5) 68 (29.9) 85 (37.4%) Number of pelvic examinations < 5 times 71 (31.3) 116 (51.1) 187 (82.4) ≥ 5 times 5 (2.2) 35 (15.4) 40 (17.6) Mode of delivery Spontaneous vaginal delivery 49 (21.6) 115 (50.6) 164 (72.2) Instrumental delivery 20 (8.8) 17 (7.5) 37 (16.3) Cesarean section 7 (3.1) 19 (8.4) 26 (11.5) Episiotomy Yes 39 (17.2) 54 (23.8) 93 (41.0) No 37 (16.3) 97 (42.7) 134 (59.0) Place of delivery Home 14 (6.2) 17 (7.5) 31 (13.7) Hospital 62 (27.3) 134 (59.0) 196 (86.3) Any previous bad obstetric history Yes 18 (7.9) 28 (12.4) 46 (20.3) No 58 (25.5) 123 (54.2) 181 (79.7) Referral status Yes 14 (6.2) 24 (10.5) 38 (16.7) No 62 (27.3) 127 (56.0) 189 (83.3) Hypertension Yes 20 (8.8) 28 (12.3) 48 (21.1) No 56 (24.7) 123 (54.2) 179 (78.9) Diabetic mellitus Yes 25 (11.0) 21 (9.3) 46 (20.3) No 51 (22.5) 130 (57.2) 181 (79.7) Sexual transmitted infection Yes 29 (12.8) 37 (16.3) 66 (29.1) No 47 (20.7) 114 (50.2) 161 (70.9) Anemia Yes 58 (25.5) 63 (27.8) 121 (53.3) No 18 (7.9) 88 (38.8) 106 (46.7) Determinants of puerperal sepsis The study found that mothers who were married were twice as likely to develop puerperal sepsis as those who were divorced (aOR: 2.0, 95%CI: 0.318–7.553). Similarly, mothers with primary education were twice as likely to develop puerperal sepsis as those with no formal education (aOR: 1.6, 95% CI: 0.232–10.588). The results also revealed that multiparous women were three times more likely to develop puerperal sepsis compared to primiparous women (those who have had only one pregnancy) (aOR: 2.8, 95% CI: 0.714–5.210). Furthermore, women who did not attend antenatal care (ANC) were three times more likely to develop puerperal sepsis compared to those who attended ANC (aOR: 3.2, 95% CI: 1.483–6.940). Additionally, women who had fewer than three ANC follow-ups were three times more likely to develop puerperal sepsis compared to those who had three or more ANC follow-ups (aOR: 3.3, 95% CI: 1.608–6.589). On the other hand, women whose membranes ruptured for less than 24 hours were five times more likely to develop puerperal sepsis compared to those whose membranes ruptured for 24 hours or more (aOR: 4.6, 95% CI: 1.933–11.028). Mothers who had fewer than five times pelvic examinations were twelve times more likely to develop puerperal sepsis (aOR: 12.1, 95% CI: 2.873–19.131). The study also found that mothers who underwent episiotomy were two times more likely to develop puerperal sepsis compared to those who did not undergo the procedure (aOR: 2.1, 95% CI: 1.009–4.488). Similarly, mothers who did not have a previous bad obstetric history were two times more likely to develop puerperal sepsis compared to those who had a previous bad obstetric history (aOR: 1.8, 95% CI: 0.614–5.557). Mothers who were not referred have a three times higher risk of developing puerperal sepsis compared to those who were referred (aOR: 2.5, 95% CI: 0.936–6.503). Mothers with hypertension had a two times higher risk of developing the condition compared to those without hypertension (aOR: 1.5, 95% CI: 0.587–3.882). ( Table 3 ) Table 3 Determinants of puerperal sepsis among mothers who gave birth in Jigjiga public hospitals, Eastern Ethiopia, 2023 (n = 227) Variables Puerperal sepsis status Total N (%) Odd Ratio (95% CI) Cases N (%) Controls N (%) COR (95% CI) AOR (95% CI) Age of the mother (In years) 15–24 18 (7.9) 19 (8.4) 37 (16.3) 0.7 (0.105–2.713) 0.08 (0.006–1.111) 25–34 37 (16.3) 86 (37.9) 123 (54.2) 1.6 (0.249–3.662) 0.6 (0.050–6.403) 35–44 19 (8.4) 43 (18.9) 62 (27.3) 1.5 (0.233–2.778) 0.3 (0.029–4.117) > 44 2 (0.9) 3 (1.35) 5 (2.2) 1 1 Marital Status Married 62 (27.3) 123 (54.2) 185 (81.5) 0.8 (0.239–2.632) 1.6 (0.318–7.553) Divorced 10 (4.4) 18 (7.9) 28 (12.3) 0.7 (0.179–2.901) 0.9 (0.151–6.038) Widowed 4 (2.5) 10 (4.4) 14 (6.2) 1 1 Educational Level No Formal 32 (14.1) 55 (24.2) 87 (38.3) 0.8 (0.363–1.757) 0.7 (0.099–5.536) Primary 15 (6.6) 36 (15.9) 51 (22.5) 1.1 (0.457–2.719) 1.6 (0.232–10.588) Secondary 16 (7.0) 32 (14.1) 48 (21.1) 0.9 (0.381–2.262) 1.5 (0.213–2.835) University/tertiary 13 (5.8) 28 (12.3) 41 (18.2) 1 1 Residence Urban 43 (19.0) 87 (38.3) 130 (57.3) 1 1 Rural 33 (14.5) 64 (28.2) 97 (42.7) 0.9 (0.549–1.673) 0.9 (0.438–2.218) Parity Primiparous 9 (4.0) 14 (6.1) 23 (10.1) 1 1 Multiparous 13 (5.7) 29 (12.8) 42 (18.5) 1.4 (0.496–4.150) 2.8 (0.714–5.210) Grand Multiparous 54 (23.8) 108 (47.6) 162 (71.4) 1.3 (0.523–3.159) 1.9 (0.591–6.372) ANC follow up Yes 59 (26.0) 117 (51.5) 176 (77.5) 1 1 No 17 (7.5) 34 (15.0) 51 (22.5) 1.01 (0.521–1.953) 3.2 (1.483–6.940) * Number of ANC follow up (n = 176) ≤ 2 times 37 (16.3) 45 (19.8) 82 (36.1) 1 1 ≥ 3 times 22 (9.7) 72 (31.7) 94 (41.4) 2.7 (1.411–5.133) 3.3 (1.608–6.589) * Duration of labor < 24 hours 35 (15.4) 75 (33.1) 110 (48.5) 1.2 (0.665–2.009) 1.1 (0.475-2.300) ≥ 24 hours 41 (18.0) 76 (33.5) 117 (51.5) 1 1 Duration of rupture of membrane < 24 hours 59 (26.0) 83 (36.6) 142 (62.6) 2.4 (1.224–4.646) 4.6 (1.933–11.028) * ≥ 24 hours 17 (7.5) 68 (29.9) 85 (37.4) 1 1 Number of pelvic examinations < 5 times 71 (31.3) 116 (51.1) 187 (82.4) 1 1 ≥ 5 times 5 (2.2) 35 (15.4) 40 (17.6) 4.3 (1.604–11.444) 12.1 (2.873–19.131) * Mode of delivery Spontaneous vaginal delivery 49 (21.6) 115 (50.6) 164 (72.2) 1 Instrumental delivery 20 (8.8) 17 (7.5) 37 (16.3) 0.4 (0.175–0.750) 0.2 (0.049–0.493) * Cesarean section 7 (3.1) 19 (8.4) 26 (11.5) 1.2 (0.457–2.928) 1.1 (0.301–4.077) Episiotomy Yes 39 (17.2) 54 (23.8) 93 (41.0) 1 1 No 37 (16.3) 97 (42.7) 134 (59.0) 1.9 (1.082–3.313) 2.1 (1.009–4.488) Place of delivery Home 14 (6.2) 17 (7.5) 31 (13.7) 0.6 (0.260–1.212) 0.5 (0.181–1.580) Hospital 62 (27.3) 134 (59.0) 196 (86.3) 1 1 Any previous bad obstetric history Yes 18 (7.9) 28 (12.4) 46 (20.3) 1 1 No 58 (25.5) 123 (54.2) 181 (79.7) 1.4 (0.698–2.663) 1.8 (0.614–5.557) Referral status Yes 14 (6.2) 24 (10.5) 38 (16.7) 1 1 No 62 (27.3) 127 (56.0) 189 (83.3) 1.2 (0.578–2.469) 2.5 (0.936–6.503) Hypertension Yes 20 (8.8) 28 (12.3) 48 (21.1) 0.6 (0.331–1.227) 1.5 (0.587–3.882) No 56 (24.7) 123 (54.2) 179 (78.9) 1 1 Diabetic mellitus Yes 25 (11.0) 21 (9.3) 46 (20.3) 0.3 (0.170–0.640) 0.4 (0.166–0.990) No 51 (22.5) 130 (57.2) 181 (79.7) 1 1 Sexual transmitted infection Yes 29 (12.8) 37 (16.3) 66 (29.1) 0.5 (0.291–0.952) 0.7 (0.310–1.803) No 47 (20.7) 114 (50.2) 161 (70.9) 1 1 Anemia Yes 58 (25.5) 63 (27.8) 121 (53.3) 0.2 (0.120–0.413) 0.3 (0.122–0.615) No 18 (7.9) 88 (38.8) 106 (46.7) 1 1 *P Value < 0.05 DISCUSSION The present study investigated the determinants of puerperal sepsis among mothers who gave birth at Jigjiga public hospitals in Eastern Ethiopia. The results indicate that being married, having primary education, being grand multiparous, not attending antenatal care (ANC), having fewer than three ANC follow-ups, and having membranes rupture for 24 hours or more are all independent predictors of puerperal sepsis. The results showed that married mothers were more likely to develop puerperal sepsis compared to divorced mothers. This may be due to the fact that married women may be more likely to have a higher parity, which is a known risk factor for puerperal sepsis. This finding is supported by a study in Nigeria [ 14 ]. Similarly, mothers with primary education were more likely to develop puerperal sepsis compared to those with no formal education, which is consistent with a study conducted in Ethiopia [ 15 , 16 ]. The results also revealed that grand multiparous women were more likely to develop puerperal sepsis compared to primiparous women. This may be due to the fact that grand multiparous women may be more likely to experience placental abruption, placenta previa, and other complications that increase their risk of developing puerperal sepsis. This is consistent with previous study conducted in Ethiopia [ 17 ] and Nepal [ 18 ]. The study also found that women who did not attend antenatal care (ANC) were more likely to develop puerperal sepsis compared to those who attended ANC. ANC attendance is an important indicator of the quality of prenatal care, and women who do not attend ANC may be more likely to experience complications during pregnancy and childbirth. This is in line with previous research conducted in Ethiopia [ 19 ]. Similarly, the finding that women who had fewer than three ANC follow-ups were three times more likely to develop puerperal sepsis compared to those who had three or more ANC follow-ups suggests that frequent ANC attendance is an important factor in reducing the risk of puerperal sepsis. Women who had fewer than five times pelvic examinations were twelve times more likely to develop puerperal sepsis. This suggests that inadequate prenatal care and lack of provider-patient interaction may contribute to the development of puerperal sepsis. This is consistent with a study conducted in Uganda [ 20 ]. The study also found that women whose membranes ruptured for less than 24 hours were more likely to develop puerperal sepsis compared to those whose membranes ruptured for 24 hours and more. This is supported by previous research conducted in Kenya [ 21 ]. The study found that mothers who underwent episiotomy were two times more likely to develop puerperal sepsis compared to those who did not undergo the procedure. Episiotomy can cause lacerations and trauma to the perineum, which can provide a portal of entry for bacteria and increase the risk of infection. This finding is consistent with previous study in Ethiopia [ 22 , 23 ]. The study also found that mothers who did not have a previous bad obstetric history were two times more likely to develop puerperal sepsis compared to those who had a previous bad obstetric history. This may be because women who have had previous complications during pregnancy or childbirth may be more aware of their risk factors and take steps to prevent complications during subsequent pregnancies, such as seeking antenatal care and delivering in a hospital setting. This is consistent with the study conducted in Kenya[ 21 ] and India [ 24 ]. Moreover, the study found that mothers who were not referred were three times more likely to develop puerperal sepsis compared to those who were referred. This suggests that delayed or inadequate referral for medical attention may contribute to the development of puerperal sepsis. This finding is supported by a study conducted in Uganda [ 25 ], and Ethiopia [ 26 ]. Conclusion The present study identified several significant determinants of puerperal sepsis among mothers who gave birth at Jigjiga public hospitals in Somali Regional State, Eastern Ethiopia. The analysis of this study indicated that not attending antenatal care regularly, having fewer antenatal care follow-ups, membranes rupturing for less than 24 hours, having fewer pelvic examinations, undergoing episiotomy, not having a previous bad obstetric history, being not referred for further care, and having hypertension were all identified as determinants of puerperal sepsis. Healthcare providers and policymakers should prioritize improving access to quality antenatal care, enhancing maternal education and empowerment, and implementing evidence-based guidelines for managing obstetric complications. Furthermore, community-based education campaigns should be implemented to raise awareness about the importance of antenatal care and proper hygiene practices during childbirth. Abbreviations AOR Adjusted Odds Ratio ANC Antenatal Care CI Confidence Interval EDH S Ethiopia Demographic and Health Survey IRB Institutional Review Board OR Odds Ratio SPSS Statistical Package for the Social Sciences WHO World Health Organization Declarations Ethical Considerations This study was approved by the by the Institutional Review Board (IRB) of Jigjiga University, Jigjiga, Eastern EthiopIa [HRERC/088/2022]. Written permission was secured from the relevant authorities of the study settings, including Sultan Sheik Hassan Yabare Comprehensive Specialized Hospital and Karamara General Hospital. Informed consent was obtained from all participants prior to data collection. For participants under 18 years of age, written assent was obtained from their and consent from their guardian. The data collectors were instructed to maintain patient confidentiality throughout the data collection process. To ensure the confidentiality of participants, personal identifiers such as names were not used, and codes were employed instead. Participants were informed of their right to refuse or terminate participation at any point during the interview. Consent for Publication No applicable. Availability of Data and Materials The datasets generated and analyzed during the current study are available from the corresponding authors upon reasonable request. Competing Interests The authors declare that they have no competing interests regarding the conduct of this study or the publication of its findings. Funding This research did not receive any specific grant from funding for the publication of this article. Authors' Contributions H.N.A., A.A.T., M.A.M., and A.M.I. Conceptualization of the study, methodology, data collection, performed statistical analysis, interpretation and drafted the manuscript. F.I.D., T.G., and C.D.U provided critical insights and revisions to the final manuscript. All authors reviewed and approved the final version prior to submission. Acknowledgment The authors would like to express their gratitude to the health workers at Jigjiga public hospitals for their invaluable support during data collection. We also acknowledge the study participants for their willingness to share their experiences and contribute to this research. References Nayak, A.H., Khade, S.A.: Obstetric Sepsis: A Review Article. Journal of Obstetrics and Gynecology of India. 72, 470–478 (2022). https://doi.org/10.1007/s13224-022-01706-y Say, L., Chou, D., Gemmill, A., Tunçalp, Ö., Moller, A.B., Daniels, J., Gülmezoglu, A.M., Temmerman, M., Alkema, L.: Global causes of maternal death: A WHO systematic analysis. Lancet Glob Health. 2, (2014). https://doi.org/10.1016/S2214-109X(14)70227-X Van Dillen, J., Zwart, J., Schutte, J., Van Roosmalen, J.: Maternal sepsis: Epidemiology, etiology and outcome. Curr Opin Infect Dis. 23, 249–254 (2010). https://doi.org/10.1097/QCO.0b013e328339257c Tesfaye, T., Samuel, S., Lera, T.: Determinants of puerperal sepsis among postpartum women at public hospitals of Hawassa city, Southern Ethiopia: Institution-based unmatched case-control study. Heliyon. 9, (2023). https://doi.org/10.1016/j.heliyon.2023.e14809 Arulkumaran, N., Singer, M.: Puerperal sepsis. Best Pract Res Clin Obstet Gynaecol. 27, 893–902 (2013). https://doi.org/10.1016/j.bpobgyn.2013.07.004 AD Kearns, J.C.P. ten H.-B.A.L.: Antenatal and postnatal care: a review of innovative models for improving availability, accessibility, acceptability and quality of services in low-resource settings. BJOG. 123, 558 (2016). https://doi.org/10.1111/1471-0528.13937 Fatouh Abdel, E., -Nora Mansour Abdel, fattah, Eid Farrag -, hak, Abd El, R.: The Effect of Instructional Guidelines Regarding Puerperal Sepsis Prevention on the Knowledge and Practice of Postpartum Mothers. Helwan International Journal for Nursing Research and Practice. 1, (2022) Melkie, A., Dagnew, E.: Burden of puerperal sepsis and its associated factors in Ethiopia: a systematic review and meta-analysis. Archives of Public Health. 79, (2021). https://doi.org/10.1186/s13690-021-00732-y Berhe, A.K., Kassa, G.M., Fekadu, G.A., Muche, A.A.: Prevalence of hypertensive disorders of pregnancy in Ethiopia: A systemic review and meta-analysis. BMC Pregnancy Childbirth. 18, (2018). https://doi.org/10.1186/s12884-018-1667-7 Fekadu, G.A., Ambaw, F., Kidanie, S.A.: Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: Further analysis of the 2016 demographic and health survey. BMC Pregnancy Childbirth. 19, (2019). https://doi.org/10.1186/s12884-019-2216-8 Hailemariam, S.N., Soromessa, T., Teketay, D.: Land use and land cover change in the bale mountain eco-region of Ethiopia during 1985 to 2015. Land (Basel). 5, (2016). https://doi.org/10.3390/land5040041 Kitessa, S.G., Teferi Bala, E., Makuria, M., Deriba, B.S.: Determinants of puerperal sepsis at public hospitals in West Ethiopia: A case-control study. Health N Hav. 6, 2021. https://doi.org/10.15761/FWH.1000207 Demisse, G.A., Sifer, S.D., Kedir, B., Fekene, D.B., Bulto, G.A.: Determinants of puerperal sepsis among post partum women at public hospitals in west SHOA zone Oromia regional STATE, Ethiopia (institution BASEDCASE control study). BMC Pregnancy Childbirth. 19, (2019). https://doi.org/10.1186/s12884-019-2230-x A.S. Olutoye, A.D.A.O.O.B.: Puerperal sepsis at university college hospital, Ibadan, Nigeria: a 10-year review. Ann Ib Postgrad Med. 20, 32–39 (2022) Demisse, G.A., Sifer, S.D., Kedir, B., Fekene, D.B., Bulto, G.A.: Determinants of puerperal sepsis among postpartum women at public hospitals in west SHOA zone Oromia regional STATE, Ethiopia (institution BASEDCASE control study). BMC Pregnancy Childbirth. 19, (2019). https://doi.org/10.1186/s12884-019-2230-x Seboka, K., Gurara, A.M., Bekele, N.T., Belachwe, Y.A., Getahun, M.S., Negussie, Y.M.: Determinants of puerperal sepsis among postpartum women at a tertiary care hospital in Ethiopia: an unmatched case-control study. Contracept Reprod Med. 9, (2024). https://doi.org/10.1186/s40834-024-00283-x Oyato, B.T., Debele, T., Edosa, D., Abasimel, H.Z., Awol, M., Kebede, E.T., Gezahagn, A., Desta, A.A., Alemu, F.T., Asfaw, S.B.: Determinants of puerperal sepsis among postpartum women: a case-control study in East Shoa Zone public hospitals, Central Ethiopia. BMJ Open. 14, e083230 (2024). https://doi.org/10.1136/bmjopen-2023-083230 Pradhan, B., Duwal, S., Singh, A., Bhandary, S., RC, L., Shrestha, R.: Puerperal Sepsis and its Cause in Patan Hospital. Nepal Journal of Obstetrics and Gynaecology. 10, 33–35 (2015). https://doi.org/10.3126/njog.v10i1.13192 Sahle, S.G., Weldemariam, S., Mehari, M. ab, Abraha, T.A.: Determinants of puerperal sepsis among post-partum mothers in Mekelle city public hospitals, Tigray, Ethiopia, 2021: a case control study. BMC Womens Health. 23, (2023). https://doi.org/10.1186/s12905-023-02643-2 Ngonzi, J., Bebell, L.M., Fajardo, Y., Boatin, A.A., Siedner, M.J., Bassett, I. V., Jacquemyn, Y., Van geertruyden, J.P., Kabakyenga, J., Wylie, B.J., Bangsberg, D.R., Riley, L.E.: Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda. BMC Pregnancy Childbirth. 18, (2018). https://doi.org/10.1186/s12884-018-1891-1 Chepchirchir, M. V, Nyamari, J., Keraka, M.: Associated Factors with Puerperal Sepsis among Reproductive Age Women in Nandi County. Kenya. Journal of Midwifery and Reproductive Health. 5, 1032–1040 (2017). https://doi.org/10.22038/JMRH.2017.9348 Anumba, D.O.C., Alemu, A., Addisu, D., Bekele, H., Tamiru, D., Debella, A., Getachew, A., Yohannes, E., Lami, M., Negash, A., Asfaw, H., Ketema, I., Eyeberu, A., Habte, S., Eshetu, B., Getachew, T., Mesfin, S., Birhanu, B., Heluf, H., Kibret, H., Negash, B., Alemu, A., Dessie, Y., Balis, B.: Magnitude of episiotomy practice and associated factors among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. Woretaw, E., Teshome, M., Alene, M.: Episiotomy practice and associated factors among mothers who gave birth at public health facilities in Metema district, northwest Ethiopia. Reprod Health. 18, (2021). https://doi.org/10.1186/s12978-021-01194-9 Goud, N.S., Reddy, M.M., Desai, S.: Incidence and pattern of infections in pregnant women with bad obstetric history. Int J Reprod Contracept Obstet Gynecol. 10, 3846 (2021). https://doi.org/10.18203/2320-1770.ijrcog20213848 Ngonzi, J., Tornes, Y.F., Mukasa, P.K., Salongo, W., Kabakyenga, J., Sezalio, M., Wouters, K., Jacqueym, Y., Van Geertruyden, J.P.: Puerperal sepsis, the leading cause of maternal deaths at a Tertiary University Teaching Hospital in Uganda. BMC Pregnancy Childbirth. 16, (2016). https://doi.org/10.1186/s12884-016-0986-9 Kitessa, S.G., Teferi Bala, E., Makuria, M., Deriba, B.S.: Determinants of puerperal sepsis at public hospitals in West Ethiopia: A case-control study. Front Womens Health. 6, 1–7 (2021). https://doi.org/10.15761/FWH.1000207 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Sep, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 05 Dec, 2024 Reviews received at journal 03 Nov, 2024 Reviewers agreed at journal 19 Oct, 2024 Reviewers agreed at journal 18 Oct, 2024 Reviewers agreed at journal 01 Oct, 2024 Reviews received at journal 19 Sep, 2024 Reviewers agreed at journal 18 Sep, 2024 Reviewers agreed at journal 02 Sep, 2024 Reviewers invited by journal 31 Aug, 2024 Editor assigned by journal 27 Aug, 2024 Submission checks completed at journal 25 Aug, 2024 First submitted to journal 24 Aug, 2024 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board 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-4970368","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":357970370,"identity":"a580febb-9c0c-481d-94b1-2c3d98e28dc1","order_by":0,"name":"Hassan Nur Ali","email":"","orcid":"","institution":"College of Medicine and Health Science, Jigjiga University, Jigjiga","correspondingAuthor":false,"prefix":"","firstName":"Hassan","middleName":"Nur","lastName":"Ali","suffix":""},{"id":357970371,"identity":"ea9c3091-bf93-4859-ae0d-fbed4164546a","order_by":1,"name":"Abdullahi Ahmed Tahlil","email":"data:image/png;base64,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","orcid":"","institution":"National Institute of Health, Ministry of Health and Human Services, Mogadishu","correspondingAuthor":true,"prefix":"","firstName":"Abdullahi","middleName":"Ahmed","lastName":"Tahlil","suffix":""},{"id":357970372,"identity":"0ed24191-8104-4eac-a944-6c90a66b1085","order_by":2,"name":"Mahad Ali Mohamud","email":"","orcid":"","institution":"College of Medicine and Health Science, Jigjiga University, Jigjiga","correspondingAuthor":false,"prefix":"","firstName":"Mahad","middleName":"Ali","lastName":"Mohamud","suffix":""},{"id":357970373,"identity":"783c3e3c-8473-4eab-a1b2-065a8ce2a9d5","order_by":3,"name":"Fuad Ismail Daud","email":"","orcid":"","institution":"College of Medicine and Health Science, Jigjiga University, Jigjiga","correspondingAuthor":false,"prefix":"","firstName":"Fuad","middleName":"Ismail","lastName":"Daud","suffix":""},{"id":357970374,"identity":"cac3d0a2-5cc3-492a-b800-2f5daa867751","order_by":4,"name":"Tesfaye Gobena","email":"","orcid":"","institution":"College of Health and Medical Sciences, Haramaya University, Harar","correspondingAuthor":false,"prefix":"","firstName":"Tesfaye","middleName":"","lastName":"Gobena","suffix":""},{"id":357970375,"identity":"b9ed8520-d0e3-407d-88d3-e09c478e577a","order_by":5,"name":"Chukwuma David Umeokonkwo","email":"","orcid":"","institution":"African Field Epidemiology Network, Kampala","correspondingAuthor":false,"prefix":"","firstName":"Chukwuma","middleName":"David","lastName":"Umeokonkwo","suffix":""},{"id":357970376,"identity":"9c4a28a2-b23d-4eae-8176-4c675888629c","order_by":6,"name":"Ahmed Mohammed Ibrahim","email":"","orcid":"","institution":"College of Medicine and Health Science, Jigjiga University, Jigjiga","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"Mohammed","lastName":"Ibrahim","suffix":""}],"badges":[],"createdAt":"2024-08-24 18:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4970368/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4970368/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-025-08054-5","type":"published","date":"2025-09-02T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90828043,"identity":"64f4ba09-ad1e-4b5e-96be-3f266b684be1","added_by":"auto","created_at":"2025-09-08 16:05:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1610941,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4970368/v1/68d071fb-f2ab-4747-a9f4-8f0debc20fc3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of puerperal sepsis among mothers who give birth at Jigjiga public hospitals, Somali Regional State, Eastern Ethiopia","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePuerperal sepsis remains a serious and life-threatening infection that impacts women during the postpartum period, especially in low-resource settings such as Ethiopia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is a major contributor to maternal morbidity and mortality worldwide, accounting for around 11% of maternal deaths, with the highest incidence in developing countries where access to quality maternal healthcare is limited [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is estimated that there are between 15 to 19\u0026nbsp;million cases of maternal sepsis annually, resulting in approximately 75,000 maternal deaths, making it a significant public health\u003c/p\u003e \u003cp\u003econcern [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Africa, the prevalence of puerperal sepsis is higher than the global average, ranging from 8\u0026ndash;15% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In Ethiopia, where maternal mortality rates remain high despite recent improvements in healthcare access and quality, puerperal sepsis is the fourth leading cause of maternal mortality, contributing for 13% of all maternal death [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. According to the 2016 Ethiopia Demographic and Health Survey (EDHS) report, the maternal mortality ratio was 412 per 100,000 live births. Therefore, four women died during pregnancy, childbirth, or within two months of giving birth for every 1,000 live births [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Puerperal sepsis is a significant public health concern in Jigjiga Public hospitals, Somali Regional State, Eastern Ethiopia, where it is associated with high maternal morbidity and mortality rates. Despite this, there is limited understanding of the determinants of puerperal sepsis in this setting. Identifying the determinants of puerperal sepsis is crucial for the development of targeted interventions to reduce its incidence and improve maternal outcomes. This study investigated the determinants of puerperal sepsis among mothers who give birth at Jigjiga Public Hospitals in Jigjiga, Somali Regional State, eastern Ethiopia.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design, Period and Setting\u003c/h2\u003e \u003cp\u003eThis study employed a facility-based unmatched case-control design to investigate the determinants of puerperal sepsis among mothers who delivered at Jigjiga public hospitals between January 2022 and December 2022. The Somali Regional State is a regional state located in eastern Ethiopia, which holds the second-largest territory in the country after the Oromia Region. It is bordered by the Ethiopian regions of Afar and Oromia to the west, Djibouti to the north, Somalia to the northeast, east, and south, and Kenya to the southwest. Jigjiga is the capital city, located 621 kilometers from Addis Ababa, Ethiopia's capital city. The city has a population of approximately 304,400 people, comprising 151,422 males and 153,578 females [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The study was conducted at two public hospitals in Jigjiga, specifically Sultan Sheikh Hassan Yabare Comprehensive Specialized Hospital and Karamara General Hospital. These hospitals provide health services to the local community as well as serving an estimated population of more than 7\u0026nbsp;million people living in the region, including neighboring districts of the Oromia region, region in northern Somalia (approximately 3.5-5\u0026nbsp;million according to the standard). The hospitals are responsible for training, teaching, and research for Jigjiga University's College of Medicine and Health Sciences, as well as internship training for students from other health science colleges in the region.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eThe study population comprised all postpartum mothers who delivered at Jigjiga Public hospitals over a 12-month period. The case group consisted of mothers who were admitted with puerperal sepsis, while the control group comprised mothers who did not develop puerperal sepsis and remained hospitalized for more than 24 hours.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEligibility Criteria\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eCases\u003c/strong\u003e \u003cp\u003ePostpartum mothers who developed puerperal sepsis within 24 hours after delivery or within 42 days after delivery admitted to Jigjiga Public hospitals during the data collection period were included in the study. Postpartum mothers who had a history of previous puerperal sepsis, who had pre-existing medical conditions, and who had incomplete or inaccurate medical records admitted to Jigjiga Public hospitals during the data collection period were excluded from the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eControls\u003c/strong\u003e \u003cp\u003ePostpartum mothers who did not develop puerperal sepsis within 24 hours after delivery or within 42 days after delivery, gave birth normally, had a normal pregnancy outcome admitted to Jigjiga Public hospitals during the data collection period were included in the study.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSample Size Determination\u003c/h2\u003e \u003cp\u003eThe sample size was determined using the double population proportion formula, with Epi Info 7, taking into account the prevalence of puerperal sepsis based on a previous study in West Ethiopia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], the desired level of precision (5%), a power of 80%, and an expected odds ratio of 3.4. Therefore, the calculated sample size was calculated to be 216 (72 cases and 144 controls), and considering a 5% non-response rate, the final sample size for this study was 227 (76 cases and 151 controls).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSampling Procedure\u003c/h2\u003e \u003cp\u003eConsecutive sampling was used to select cases from postpartum mothers with puerperal sepsis admitted to the maternity wards of the two public hospitals Sultan Sheikh Hassan Yabare Comprehensive Specialized Hospital and Karamara General Hospital. The total sample size was allocated proportionally to each hospital based on the number of registered puerperal sepsis cases in each hospital. Cases were selected from the medical records of mothers who had developed puerperal sepsis during their postpartum stay. Controls were selected from the same population, but were mothers who did not develop puerperal sepsis during their postpartum stay. Every third case of puerperal sepsis and every third mother without puerperal sepsis were selected from the hospital records until the desired sample size was reached.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Tool and Procedure\u003c/h2\u003e \u003cp\u003eA standardized questionnaire was utilized to collect data for this study, which was adapted from a previous study conducted in Ethiopia [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The questionnaire was initially developed in English and subsequently translated into Somali language, followed by a back-translation into English by independent language experts to ensure consistency between the two versions. The questionnaire comprehensively covers all relevant information necessary to meet the objectives of the study, categorized into the following sections: socio-demographic characteristics, obstetric factors, and maternal and co-morbidities. All collected data were recorded on a specially designed data collection sheet for the study. A team of trained data collectors and supervisors was recruited for this study. Two midwives and two nurses served as data collectors, while a health officer acted as a supervisor. Prior to data collection, a comprehensive one-day training session was conducted by the principal investigator, emphasizing the study's objectives, data recording methods, data quality control measures, and confidentiality protocols. The training also covered the contents of the questionnaire and the approach to be taken when interacting with study participants (cases and controls), with the aim of minimizing information bias and ensuring high-quality data collection.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eData Quality Control\u003c/h2\u003e \u003cp\u003eTo assure the quality of data, adequate training was given to data collectors and supervisor for one-day duration, the objective of the training is to clearly explain data collectors and supervisor the objective of the study to strengthen their skills about how to interview and approach with the study participants during the actual data collection. The questioners were pre-tested on 5% (4 Cases and 8 Controls) of the total sample size at Jigjiga public hospitals. The Questionnaires were checked for their completeness, validity and consistency by the principal investigator.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe collected and cleaned data were subsequently entered into Epi data version 3.1 and exported to SPSS version 26 for analysis. Descriptive statistics were performed to examine the distribution of variables, and the results were presented in text, frequency tables, and proportion formats. The Pearson Chi-square test was employed to identify the determinants of puerperal sepsis among mothers who gave birth in Jigjiga public hospitals. Binary logistic regression analysis was conducted to investigate the relationship between puerperal sepsis and the explanatory variables. Variables with a p-value less than 0.25 in the bivariate analysis were selected as candidate variables for multivariate logistic regression modeling to account for confounding variables. The model fitness was subsequently assessed using the Hosmer-Lemeshow test. The strength of the associations between independent and dependent variables was evaluated using odds ratios with 95% confidence intervals. Finally, a statistically significant level was declared at a p-value less than 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic Characteristics of the Study Participants\u003c/h2\u003e \u003cp\u003eA total of 227 participants were included in the study, with 76 cases and 151 controls. The mean age of the mothers was 30.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2 years for cases and 31.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7 years for controls. A majority of mothers, 37 (16.3%) of cases and 86 (37.9%) of controls were between the ages of 25\u0026ndash;34 years. A significant proportion, 62 (27.3%) of cases and about half, 123 (54.2%), of controls, were married. Most of the participants, 32 (14.1%) of cases and 55 (24.2%) of controls, had no formal education. The majority of the participants, 43 (19.0%) cases and 87 (38.3%) controls, resided in urban areas. \u003cem\u003e(\u003c/em\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of mothers who gave birth in Jigjiga public hospitals, Eastern Ethiopia, 2023 (n\u0026thinsp;=\u0026thinsp;227)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePuerperal sepsis status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControls N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of the mother (In years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (8.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (16.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (16.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (37.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e123 (54.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (8.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (18.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123 (54.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185 (81.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Formal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e87 (38.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity/tertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (19.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87 (38.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e130 (57.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (28.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97 (42.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eObstetric Characteristics of the Study Participants\u003c/h2\u003e \u003cp\u003eAround a quarter of the cases 54 (23.8%) and nearly half of the controls 108 (47.6%) were grand multiparous. Approximately one-quarter of cases 59 (26.0%) and more than half of controls 117 (51.5%) had received antenatal care (ANC) services. Of those who received ANC follow-up, in most cases 22 (9.7%) and controls 72 (31.7%) visited ANC three or more times. Regarding the duration of labor, 41 (18.0%) of cases and 76 (33.5%) of controls had experienced labor lasting 24 hours or more. The majority of mothers, 59 (26.0%) of cases and 83 (36.6%) of controls, had a duration of rupture of membrane of less than 24 hours. Most cases (71, 31.3%) and controls (116, 51.1%) had pelvic examinations performed fewer than five times. The majority of mothers, 49 (21.6%) of cases and 115 (50.6%) of controls, had spontaneous vaginal deliveries. 49 (21.6%) of cases and 54 (23.8%) of controls underwent episiotomy. A significant proportion of mothers, 62 (27.3%) of cases and 134 (59.0%) of controls, delivered in hospitals. Regarding previous obstetric history, 18 (7.9%) of cases and 28 (12.4%) of controls had a history of bad obstetric outcomes. Additionally, 14 (6.2%) of cases and 24 (10.5%) of controls were referred from other healthcare facilities before giving birth. Among the study population, the majority of cases 56 (24.7%) and controls 123 (54.2%) did not have hypertension. Similarly, most cases 51 (22.5%) and controls 130 (57.2%) did not have diabetic mellitus. Additionally, nearly one-third of the cases 29 (12.8%) and half of the controls 114 (50.2%) had a history of sexually transmitted infections. Furthermore, 58 (25.5%) of the cases and 63 (27.8%) of the controls had anemia. \u003cem\u003e(\u003c/em\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetric characteristics among mothers who gave birth in Jigjiga public hospitals, Eastern Ethiopia, 2023 (n\u0026thinsp;=\u0026thinsp;227)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePuerperal sepsis status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControls N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (10.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42 (18.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrand Multiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54 (23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e162 (71.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eANC follow up\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e117 (51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e176 (77.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51 (22.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of ANC follow up (n\u0026thinsp;=\u0026thinsp;176)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82 (36.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72 (31.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94 (41.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of labor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75 (33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110 (48.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76 (33.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e117 (51.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of rupture of membrane\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83 (36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e142 (62.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85 (37.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of pelvic examinations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e187 (82.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40 (17.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMode of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpontaneous vaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e115 (50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e164 (72.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstrumental delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (16.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (11.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEpisiotomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54 (23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93 (41.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97 (42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e134 (59.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31 (13.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134 (59.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e196 (86.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny previous bad obstetric history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46 (20.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e181 (79.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReferral status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127 (56.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e189 (83.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48 (21.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56 (24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e179 (78.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetic mellitus\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46 (20.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130 (57.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e181 (79.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual transmitted infection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66 (29.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114 (50.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e161 (70.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnemia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e121 (53.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e106 (46.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of puerperal sepsis\u003c/h2\u003e \u003cp\u003eThe study found that mothers who were married were twice as likely to develop puerperal sepsis as those who were divorced (aOR: 2.0, 95%CI: 0.318\u0026ndash;7.553). Similarly, mothers with primary education were twice as likely to develop puerperal sepsis as those with no formal education (aOR: 1.6, 95% CI: 0.232\u0026ndash;10.588). The results also revealed that multiparous women were three times more likely to develop puerperal sepsis compared to primiparous women (those who have had only one pregnancy) (aOR: 2.8, 95% CI: 0.714\u0026ndash;5.210). Furthermore, women who did not attend antenatal care (ANC) were three times more likely to develop puerperal sepsis compared to those who attended ANC (aOR: 3.2, 95% CI: 1.483\u0026ndash;6.940). Additionally, women who had fewer than three ANC follow-ups were three times more likely to develop puerperal sepsis compared to those who had three or more ANC follow-ups (aOR: 3.3, 95% CI: 1.608\u0026ndash;6.589). On the other hand, women whose membranes ruptured for less than 24 hours were five times more likely to develop puerperal sepsis compared to those whose membranes ruptured for 24 hours or more (aOR: 4.6, 95% CI: 1.933\u0026ndash;11.028). Mothers who had fewer than five times pelvic examinations were twelve times more likely to develop puerperal sepsis (aOR: 12.1, 95% CI: 2.873\u0026ndash;19.131). The study also found that mothers who underwent episiotomy were two times more likely to develop puerperal sepsis compared to those who did not undergo the procedure (aOR: 2.1, 95% CI: 1.009\u0026ndash;4.488). Similarly, mothers who did not have a previous bad obstetric history were two times more likely to develop puerperal sepsis compared to those who had a previous bad obstetric history (aOR: 1.8, 95% CI: 0.614\u0026ndash;5.557). Mothers who were not referred have a three times higher risk of developing puerperal sepsis compared to those who were referred (aOR: 2.5, 95% CI: 0.936\u0026ndash;6.503). Mothers with hypertension had a two times higher risk of developing the condition compared to those without hypertension (aOR: 1.5, 95% CI: 0.587\u0026ndash;3.882). \u003cem\u003e(\u003c/em\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDeterminants of puerperal sepsis among mothers who gave birth in Jigjiga public hospitals, Eastern Ethiopia, 2023 (n\u0026thinsp;=\u0026thinsp;227)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePuerperal sepsis status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eOdd Ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases \u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControls \u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of the mother (In years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7 (0.105\u0026ndash;2.713)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.08 (0.006\u0026ndash;1.111)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e123 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.6 (0.249\u0026ndash;3.662)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6 (0.050\u0026ndash;6.403)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5 (0.233\u0026ndash;2.778)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3 (0.029\u0026ndash;4.117)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185 (81.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8 (0.239\u0026ndash;2.632)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.6 (0.318\u0026ndash;7.553)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28 (12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7 (0.179\u0026ndash;2.901)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9 (0.151\u0026ndash;6.038)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Formal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e87 (38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8 (0.363\u0026ndash;1.757)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.7 (0.099\u0026ndash;5.536)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1 (0.457\u0026ndash;2.719)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.6 (0.232\u0026ndash;10.588)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9 (0.381\u0026ndash;2.262)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.5 (0.213\u0026ndash;2.835)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity/tertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87 (38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e130 (57.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97 (42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9 (0.549\u0026ndash;1.673)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9 (0.438\u0026ndash;2.218)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4 (0.496\u0026ndash;4.150)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.8 (0.714\u0026ndash;5.210)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrand Multiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54 (23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e162 (71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3 (0.523\u0026ndash;3.159)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.9 (0.591\u0026ndash;6.372)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eANC follow up\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e117 (51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e176 (77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01 (0.521\u0026ndash;1.953)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.2 (1.483\u0026ndash;6.940) *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of ANC follow up (n\u0026thinsp;=\u0026thinsp;176)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82 (36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72 (31.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.7 (1.411\u0026ndash;5.133)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.3 (1.608\u0026ndash;6.589) *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of labor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75 (33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110 (48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2 (0.665\u0026ndash;2.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1 (0.475-2.300)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76 (33.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e117 (51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of rupture of membrane\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83 (36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e142 (62.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.4 (1.224\u0026ndash;4.646)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.6 (1.933\u0026ndash;11.028) *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of pelvic examinations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e187 (82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3 (1.604\u0026ndash;11.444)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.1 (2.873\u0026ndash;19.131) *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMode of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpontaneous vaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e115 (50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e164 (72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstrumental delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4 (0.175\u0026ndash;0.750)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2 (0.049\u0026ndash;0.493) *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2 (0.457\u0026ndash;2.928)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1 (0.301\u0026ndash;4.077)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEpisiotomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54 (23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93 (41.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97 (42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e134 (59.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9 (1.082\u0026ndash;3.313)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.1 (1.009\u0026ndash;4.488)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6 (0.260\u0026ndash;1.212)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5 (0.181\u0026ndash;1.580)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134 (59.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e196 (86.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny previous bad obstetric history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e181 (79.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4 (0.698\u0026ndash;2.663)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.8 (0.614\u0026ndash;5.557)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReferral status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127 (56.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e189 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2 (0.578\u0026ndash;2.469)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.5 (0.936\u0026ndash;6.503)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6 (0.331\u0026ndash;1.227)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.5 (0.587\u0026ndash;3.882)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56 (24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e179 (78.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetic mellitus\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3 (0.170\u0026ndash;0.640)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.4 (0.166\u0026ndash;0.990)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130 (57.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e181 (79.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual transmitted infection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5 (0.291\u0026ndash;0.952)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.7 (0.310\u0026ndash;1.803)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114 (50.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e161 (70.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnemia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e121 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2 (0.120\u0026ndash;0.413)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3 (0.122\u0026ndash;0.615)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e106 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*P Value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe present study investigated the determinants of puerperal sepsis among mothers who gave birth at Jigjiga public hospitals in Eastern Ethiopia. The results indicate that being married, having primary education, being grand multiparous, not attending antenatal care (ANC), having fewer than three ANC follow-ups, and having membranes rupture for 24 hours or more are all independent predictors of puerperal sepsis.\u003c/p\u003e \u003cp\u003eThe results showed that married mothers were more likely to develop puerperal sepsis compared to divorced mothers. This may be due to the fact that married women may be more likely to have a higher parity, which is a known risk factor for puerperal sepsis. This finding is supported by a study in Nigeria [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, mothers with primary education were more likely to develop puerperal sepsis compared to those with no formal education, which is consistent with a study conducted in Ethiopia [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The results also revealed that grand multiparous women were more likely to develop puerperal sepsis compared to primiparous women. This may be due to the fact that grand multiparous women may be more likely to experience placental abruption, placenta previa, and other complications that increase their risk of developing puerperal sepsis. This is consistent with previous study conducted in Ethiopia [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and Nepal [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study also found that women who did not attend antenatal care (ANC) were more likely to develop puerperal sepsis compared to those who attended ANC. ANC attendance is an important indicator of the quality of prenatal care, and women who do not attend ANC may be more likely to experience complications during pregnancy and childbirth. This is in line with previous research conducted in Ethiopia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Similarly, the finding that women who had fewer than three ANC follow-ups were three times more likely to develop puerperal sepsis compared to those who had three or more ANC follow-ups suggests that frequent ANC attendance is an important factor in reducing the risk of puerperal sepsis. Women who had fewer than five times pelvic examinations were twelve times more likely to develop puerperal sepsis. This suggests that inadequate prenatal care and lack of provider-patient interaction may contribute to the development of puerperal sepsis. This is consistent with a study conducted in Uganda [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The study also found that women whose membranes ruptured for less than 24 hours were more likely to develop puerperal sepsis compared to those whose membranes ruptured for 24 hours and more. This is supported by previous research conducted in Kenya [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study found that mothers who underwent episiotomy were two times more likely to develop puerperal sepsis compared to those who did not undergo the procedure. Episiotomy can cause lacerations and trauma to the perineum, which can provide a portal of entry for bacteria and increase the risk of infection. This finding is consistent with previous study in Ethiopia [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The study also found that mothers who did not have a previous bad obstetric history were two times more likely to develop puerperal sepsis compared to those who had a previous bad obstetric history. This may be because women who have had previous complications during pregnancy or childbirth may be more aware of their risk factors and take steps to prevent complications during subsequent pregnancies, such as seeking antenatal care and delivering in a hospital setting. This is consistent with the study conducted in Kenya[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and India [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Moreover, the study found that mothers who were not referred were three times more likely to develop puerperal sepsis compared to those who were referred. This suggests that delayed or inadequate referral for medical attention may contribute to the development of puerperal sepsis. This finding is supported by a study conducted in Uganda [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], and Ethiopia [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study identified several significant determinants of puerperal sepsis among mothers who gave birth at Jigjiga public hospitals in Somali Regional State, Eastern Ethiopia. The analysis of this study indicated that not attending antenatal care regularly, having fewer antenatal care follow-ups, membranes rupturing for less than 24 hours, having fewer pelvic examinations, undergoing episiotomy, not having a previous bad obstetric history, being not referred for further care, and having hypertension were all identified as determinants of puerperal sepsis. Healthcare providers and policymakers should prioritize improving access to quality antenatal care, enhancing maternal education and empowerment, and implementing evidence-based guidelines for managing obstetric complications. Furthermore, community-based education campaigns should be implemented to raise awareness about the importance of antenatal care and proper hygiene practices during childbirth.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eANC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntenatal Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eEDH\u003c/b\u003eS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEthiopia Demographic and Health Survey\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIRB\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitutional Review Board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSPSS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eWHO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the by the Institutional Review Board (IRB) of\u0026nbsp;Jigjiga University, Jigjiga, Eastern EthiopIa [HRERC/088/2022]. Written permission was secured from the relevant authorities of the study settings, including Sultan Sheik Hassan Yabare Comprehensive Specialized Hospital and Karamara General Hospital. Informed consent was obtained from all participants prior to data collection. For participants under 18 years of age, written assent was obtained from their and consent from their guardian. The data collectors were instructed to maintain patient confidentiality throughout the data collection process. To ensure the confidentiality of participants, personal identifiers such as names were not used, and codes were employed instead. Participants were informed of their right to refuse or terminate participation at any point during the interview.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding authors upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests regarding the conduct of this study or the publication of its findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding for the publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH.N.A., A.A.T., M.A.M., and A.M.I. Conceptualization of the study, methodology, data collection, performed statistical analysis, interpretation and drafted the manuscript. F.I.D., T.G., and C.D.U provided critical insights and revisions to the final manuscript. All authors reviewed and approved the final version prior to submission.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to the health workers at Jigjiga public hospitals for their invaluable support during data collection. We also acknowledge the study participants for their willingness to share their experiences and contribute to this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eNayak, A.H., Khade, S.A.: Obstetric Sepsis: A Review Article. Journal of Obstetrics and Gynecology of India. 72, 470\u0026ndash;478 (2022). https://doi.org/10.1007/s13224-022-01706-y\u003c/li\u003e\n \u003cli\u003eSay, L., Chou, D., Gemmill, A., Tun\u0026ccedil;alp, \u0026Ouml;., Moller, A.B., Daniels, J., G\u0026uuml;lmezoglu, A.M., Temmerman, M., Alkema, L.: Global causes of maternal death: A WHO systematic analysis. Lancet Glob Health. 2, (2014). https://doi.org/10.1016/S2214-109X(14)70227-X\u003c/li\u003e\n \u003cli\u003eVan Dillen, J., Zwart, J., Schutte, J., Van Roosmalen, J.: Maternal sepsis: Epidemiology, etiology and outcome. Curr Opin Infect Dis. 23, 249\u0026ndash;254 (2010). https://doi.org/10.1097/QCO.0b013e328339257c\u003c/li\u003e\n \u003cli\u003eTesfaye, T., Samuel, S., Lera, T.: Determinants of puerperal sepsis among postpartum women at public hospitals of Hawassa city, Southern Ethiopia: Institution-based unmatched case-control study. Heliyon. 9, (2023). https://doi.org/10.1016/j.heliyon.2023.e14809\u003c/li\u003e\n \u003cli\u003eArulkumaran, N., Singer, M.: Puerperal sepsis. Best Pract Res Clin Obstet Gynaecol. 27, 893\u0026ndash;902 (2013). https://doi.org/10.1016/j.bpobgyn.2013.07.004\u003c/li\u003e\n \u003cli\u003eAD Kearns, J.C.P. ten H.-B.A.L.: Antenatal and postnatal care: a review of innovative models for improving availability, accessibility, acceptability and quality of services in low-resource settings. BJOG. 123, 558 (2016). https://doi.org/10.1111/1471-0528.13937\u003c/li\u003e\n \u003cli\u003eFatouh Abdel, E., -Nora Mansour Abdel, fattah, Eid Farrag -, hak, Abd El, R.: The Effect of Instructional Guidelines Regarding Puerperal Sepsis Prevention on the Knowledge and Practice of Postpartum Mothers. Helwan International Journal for Nursing Research and Practice. 1, (2022)\u003c/li\u003e\n \u003cli\u003eMelkie, A., Dagnew, E.: Burden of puerperal sepsis and its associated factors in Ethiopia: a systematic review and meta-analysis. Archives of Public Health. 79, (2021). https://doi.org/10.1186/s13690-021-00732-y\u003c/li\u003e\n \u003cli\u003eBerhe, A.K., Kassa, G.M., Fekadu, G.A., Muche, A.A.: Prevalence of hypertensive disorders of pregnancy in Ethiopia: A systemic review and meta-analysis. BMC Pregnancy Childbirth. 18, (2018). https://doi.org/10.1186/s12884-018-1667-7\u003c/li\u003e\n \u003cli\u003eFekadu, G.A., Ambaw, F., Kidanie, S.A.: Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: Further analysis of the 2016 demographic and health survey. BMC Pregnancy Childbirth. 19, (2019). https://doi.org/10.1186/s12884-019-2216-8\u003c/li\u003e\n \u003cli\u003eHailemariam, S.N., Soromessa, T., Teketay, D.: Land use and land cover change in the bale mountain eco-region of Ethiopia during 1985 to 2015. Land (Basel). 5, (2016). https://doi.org/10.3390/land5040041\u003c/li\u003e\n \u003cli\u003eKitessa, S.G., Teferi Bala, E., Makuria, M., Deriba, B.S.: Determinants of puerperal sepsis at public hospitals in West Ethiopia: A case-control study. Health N Hav. 6, 2021. https://doi.org/10.15761/FWH.1000207\u003c/li\u003e\n \u003cli\u003eDemisse, G.A., Sifer, S.D., Kedir, B., Fekene, D.B., Bulto, G.A.: Determinants of puerperal sepsis among post partum women at public hospitals in west SHOA zone Oromia regional STATE, Ethiopia (institution BASEDCASE control study). BMC Pregnancy Childbirth. 19, (2019). https://doi.org/10.1186/s12884-019-2230-x\u003c/li\u003e\n \u003cli\u003eA.S. Olutoye, A.D.A.O.O.B.: Puerperal sepsis at university college hospital, Ibadan, Nigeria: a 10-year review. Ann Ib Postgrad Med. 20, 32\u0026ndash;39 (2022)\u003c/li\u003e\n \u003cli\u003eDemisse, G.A., Sifer, S.D., Kedir, B., Fekene, D.B., Bulto, G.A.: Determinants of puerperal sepsis among postpartum women at public hospitals in west SHOA zone Oromia regional STATE, Ethiopia (institution BASEDCASE control study). BMC Pregnancy Childbirth. 19, (2019). https://doi.org/10.1186/s12884-019-2230-x\u003c/li\u003e\n \u003cli\u003eSeboka, K., Gurara, A.M., Bekele, N.T., Belachwe, Y.A., Getahun, M.S., Negussie, Y.M.: Determinants of puerperal sepsis among postpartum women at a tertiary care hospital in Ethiopia: an unmatched case-control study. Contracept Reprod Med. 9, (2024). https://doi.org/10.1186/s40834-024-00283-x\u003c/li\u003e\n \u003cli\u003eOyato, B.T., Debele, T., Edosa, D., Abasimel, H.Z., Awol, M., Kebede, E.T., Gezahagn, A., Desta, A.A., Alemu, F.T., Asfaw, S.B.: Determinants of puerperal sepsis among postpartum women: a case-control study in East Shoa Zone public hospitals, Central Ethiopia. BMJ Open. 14, e083230 (2024). https://doi.org/10.1136/bmjopen-2023-083230\u003c/li\u003e\n \u003cli\u003ePradhan, B., Duwal, S., Singh, A., Bhandary, S., RC, L., Shrestha, R.: Puerperal Sepsis and its Cause in Patan Hospital. Nepal Journal of Obstetrics and Gynaecology. 10, 33\u0026ndash;35 (2015). https://doi.org/10.3126/njog.v10i1.13192\u003c/li\u003e\n \u003cli\u003eSahle, S.G., Weldemariam, S., Mehari, M. ab, Abraha, T.A.: Determinants of puerperal sepsis among post-partum mothers in Mekelle city public hospitals, Tigray, Ethiopia, 2021: a case control study. BMC Womens Health. 23, (2023). https://doi.org/10.1186/s12905-023-02643-2\u003c/li\u003e\n \u003cli\u003eNgonzi, J., Bebell, L.M., Fajardo, Y., Boatin, A.A., Siedner, M.J., Bassett, I. V., Jacquemyn, Y., Van geertruyden, J.P., Kabakyenga, J., Wylie, B.J., Bangsberg, D.R., Riley, L.E.: Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda. BMC Pregnancy Childbirth. 18, (2018). https://doi.org/10.1186/s12884-018-1891-1\u003c/li\u003e\n \u003cli\u003eChepchirchir, M. V, Nyamari, J., Keraka, M.: Associated Factors with Puerperal Sepsis among Reproductive Age Women in Nandi County. Kenya. Journal of Midwifery and Reproductive Health. 5, 1032\u0026ndash;1040 (2017). https://doi.org/10.22038/JMRH.2017.9348\u003c/li\u003e\n \u003cli\u003eAnumba, D.O.C., Alemu, A., Addisu, D., Bekele, H., Tamiru, D., Debella, A., Getachew, A., Yohannes, E., Lami, M., Negash, A., Asfaw, H., Ketema, I., Eyeberu, A., Habte, S., Eshetu, B., Getachew, T., Mesfin, S., Birhanu, B., Heluf, H., Kibret, H., Negash, B., Alemu, A., Dessie, Y., Balis, B.: Magnitude of episiotomy practice and associated factors among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.\u003c/li\u003e\n \u003cli\u003eWoretaw, E., Teshome, M., Alene, M.: Episiotomy practice and associated factors among mothers who gave birth at public health facilities in Metema district, northwest Ethiopia. Reprod Health. 18, (2021). https://doi.org/10.1186/s12978-021-01194-9\u003c/li\u003e\n \u003cli\u003eGoud, N.S., Reddy, M.M., Desai, S.: Incidence and pattern of infections in pregnant women with bad obstetric history. Int J Reprod Contracept Obstet Gynecol. 10, 3846 (2021). https://doi.org/10.18203/2320-1770.ijrcog20213848\u003c/li\u003e\n \u003cli\u003eNgonzi, J., Tornes, Y.F., Mukasa, P.K., Salongo, W., Kabakyenga, J., Sezalio, M., Wouters, K., Jacqueym, Y., Van Geertruyden, J.P.: Puerperal sepsis, the leading cause of maternal deaths at a Tertiary University Teaching Hospital in Uganda. BMC Pregnancy Childbirth. 16, (2016). https://doi.org/10.1186/s12884-016-0986-9\u003c/li\u003e\n \u003cli\u003eKitessa, S.G., Teferi Bala, E., Makuria, M., Deriba, B.S.: Determinants of puerperal sepsis at public hospitals in West Ethiopia: A case-control study. Front Womens Health. 6, 1\u0026ndash;7 (2021). https://doi.org/10.15761/FWH.1000207\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-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Case-control, Determinants, Eastern Ethiopia, Mothers, Puerperal sepsis, Somali Regional State","lastPublishedDoi":"10.21203/rs.3.rs-4970368/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4970368/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Puerperal sepsis is a significant public health concern in low-resource settings, including Ethiopia, where it is a major contributor to maternal mortality, accounting for 13% of maternal deaths. We investigated the determinants of puerperal sepsis among mothers who give birth at Jigjiga Public Hospitals, Somali Regional State, Eastern Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eA facility-based unmatched case-control design was employed, with a sample size of 227 (76 cases and 151 controls). The study was conducted at two public hospitals in Jigjiga, Eastern Ethiopia, from January 2022 to December 2022. Data was collected using a standardized structured questionnaire and medical record review. Data were analyzed using SPSS software version 26. Multivariate logistic regression analysis was used to identify the determinants of puerperal sepsis. The level of significance was set at 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe mean age of the mothers was 30.2±10.2 years for cases and 31.5±6.7 years for controls. The results showed that not attending antenatal care regularly (aOR: 3.2, 95% CI: 1.483-6.940), having fewer antenatal care follow-ups (aOR: 3.3, 95% CI: 1.608-6.589), membranes rupturing for less than 24 hours (aOR: 4.6, 95% CI: 1.933-11.028), and having fewer pelvic examinations (aOR: 12.1, 95% CI: 2.873-19.131) were determinants of puerperal sepsis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe study found that several factors were associated with puerperal sepsis, including irregular antenatal care attendance, fewer antenatal follow-ups, delayed membrane rupture, and fewer pelvic examinations. To address this issue, healthcare providers and policymakers should prioritize improving access to quality antenatal care, empowering mothers through education and enhancing maternal education, and implementing evidence-based guidelines for managing obstetric complications.\u003c/p\u003e","manuscriptTitle":"Determinants of puerperal sepsis among mothers who give birth at Jigjiga public hospitals, Somali Regional State, Eastern Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-25 12:07:22","doi":"10.21203/rs.3.rs-4970368/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-05T12:41:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-03T19:01:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86737892209040445542392836757981229087","date":"2024-10-19T18:00:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139591140911265334766533998218809930117","date":"2024-10-19T01:19:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271806061334078115700388315145176986642","date":"2024-10-01T18:37:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-19T18:59:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"157772229837482643695426557075040309750","date":"2024-09-18T16:11:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204812228277413731826535852821804291124","date":"2024-09-03T01:06:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-31T17:49:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-27T14:58:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-26T01:18:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2024-08-24T18:50:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"65d07f66-4884-4ac6-915f-0ba9a238bbbe","owner":[],"postedDate":"September 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-08T16:03:11+00:00","versionOfRecord":{"articleIdentity":"rs-4970368","link":"https://doi.org/10.1186/s12884-025-08054-5","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-09-02 15:57:58","publishedOnDateReadable":"September 2nd, 2025"},"versionCreatedAt":"2024-09-25 12:07:22","video":"","vorDoi":"10.1186/s12884-025-08054-5","vorDoiUrl":"https://doi.org/10.1186/s12884-025-08054-5","workflowStages":[]},"version":"v1","identity":"rs-4970368","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4970368","identity":"rs-4970368","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}