Determinants of low fifth-minute APGAR score among newborn : A case control study conducted in north shewa Zone public hospitals, Central Ethiopia:2023

Determinants of low fifth-minute APGAR score among newborn : A case control study conducted in north shewa Zone public hospitals, Central Ethiopia:2023 | 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 low fifth-minute APGAR score among newborn : A case control study conducted in north shewa Zone public hospitals, Central Ethiopia:2023 Teshome Ketema, Yilma jangule, Buta Adugna This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5330388/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Globally, 2.6 million children under the age of five and around 7,000 newborns died in the first month of birth, with the majority of these deaths occurring in the first few weeks. Neonatal mortality has a significant influence on under-five mortality . Objectives: The study aimed to assess the determinants of low fifth-minute APGAR score among newborn delivered at hospitals in north shewa, Oromia, Ethiopia, 2023 Design and settings: A facility based unmatched case-control study was conducted among 411 newborns was conducted from March 30 to April 30, 2023, in North Shoa Zone public hospitals. Participants: 147 Newborns with 5 th APGAR score less than 7 were considered as cases whereas 293 Newborns presented with 5 th APGAR score greater than 7 were considered as controls. A consecutive sampling technique was employed to recruit cases, while a systematic random sampling technique was used to select controls. A pretested structured questionnaire through a face-to-face interview, a mother's medical records review, and observational checklist were used to collect data. The AOR with a 95 % confidence level were performed. Finally, variables with P < 0.05 were considered statistically significant. Outcome measures : The medical charts of participants were used to recruit cases and controls Results: Anemia [AOR = 2.4, 95% CI: 1.76–3.04], low birth weight [AOR = 2.4, 95% CI: 1.54–3.08], twin pregnancy [AOR = 1.7, 95% CI: 1.23–2.17], and absence of ANC follow up[AOR = 1.6, 95% CI: 1.02–2.18] were revealed as significant predictors of low Apgar score. Conclusions: A low fifth minute Apgar score was associated with low birth weight, antepartum hemorrhage, twin pregnancy, and not receiving ANC follow-up. It will be easier to identify high-risk pregnancies that result in low Apgar scores if pregnant women get effective health education on anemia during pregnancy,twin pregnancy,low birth weight and ANC before getting pregnant. 5th minute Newborn Apgar score Determinant Ethiopia Figures Figure 1 Introduction Neonate is a period from birth to the first 28 days of life which is classified as early neonate for the first three weeks of life after delivery, whereas late neonate refers to the final three weeks 1 . APGAR score is a American pediatric growth assessment record used to rapidly and simply evaluate the newborn's health just after birth. A grade of zero to two is given to each five vital signs parameters developed by virginia. The resultant APGAR score is between zero and ten 2 . The scoring systems contain five parameters with each of them holding 0–2 points. These parameters are Activity, Pulse, Grimace, Appearance, and Respiration. It is interpreted as a Low APGAR score of 0–3 - Moderate APGAR score of 4–6 & Normal APGAR score of 7–10. A newborn with an APGAR score of fewer than 7 needs special attention 1 . Newborn who has a low score at 1 minute and a normal score at 5 minutes should not have any long-term problems while the vice versa exposes the neonate to different long-term problems 3 . Globally, 2.6 million children under the age of five and around 7,000 newborns died in the first month of birth, with the majority of these deaths occurring in the first few weeks. Neonatal mortality has a significant influence on under-five mortality 4 . The Sustainable development Goal (SDG) in South-East Asia aims to reduce newborn mortality to at least 12 per 1000 live births by 2030, only accounting for about one-third of neonatal fatalities in 2018 5 . A poor APGAR score at 5 minutes was significantly linked with neonatal mortality 6 , 7 . Low APGAR score accounting for 100–250/1000 live births as compared to 5–10/1000 live births in developed countries. Currently, 1 in every 30 children in Ethiopia dies within the first month which is still significant 8 . Newborn mortality in Ethiopia reduced from 39 to 29 during the Ethiopian demographic health survey (EDHS) of 2005 and 2016, but has subsequently stabilized 9 , 10 . Currently, 1 in every 30 children in Ethiopia dies within the first month which is still significant. In the United States, cohort studies have shown a high correlation between low APGAR scores and neonatal mortality, as seen by the 0.06% overall neonatal mortality rate and the 0.2% infant mortality rate 11 . Several studies have shown that a low fifth-minute APGAR score is linked to greater mortality rates, lower IQ scores, and a higher chance of arterial septal defect 12 – 14 . The risk of recurrence of a low APGAR score in the subsequent pregnancy was 1.1% 15,16 . So, more attention should be given to providing crucial newborn care & promptly determining the newborn APGAR score concerned with reducing neonatal mortality. A hospital-based retrospective case-control study with 277 medical records showed that 42 of the 79 newborns with a 5-minute APGAR score of less than 7 have died 17 . Despite having adequate resuscitation 13.8% of neonates died making up 28.72% of all neonates who died due to low APGAR score at 5 minutes. This shows that even after having an efficient resuscitation, newborns with poor APGAR scores are still at a higher risk of perinatal morbidity and death 18 . The odds of a low APGAR score at 5 minute is significantly correlated with obstetric factors such as antepartum hemorrhage, pregnancy-induced hypertension, anemia, heart disease, diabetes mellitus, birth injury, caesarian delivery, prolonged second stages of labor, and severe birth asphyxia 19 , 20 . Despite many study has been conducted in our setup, to the knowledge of the author no study conducted in the area and no Previous study examined the effect of common medical conditions that were during current pregnancy on the low Apgar score at five minute. Therefore, this study aimed to assess determinants of low fifth minutes AGAR score among newborns delivered at public hospitals of North Shoa zone, central Ethiopia. Methods and Materials Stud setting and period This study was conducted in North Shoa public hospitals, central Ethiopia from March 30 to April 30, 2023. The North Shewa zone is located in the Oromia region, Ethiopia, 112 km northwest of the capital city, Addis Ababa. The zone has a total population of about 1,639,586, of which a majority (89.75%) of the population residing in rural areas. A total of 71 public health institutions serve the population, including 64 health centers, seven hospitals, and 30 private medium clinics. All of these hospitals offer obstetrical services for mothers. The zonal health office's report indicates that overall, 9,364 births were made at the chosen hospital each year. The North Shewa zone's main city Fiche town is home to Salale university comprehensive specialized hospital, which performs about 2,487 births annually. Similarly, Sendafa hospital, M/Turi hospital, G/Meskel hospital , and Chancho hospital oversees around 2004, 1317 and 1645 deliveries annually, 2234 deliveries annually respectively. Study design A facility based prospective case-control was conducted. Population Source Population All newborn mothers who gave birth at selected North Shewa Zone public hospitals will be the source population. Study Population All selected newborn mothers who gave birth at North Shewa Zone public hospitals during the study period. Cases : All newborns with a low fifth-minute APGAR score (APGAR=7) at the randomly selected hospitals of North Shewa Zone that fulfilled the inclusion criteria. Inclusion and Exclusion Criteria All babies delivered after 28 weeks of gestation & during the study period at North shewa public health facility were included in the study. Charts with incomplete documentation, Newborns referred from other health facilities, Newborns with gross congenital anomalies incompatible with life. Such as anencephaly, severe hydrocephaly, and Gastroschisis, Preterm, Multiple pregnancies except twin pregnancies were excluded from the study Determination of Sample Size To determine the required sample size for this study Epi-info version 7.2.2.12 stat calculation software was used for variables that have significant associations with a low fifth-minute APGAR score. Mothers who had a history of khat use, maternal APH in the current pregnancy, Maternal PIH in the current pregnancy, MSAF, and birth injury are considered to calculate the required sample size. From these maternal gravidity is chosen as an independent variable hence it gives us the maximum sample size as compared to other predictor variables. The sample size was determined using a formula for two population proportions and calculated using Epi-info version 7.2.2.12 stat calculation software by considering that the percent of controls exposed (having Grandmultiparity history) were 5.4% whereas 12.09% of cases exposed (main exposure variable) which is estimated from other studies 21 , 95% CI, 80% power of the study and control to case ratio of 2:1. Accordingly, after adding 10% for non-response rate 147 cases and 294 controls (a total sample size of 441) are planned to be involved in this study. Table 1 Sample size calculation for unmatched case-control study by open Epi software Factors considered for Percent of Percent of cases N o of cases N o of Controls Ref calculating sample size controls exposed (%) With exposure (%) MSAF 19.1 6.4 87 174 (16) Pregnancy induced HTN 8.3 31.2 107 213 (14) Birth injury 22 41 76 151 (11) Grandmultiparity 5.4 12.09 221 441 (25) Mothers who had history of khat use 10.65 4.6 68 135 (18) Sampling Procedure From the 7 functional public hospitals in North Shewa; using the rule of thumb ( > = 30%) five public hospitals were selected through a simple random sampling technique by lottery method. According to the 2015 E.C semi-annual delivery report of randomly selected health institutions, the lowest monthly proportion of institutional delivery was taken from delivery registration logo book Accordingly, the sample size was proportionally allocated for hospitals for each hospital by fixing one month average delivery flow. All cases and subsequent two eligible controls in the study sites were included in the study. A consecutive sampling technique was employed to recruit cases, while a systematic random sampling technique every two intervals was used to select controls. Non-respondents for controls were replaced by the subsequent controls delivered to make the case-to-control ratio even. \(\:K=\frac{N}{n}\) = \(\:\:K=\frac{660}{294}\) ≈ 2 Where, K= f requency interval N = the total number of the population n = the required number in the sample Table 2 Show how the sample allocation was calculated for each randomly selected hospitals in North Shoa Zone, Oromia, Ethiopia, 2023 Institutional name The average Monthly delivery report Proportion of neonate delivered Sample allocated Number of cases Number of controls G/meskel Hospital 137 17% 75 25 50 Salale university comprehensive specialized Hospital 207 25.7% 113 38 75 M/Turi 110 13.6% 60 20 40 Chancho Hospital 186 23% 102 34 68 Sendafa hospital 167 20.7% 91 30 61 Total 807 100% 441 147 294 Sampling techniques Data Collection Procedure & Quality Assurance: A pretest was conducted on 5% of the sample size at Kuyu hospital which is other than the selected hospitals to assess the reliability of data collection instruments. Based on the pretest result, corrective measures were taken on the questionnaire. Before the actual data collection, Training was given to data collectors & supervisors on how to measure the weight of the baby, APGAR score, & on how to take informed consent. The data collectors were clarifed the study's intent and receive verbal consent from the respondents. Data was collected by Eight trained Bsc midwives working in delivery wards of each selected public hospital, and two second-degree holding supervisors from the health discipline, respectively. The data was collected through a face-to-face interview using a structured & pretested questionnaire, a mother's medical records review as well as by using an observational checklist. Calibrated Seca scale & observational checklist was used to assess fetal birth weight & APGAR score respectively. Information which could not be obtained by interview, like common medical conditions during current pregnancy, obstetrics factors, intra partum events, and newborn related information, was extracted from maternal records at the postnatal ward. Questionnaire was primarily prepared in the English language and translated into Local language by professional who is familiar on this field and fluent in the two languages and back-translated to English language by another expert, who is not familiar with the original questionnaires in order to guarantee its consistency. To assure the completeness of the questionnaire, the collected data was checked daily during data collection. Data Processing & Analysis Firstly, the collected data was cleaned, coded, and checked for missing values & completeness before actual analysis. Then after entered using Epi data version 3.1 and then exported to statistical software and SPSS version 26.0 statistical packages for analysis. To assess the association between predictor variables with the dependent variable, first Binary logistic regression analysis was used. Variables with a significant association at P < 0.25 in the binary analysis were entered into multivariable logistic regression analysis using the stepwise forward variable elimination technique method to determine the determinants of the low fifth-minute APGAR score and those variables with P < 0.05 were considered to be statistically significant. Multicolinearity was checked by variance inflation factorsof less than 10%. Hosmer- Lemeshow tests for goodness of fit was carried out(p = 0.472). Finally, the analyzed data was summarized as Frequency, percentage, mean, and standard deviation. Significance was determined using crude and adjusted odds ratios with 95% confidence intervals. Study Variables The variables to be included in this questionnaire are both independent and dependent variables for which an association is going to be assessed among cases as well as controls. Dependent variable Low fifth-minute APGAR score Independent variables Socio-demographic Factors: Age, Sex, Level of education, marital status, residence, Parents in come, Occupation. Maternal medical/obstetrics factors: mode of delivery, fetal presentation, MSAF, ANC contact, the onset of labor, instrumental delivery, prolonged second stage of labor, DM, Anemia,hyperemesis gravidarum,cardiac disease and PIH Neonatal-related factors: sex, birth weight, gestation at birth Operational Definition Fetal gestational age: gestational age of the fetus at the time of delivery High APGAR Score (Controls): A similar group of newborns with APGAR scores of 7 or above at five minute of delivery 22 . Low APGAR score (Cases): Newborns who delivered with APGAR scores below 7 at five minute of delivery 22 . Fifth minute: 5 minute from the fully delivery of newborn Results 5.1 Socio-demographic characteristics study participants A total of 294 controls and 147 cases were involved in the study. All 411 mothers who were asked for an interview was contacted for the research making the response rate 100%. The mothers' ages ranged from 18–43 with mean and standard deviation of (26.8 ± 5.7) respectively. The age group between 20 and 35 years old accounted for around two third of the age distribution of mothers who were cases and controls (62.5%). The independent sample t-test indicates that there is no statistically significant difference in the mean age between the cases and controls (P-value = 0.498). The percentage of housewives among the mothers in the cases was almost similar with the percentage in the controls with the difference is not siginficant (74.8% vs. 74.4%, p = 0.672). Regarding residence there were a relatively greater percentage of mothers of cases(62.5%) who lived in urban than controls(60.6%). However The independent sample t-test indicates that there is no statistically significant difference(p = 0.075). About 74.8% of the cases and 77.1% of controls were married with no statistically difference between them(p = 0.321). The educational background shows there is slight difference between cases who did not attend formal education(34%) as compared to controlswho did not attend formal education(37.4%) but the difference is not statistically significant(p = 0.179). There is not a significant difference among oromo ethinic group of cases (74.8%) and controls (78.2%) with p –value = 0.548. About 13.6% of the cases and 13.2% of controls were muslim religious follower with no statistically difference between them(p = 0.081). Women khat chewing history among cases(8.2%) and controls(8.1%) were no statistically significant(p = 0.057). there is no statistically significant difference among women who had Physical and emotional support during labor and delivery of cases(65.8%) versus controls(68%) at p value = 0.086 (Table 3 ). Table 3 Socio-demographic characteristics of mothers of cases and controls who gave birth at public hospitals of North Shoa Zone, Oromia, Ethiopia;2023(n = 441) QUESTIONS Category Low APGAR score at 5th minutes Total P value Cases Control Age of the mother? 35 36(24.4) 70(23.8) 106(24) Residence Urban 58(39.4) 110(37.4) 168(38) 0.075 Rural 89(60.6) 184(62.5) 273(62) Marital status single 6(4) 4(1.3) 10(2.2) 0.321 married 110(74.8) 230(78.2) 340(77.1) divorced 11(7.4) 24(8.1) 35(8) Widowed 20(13.6) 36(12.2) 56(12.7) Ethnicity Oromo 85(57.8) 171(58.1) 256(58) 0.548 Amhara 30()20.4 60(20.4) 90(20.4) Tigre 14(9.5) 28(9.5) 42(9.5) Guraghe 18(12.2) 35(11.9) 53(12) Religion Orthodox 70(47.6) 140(47.6) 210(47.6) 0.081 Protestant 54(36.7) 108(36.7) 162(36.7) Muslim 20(13.6) 39(13.2) 59(13.3) Catholic 3(2) 7(2.3) 10(2.2) Educational status? No formal education 50(34) 110(37.4) 160()36 0.179 Primary education 50(34) 90(30.6) 140(32) Secondary education (9–12) 25(17) 50(17) 75(17) College and above 22()14.9 44(14.9) 66(15) Occupation? House wife 110(74.8) 220(74.8) 330(74.8) 0.672 Government employee 7(4.7) 20(6.8) 27()6.1 Private employee 2(1.3) 14(4.7) 16(3.6) Merchant 28(19) 40(13.6) 68(15.4) Khat chewing history? Yes 12(8.2) 24(8.1) 36(8.2) 0.057 No 135(91.8) 270(91.8) 405(91.8) Physical and emotional support during labor and delivery Yes 97(65.9) 200(68) 297(67.4) 0.086 No 50(34.1) 94(32) 144(32.6) 5.2 Obstetrics characteristics of mothers There was a significant difference (p = 0.093) between the proportion of mothers of cases who had no ANC contact and that of controls (65.9% vs. 68%). There was no significant difference(0.342) between the control and case groups in terms of the percentage of women who were Primigravida 10.2% vs 10.2%, Multigravida 57.8% vs 61.2%, and Grand multigravida 32% vs 28.5% respectively. In comparison to controls, cases were more likely to experience antepartum hemorrhage, and delivered from twin pregnancy and premature membrane rupture Type of the Pregnancy (7.4% versus 7.5%;P = 0.023), and (13.6% versus 11.9%;p = 0.002) respectively. The percentage of women who had PIH in the current pregnancy did not change significantly between the case and control groups (14.3% versus 11.9% = 0.074). Among controls compared to cases, the proportion of women who had Duration of PROM > 12 hours, and cord prolapse was not significantly greater (19.1% versus 11.6%; P = 0.084), and ( 11.5% versus 2.3%;P = 0.071) respectively. The percentage of women who had PROM in the current pregnancy did not change significantly between the case and control groups (38.7% versus 32%; P = 0.192). Nevertheless, the chi-square test p-value of 0.093 indicates that there is no statistically significant difference in presence of chorioamniotitis between cases and controls (25% versus 15%).Among controls compared to cases, the proportion of women who undergone Induced onset of labor, and augumented with oxytocin was not significantly greater(19.8% versus 13%; P = 0.079), and (24% versus 15%; P = 0.142) respectively Only 18.3%of mothers of controls and 15%of mothers of cases had Prolonged second stage of labor, yet there is no statistically significant difference between the two groups (chi-square test-p-value = 0.065). Meconium-stained liquor, Caesarean section mode of delivery, Anemia were vary between controls and cases in a statistically significant way (20.4%, versus 13%; P = 0.004), (19.8% versus 19.8%; P = 0.036), and (14.2% versus 10.2%;P = 0.024) for the Chi-square test, respectively (Table 4 ). Table 4 Obstetric characteristics of mothers of cases and controls who gave birth public hospitals of North Shoa Zone, Oromia, Ethiopia;2023(n = 441) Variables Category Low 5th minute APGAR score Total P value Cases Control s Gravidity of the mother? Primigravida 15(10.2) 30(10.2) 45(10.2) 0.342 Multigravida 85(57.8) 180(61.2) 265(60) Grand multigravida 47(32) 84(28.5) 131(29.8) Parity of the mother? Primiparous 11(7.4) 30(10.2) 41(9.3) 0.765 Multiparous 89(60.5) 190(64.6) 279(63.2) Grand multiparous 47(32) 74(25.2) 121(27.4) ANC visit Yes 97(65.9) 200(68) 297(67.3) 0.001 No 50()34.1 96(32) 146(32.7) Number of ANC visit? 1 time 25(17) 55(18.7) 80(18.1) 0.067 2–3 times 22(14.9) 80(27.3) 102(23) >=4 times 40(27.2) 65(22) 105(23.8) Type of the Pregnancy Singleton 127(86.4) 259(88) 386(81.5) 0.002 Twins 20(13.6) 35(11.9) 55(12.5) APH Yes 11(7.4) 22(7.5) 33(7.5) 0.023 No 136(92.5) 272(92.5) 408(92.5) PIH in the current pregnancy Yes 21(14.3) 35(11.9) 56(12.7) 0.074 No 126(85.7) 259(88) 385(87.3) PROM Yes 57(38.7) 94(32) 151(34.2) 0.192 No 90(61.2) 200(68) 290(65.8) Duration of PROM < 12 hours 119(80.9) 260(88.4) 379(86) 0.084 ≥ 12 hours 28(19.1) 34(11.6) 62(14) Is there chorioamniotis Yes 37(25) 44(15) 81(18.7) 0.093 No 110(75) 250(75) 360(81.6) The onset of labor Spontaneous 118(80.2) 256(87) 374(84.8) 0.079 Induced 29(19.8) 38(13) 67(15.2) labor Augmented Yes 35(24) 44(15) 79(18) 0.142 No 112(76) 250(75) 362(82) Prolonged second stage of labor Yes 27(18.3) 44(15) 71(16) 0.065 No 120(81.7) 250(75) 370(84) Meconium-stained liquor Yes 30(20.4) 38(13) 68(15.4) 0.004 No 117(79.6) 256(87) 373(84.6) Mode of delivery SVD 98(66.6) 200(68) 298(67.4) 0.036 Operative vaginal Delivery 20(13.6) 36(12.2) 56(12.6) Caesarean section 29(19.8) 58(19.8) 87(19.7) Anemia Yes 21(14.2) 30(10.2) 51(11.6) 0.024 No 126(85.8) 264(89.8) 390(88.4) Cord prolapse Yes 17(11.5) 7(2.3) 24(5.5) 0.071 No 130(88.5) 287(98.7) 417(94.5) 5.3 Common medical illiness related factors The percentage of women who had diabetes mellitus did not change significantly between the case and control groups (85.7% vs. 88%, p = 0.057). The percentage of women who had 11.5 versus 2.3% but the difference was not statistically significantly between the case and control groups (p = 0.749). About (38.7%) of cases and (32%) controls had history of hyperemesis gravidarum but the difference was not statistically significant(p = 0.076). The percentage of women who had HIV/AIDS did not change significantly between the case and control groups (32% vs. 30.6%, p = 0.241). The percentage of women who had 11.5 versus 2.3% but the difference was not statistically significantly between the case and control groups (p = 0.749). About (18.3%) of cases and (15%) controls had history of hepatitis B virus but the difference was not statistically significant(p = 0.083)(Table 5 ). Table 5 Common medical illiness related factors of cases and controls who gave birth public hospitals of North Shoa Zone, Oromia, Ethiopia;2023(n = 441) Variables Response 5th minute APGAR score Total p-value Cases Controls Diabetes mellitus Yes 126(85.7) 259(88) 385(87.3) 0.057 No 21(14.3) 35(11.9) 56(12.7) Cardiac disease Yes 17(11.5) 7(2.3) 24(5.5) 0.749 No 130(88.5) 287(98.7) 417(94.5) Hyperemesis gravidarum Yes 57(38.7) 94(32) 151(34.2) 0.076 No 90(61.2) 200(68) 290(65.8) HIV status Reactive 47(32) 90(30.6) 137(31) 0.241 Non reactive 100(68) 204(69.4) 304(69) Hepatatis B virus status Reactive 27(18.3) 44(15) 71(16) 0.083 Non reactive 120(81.7) 250(75) 370(84) 5.4 Fetal/neonatal characteristics When it came to newborn sex, the percentage of female was 58.5% among cases and 54.4% among controls, respectively. This difference between cases and controls is not statistically significant (p-value = 0.547). Sixty seven percent of the cases were term, as compared to eighty-one percent of the controls(p = 0.071). Although the difference was not statistically significant(p = 0.176), About 68% of cases among infants had a vertex presentation, compared to 69.4% of controls. Compared to controls, cases had greater proportions of low birth weight (16.3% vs. 16.4%, p = 0.019). The observed birth weight difference between cases and controls is statistically significant (Table 6 ). Table 6 Characteristics of newborns who delivered at public hospitals of North Shoa Zone, Oromia, Ethiopia; 2023 (n = 441) Questions Category Low 5th minute APGAR score Total P value Cases Controls Fetal Sex Female 86(58.5) 160(54.4) 246(55.7) 0.547 Male 61(41.4) 134(45.6) 195(44.3) Gestational age at birth? Term 99(67.4) 240(81.6) 339(76.8) 0.071 Post-term 48(32.6) 54(18.3) 102(24.2) Fetal presentation at birth? Breech 47(32) 90(30.6) 137(31) 0.176 Cephalic 100(68) 204(69.4) 304(69) Fetal weight at birth? Low birth weight 24(16.3) 48(16.4) 72(16.4) 0.019 Macrocosmic 23(15.6) 26(8.8) 49(11.1) Normal 90(61.2) 220(74.8) 310(70.5) 5.4 Determinant factors of 5th minute low Apgar score The findings of the binary logistic regression analysis showed that the low Apgar score was significantly correlated with the following factors: antepartum hemorrhage (APH), meconium-stained amniotic fluid (MSAF), mode of delivery, anemia, fetal sex, gestational age at birth, Pregnancy type, and fetal weight at birth. All significant variables from binary logistic regression were accounted for in multivariable logistic regression. The findings indicated that women delivered from twin pregnancy had about 1.7 times the odds of having a poor five-minute Apgar score as compared to newborns delivered from single pregnancy [AOR = 1.7, 95% CI: 1.23–2.17]. Compared to a normal 5th minute Apgar score, women who had no prenatal care contactwere 1.6 times more likely to have a fifth minute low Apgar score [AOR = 1.6, 95% CI: 1.02–2.18].Furthermore, compared to normal 5th minute Apgar, there was a 2.4fold increase in the likelihood of a poor Apgar score for babies born to anemic women [AOR = 2.4, 95% CI: 1.76–3.04]. Compared to their peers, neonates who delivered with a low Apgar score in the fifth minute had a 2.4 times higher risk of having low birth weight [AOR = 2.4, 95% CI: 1.54 3.08] (Table 7 ). Table 7 Binary and multivariable logistic regression analysis on determinant factors of low Apgar score among newborns who delivered at public hospitals of North Shoa Zone, Oromia, Ethiopia;2023 (n = 441) Variables Category 5th minute low Apgar score Odds Ratio Cases Controls COR AOR Gestational age at birth Term 99(67.4) 240(81.6) 1 1 Post-term 48(32.6) 54(18.3) 2.1(1.10–3.1) 1.8(0.87–1.39) Fetal birth weight Low birth weight 24(16.3) 48(16.4) 1.2(1.04–2.43) 2.4(1.54–3.08)* Macrosomic 23(15.6) 26(8.8) 2.1(0.97–3.23) 1.9(0.67–3.13) Normal 90(61.2) 220(74.8) 1 1 ANC Visit Yes 97(65.9) 200(68) 0.93(0.27–1.94) 1.6(1.02–2.18)* No 50()34.1 96(32) 1 1 APH Yes 11(7.4) 22(7.5) 1.0(0.74–1.48) 1.2(0.63–1.77) No 136(92.5) 272(92.5) 1 1 Pregnancy type Single 127(86.4) 259(88) 1 1 Twin 20(13.6) 35(11.9) 1.1(1.07–2.14) 1.7(1.23–2.17)* MSAF Yes 30(20.4) 38(13) 1.7(0.17–3.23) 0.9(0.64–1.16) No 117(79.6) 256(87) 1 1 Mode of delivery SVD 98(66.6) 200(68) 1 1 Operative vaginal Delivery 20(13.6) 36(12.2) 1.2(0.58–1.96) 1.1(0.83–1.37) Caesarean section 29(19.8) 58(19.8) 1.02(0.64–1.28) 1.3(0.78–1.82) Anemia Yes 21(14.2) 30(10.2) 1.4(1.14–2.29) 2.4(1.76–3.04)* No 126(85.8) 264(89.8) 1 1 Discussion Apgar score can be influenced by various factors that occur before and during pregnancy including the physical and emotional support during labor and delivery. Therefore, this study identified the determinant factors for a low Apgar score which is important for proper, immediate, and sustainable intervention to improve maternal for better pregnancy outcomes. The determinants that were independently associated with the low APGAR at five minutes were no ANC follow up, anemia, and birth weight. Fifth minute low Apgar score was more likely on newborns who delivered from anemic mothers compared to normal 5th minute Apgar score. This study is consistent with studies done in Sweden, Brazil, the USA, and Gondar 13,21,24 . This similarity is due to the fact that, anemia during pregnancy puts infants at increased risk of immediate birth asphyxia and long-term permanent cognitive damage and mortality 23 . Anemia in pregnancy is more prevalent in the developing world, where under nutrition and infections are more frequent which complicates pregnancy outcome. However, a study done in Amhara region Ethiopia and Japan indicated that anemia during pregnancy is not a determinant factor for birth asphyxia/low Apgar score 13,21,22 . This difference could be due to high prevalence of a history of antepartum hemorrhage in this study and difference in study setting. This finding suggests that health care providers should take into account the potential risk of anemia during pregnancy while assessing clinical condition of the mother. The risk of the low Apgar score was higher in newborns whose mothers had no antenatal care contact compared to normal 5th minute Apgar. This finding is similar to studies done in Sweden 14,21 . This could be the fact that supplementation, treatments, birth preparedness and readiness and counseling for a danger sign of pregnancy is given during antenatal care follow up. Medical care for women with obstetric complications begins with the recognition of danger signs. Delays in recognizing danger signs, in seeking, reaching, and obtaining appropriate maternity care are key elements in maternal and perinatal health. The other possibility could be because mothers who had no ANC visits will not gain a screening opportunity for certain risk factors like, anemia during pregnancy and low birth weight which were the risk factors for the low Apgar score in this study. Low at Apgar Fifth minute score was more likely on newborns delivered from twin pregnancy when compared to newborns delivered from single pregnancy 14 . This could be related to being delivered from twin pregnancy prone the neonates to the risk of low birth weight, preterm delivery, exposed to anesthesia if the delivery is undergone by ceseaean section. Besides women with twin pregnancy is at the risk of Anemia during pregnancy as increased iron demand. This finding also indicates that the antenatal care follow up efficiently will help to mitigate the problem of low Apgar score Low birth weight was a major determinant factor that was significantly associated with a low Apgar score in the present study. Those newborns who delivered with a 5 th minute low Apgar score were higher odds of having low birth weight compared to their counterparts. This finding is also consistent with the studies conducted in Ethiopia, Iran, and Ghana 21,23,34 . This could be explained by the fact that small babies might suffer from difficult birthing, impaired thermoregulation, hypoglycemia, polycythemia and might develop difficulty in cardiopulmonary transition and perinatal asphyxia, which could further affect Apgar score. Conclusion A low Apgar score was shown to be associated with a number of characteristics , including not receiving ANC followup, having anemia during pregnancy, having low birth weight, and twin pregnancy. Therefore, it is recommended that obstetric care providers firmly adhere to advise and counseling on the importance of ANC follow up. In addition, they should provide widespread health education on factors such as low birth weight, and twin pregnancy as they increase the likelihood of low fifth minute Apgar score. Effective health education during pre pregnancy about anemia during pregnancy and Antepartuem period will aid in identifying high-risk pregnancies that could causes low fifth minutes Apgar score. Recommendation During labor and delivery, it was advised to increase access to compassion ship in addition to the normal treatment of employing electronic fetal monitoring.Effective health education, particularly that which promotes a healthy lifestyle before to conception and antenatal care, will aid in the identification of high risk pregnancy that results in a low fifth minutes APGAR score. Pregnant mothers who run the risk of giving birth to children with low Apgar scores should be screened, counseled, and given access to vital health information on the factors that contribute to low Apgar scores. Create Public awareness and provide health education for women come to health facility. Limitation of study The study lacked access to data on a number of previously documented determinant factors of low Apgar score, including analgesia during labor and delivery, uterine rupture, abnormal heart rate in fetal tissue, diabetes mellitus, antipsychotic medication, thrombocytopenia, and thyroid disorders. The results may not apply to preterm, severe congenital malformations, or numerous pregnancies because the study was limited to term and post-term pregnancies. There might be intra-observer variability as a result of the research design. Abbreviations ANC Antenatal Care APGAR American pediatrics growth assessment record APH Antepartum hemorrhage AOR Adjusted odd ratio ARR Adjusted relative risk ASD Atrial septal defect BMI Body mass index BSc Bachelor of science CI Confidence interval C/S Caesarian Section DM Diabetes mellitus EDHS Ethiopian demographic health survey ETB Ethiopian Birr HEG Hyperemesis gravidarum HIE Hypoxic ischemic necrosis HIV Human immune virus LBW Low birth weight NMR Neonatal mortality rate MD Medical doctor MSAF Meconium stained amniotic fluid MSc Masters of Science PIH Pregnancy induced hypertension PROM Premature rupture of membrane SDG Sustainable development goal SPSS Statistical package for social science U5MR Under five mortality rate US United states WHO World health organization Declarations Acknowledgements The authors are grateful to the Salale University, College of Health Science for the approval of the ethical clearance. They are also thankful to the North Shoa Zonal Health Office and the public hospitals in North Shoa Zone for their agreement to do this study in the hospitals. Finally, we would like to thank the study participants and data collectors for their cooperation throughout the study period. Authors Contributorions Conceptualization: Teshome Ketema Sime(TKS). Data curation: Buta Adugna, Teshome Ketema, Yilma Jangule. Formal analysis: Teshome Ketema, Yilma Jangule. Funding acquisition: Teshome Ketema. Investigation: Teshome Ketema, Yilma Jangule. Methodology: Teshome Ketema, Buta Adugna. Project administration: Teshome Ketema, Yilma Jangule Resources: Teshome Ketema, Buta Adugna. Software: Buta Adugna, Yilma Jangule, Teshome Ketema. Writing – original draft: Yilma Jangule, Teshome Ketema. Writing – review & editing: Buta Adugna, Yilma Jangule, Teshome Ketema. Funding The authors did not receive a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors. Competing interests None declared. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Patient consent for publication Consent obtained directly from patient(s). Ethics approval Prior to the data collection period, ethical clearance and approval were obtained from the Salale University ethical board, with reference number IRB/902/14. A letter of support was provided to the administrative office of each selected hospital, and permission was granted to conduct the study. Written informed consent was obtained from each study participant after explaining the study's purpose, procedures, benefits, duration, and any potential risks in the local language. Participants were assured of their right to withdraw from the study at any time. This study was conducted in accordance with the principles of the Declaration of Helsinki. All information collected from participants was treated confidentially, with identifiers removed to protect their privacy. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available upon reasonable request. The datasets used and/or analyzed during the current study can be obtained from the corresponding author upon reasonable request. References FMOH. Neonatal Intensive Care Unit ( NICU ) Training Participants ’ Manual. Fmoh. 2021;(November):194. Hodgins C. Apgar score. J Obstet Gynecol Neonatal Nurs. 1997;26(1):15–6. Rosa-Mangeret F, Benski AC, Golaz A, Zala PZ, Kyokan M, Wagner N, et al. 2.5 Million Annual Deaths—Are Neonates in Low-and Middle-Income Countries Too Small to Be Seen? A Bottom-Up Overview on Neonatal Morbi-Mortality. Trop Med Infect Dis. 2022;7(5):1–21. Sharrow D, Hug L, You D, Alkema L, Black R, Cousens S, et al. Global, regional, and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet Glob Heal [Internet]. 2022;10(2):e195–206. Available from: http://dx.doi.org/10.1016/S2214-109X(21)00515-5 Gillette E, Boardman JP, Calvert C, John J, Stock SJ. Associations between low Apgar scores and mortality by race in the United States: A cohort study of 6,809,653 infants. PLoS Med [Internet]. 2022;19(7):1–15. Available from: http://dx.doi.org/10.1371/journal.pmed.1004040 Modabbernia A, Sandin S, Gross R, Leonard H, Gissler M, Parner ET, et al. Apgar score and risk of autism. Eur J Epidemiol [Internet]. 2019;34(2):105–14. Available from: https://doi.org/10.1007/s10654-018-0445-1 Gudayu TW. Proportion and factors associated with low fifth minute Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia. Afr Health Sci. 2017;17(1):1–6. Odd DE, Rasmussen F, Gunnell D, Lewis G, Whitelaw A. A cohort study of low Apgar scores and cognitive outcomes. Arch Dis Child Fetal Neonatal Ed. 2008;93(2):115–20. Li F, Wu T, Lei X, Zhang H, Mao M, Zhang J. The Apgar Score and Infant Mortality. PLoS One. 2013;8(7):1–8. Ensing S, Schaaf JM, Abu-Hanna A, Mol BWJ, Ravelli ACJ. Recurrence risk of low Apgar score among term singletons: A population-based cohort study. Acta Obstet Gynecol Scand. 2014;93(9):897–904. Tavares VB, Souza J De, Vinicius M, Affonso DG, Souza E, Rocha D, et al. Factors associated with 5 ‑ min APGAR score , death and survival in neonatal intensive care : a case ‑ control study. BMC Pediatr [Internet]. 2022;1–11. Available from: https://doi.org/10.1186/s12887-022-03592-9 Province S. Journal of Pregnancy and Traditional beliefs and Practices in Newborn Care among Mothers in. 2021;4(1):1–6. Haddad B, Mercer BM, Livingston JC, Talati A, Sibai BM. Outcome after successful resuscitation of babies born with Apgar scores of 0 at both 1 and 5 minutes. Am J Obstet Gynecol. 2000;182(5):1210–4. Gebremedhin MM. Determinants of low APGAR score in newborns delivered at Lemlem Karl general hospital , Northern Ethiopia , 2018 : a case control study. Res Sq. 2018;2:1–17. Yeshaneh A, Kassa A, Kassa ZY, Adane D, Fikadu Y, Wassie ST, et al. The determinants of 5th minute low Apgar score among newborns who delivered at public hospitals in Hawassa City, South Ethiopia. BMC Pediatr. 2021;21(1):1–10. Ajibo BD, Wolka E, Aseffa A, Nugusu MA, Adem AO, Mamo M, et al. Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study. BMC Pregnancy Childbirth. 2022;22(1):1–14. Mgaya AH, Massawe SN, Kidanto HL, Mgaya HN. Grand multiparity: Is it still a risk in pregnancy? BMC Pregnancy Childbirth. 2013;13. Getachew B, Etefa T, Asefa A, Terefe B, Dereje D. Determinants of Low Fifth Minute Apgar Score among Newborn Delivered in Jimma University Medical Center, Southwest Ethiopia. Int J Pediatr (United Kingdom). 2020;2020. Obsa MS, Shanka GM, Menchamo MW, Fite RO, Awol MA. Factors Associated with Apgar Score among Newborns Delivered by Cesarean Sections at Gandhi Memorial Hospital, Addis Ababa. J Pregnancy. 2020;2020. Cnattingius S, Johansson S, Razaz N. Apgar Score and Risk of Neonatal Death among Preterm Infants. N Engl J Med. 2020;383(1):49–57. Desalew A, Sintayehu Y, Teferi N, Amare F, Geda B, Worku T, et al. Cause and predictors of neonatal mortality among neonates admitted to neonatal intensive care units of public hospitals in eastern Ethiopia: A facility-based prospective follow-up study. BMC Pediatr. 2020;20(1):1–11. Murata T, Yasuda S, Imaizumi K, Isogami H, Fukuda T, Kyozuka H, et al. Association of labour duration in spontaneous deliveries with low neonatal Apgar scores and foetal acidosis : the Japan Environment and Children ’ s Study. 2022;1–9. Kiyani AN, Khushdil A, Ehsan A. Perinatal factors leading to birth asphyxia among term newborns in a tertiary care hospital. Iran J Pediatr. 2014;24(5):637–42. E.T. D, A.T. O, B.K. O. Stillbirths and very low Apgar scores among vaginal births in a tertiary hospital in Ghana: A retrospective cross-sectional analysis. BMC Pregnancy Childbirth [Internet]. 2014;14(1):1–8. Available from: http://www.biomedcentral.com/1471-2393/14/289%5Cnhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed12&NEWS=N&AN=2014876780 Additional Declarations No competing interests reported. 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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-5330388","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":371655117,"identity":"e2195fa9-dda1-422f-b295-cfd85e957f34","order_by":0,"name":"Teshome Ketema","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYHACNhBhAGHz2AAJxsYD+NTzwLWAKZk0kJYGUrTYHAaL4tViz97+7MHHHBtjfvnmoxt+5Jy3W9t+GGhLjU00Tlt4zpgbztyWZibZxpZ2s+fM7eRtZxKBWo6l5Tbg0iKRwybNu+2wjcExHrMbvD23k80OALUwNhzGrUX++TOglv829sf4v938++9cstn5hwS0SDCYAbUcMDNg42G7zcNzwM7sBiFbzuSYSc7clmwscSzN7LYMT3KC2Q2gLQl4/MLefvyZxMdtdob9zYef3XzDY2dvdj794YMPNTY4tWCARLDKBGKVg4A9KYpHwSgYBaNgZAAAehdg9PGbkUEAAAAASUVORK5CYII=","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Teshome","middleName":"","lastName":"Ketema","suffix":""},{"id":371655118,"identity":"925270a2-d24e-468f-90e1-9c0e59c9b4f7","order_by":1,"name":"Yilma jangule","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Yilma","middleName":"","lastName":"jangule","suffix":""},{"id":371655119,"identity":"572f90f5-2336-411f-b276-79e3887d94f1","order_by":2,"name":"Buta Adugna","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Buta","middleName":"","lastName":"Adugna","suffix":""}],"badges":[],"createdAt":"2024-10-25 07:38:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5330388/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5330388/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69081902,"identity":"62f6b1e3-ed8e-4111-bd78-7ad5e467c24c","added_by":"auto","created_at":"2024-11-15 12:07:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37117,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 2: shows the Schematic presentation of the Sampling technique and procedure for each randomly selected public hospitals in North shewa zone, Oromia, Ethiopia, 2023\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5330388/v1/e8253fc2c04f37bc55024363.png"},{"id":90253581,"identity":"06d7c9b2-bfd2-4670-bdfa-59f81a59a250","added_by":"auto","created_at":"2025-08-31 09:38:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1413768,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5330388/v1/4a74ba4c-ec2a-4e45-99de-86a1ec0cbe52.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of low fifth-minute APGAR score among newborn : A case control study conducted in north shewa Zone public hospitals, Central Ethiopia:2023","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eNeonate is a period from birth to the first 28 days of life which is classified as early neonate for the first three weeks of life after delivery, whereas late neonate refers to the final three weeks\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. APGAR score is a American pediatric growth assessment record used to rapidly and simply evaluate the newborn's health just after birth. A grade of zero to two is given to each five vital signs parameters developed by virginia. The resultant APGAR score is between zero and ten\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe scoring systems contain five parameters with each of them holding 0\u0026ndash;2 points. These parameters are Activity, Pulse, Grimace, Appearance, and Respiration. It is interpreted as a Low APGAR score of 0\u0026ndash;3 - Moderate APGAR score of 4\u0026ndash;6 \u0026amp; Normal APGAR score of 7\u0026ndash;10. A newborn with an APGAR score of fewer than 7 needs special attention\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Newborn who has a low score at 1 minute and a normal score at 5 minutes should not have any long-term problems while the vice versa exposes the neonate to different long-term problems\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eGlobally, 2.6\u0026nbsp;million children under the age of five and around 7,000 newborns died in the first month of birth, with the majority of these deaths occurring in the first few weeks. Neonatal mortality has a significant influence on under-five mortality\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. The Sustainable development Goal (SDG) in South-East Asia aims to reduce newborn mortality to at least 12 per 1000 live births by 2030, only accounting for about one-third of neonatal fatalities in 2018\u003csup\u003e5\u003c/sup\u003e. A poor APGAR score at 5 minutes was significantly linked with neonatal mortality\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eLow APGAR score accounting for 100\u0026ndash;250/1000 live births as compared to 5\u0026ndash;10/1000 live births in developed countries. Currently, 1 in every 30 children in Ethiopia dies within the first month which is still significant\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Newborn mortality in Ethiopia reduced from 39 to 29 during the Ethiopian demographic health survey (EDHS) of 2005 and 2016, but has subsequently stabilized\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Currently, 1 in every 30 children in Ethiopia dies within the first month which is still significant. In the United States, cohort studies have shown a high correlation between low APGAR scores and neonatal mortality, as seen by the 0.06% overall neonatal mortality rate and the 0.2% infant mortality rate \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Several studies have shown that a low fifth-minute APGAR score is linked to greater mortality rates, lower IQ scores, and a higher chance of arterial septal defect \u003csup\u003e\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe risk of recurrence of a low APGAR score in the subsequent pregnancy was 1.1% \u003csup\u003e15,16\u003c/sup\u003e. So, more attention should be given to providing crucial newborn care \u0026amp; promptly determining the newborn APGAR score concerned with reducing neonatal mortality. A hospital-based retrospective case-control study with 277 medical records showed that 42 of the 79 newborns with a 5-minute APGAR score of less than 7 have died \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite having adequate resuscitation 13.8% of neonates died making up 28.72% of all neonates who died due to low APGAR score at 5 minutes. This shows that even after having an efficient resuscitation, newborns with poor APGAR scores are still at a higher risk of perinatal morbidity and death \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. The odds of a low APGAR score at 5 minute is significantly correlated with obstetric factors such as antepartum hemorrhage, pregnancy-induced hypertension, anemia, heart disease, diabetes mellitus, birth injury, caesarian delivery, prolonged second stages of labor, and severe birth asphyxia \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite many study has been conducted in our setup, to the knowledge of the author no study conducted in the area and no Previous study examined the effect of common medical conditions that were during current pregnancy on the low Apgar score at five minute. Therefore, this study aimed to assess determinants of low fifth minutes AGAR score among newborns delivered at public hospitals of North Shoa zone, central Ethiopia.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cp\u003e\u003cstrong\u003eStud setting and period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in North Shoa public hospitals, central Ethiopia from March 30 to April 30, 2023. The North Shewa zone is located in the Oromia region, Ethiopia, 112 km northwest of the capital city, Addis Ababa. The zone has a total population of about 1,639,586, of which a majority (89.75%) of the population residing in rural areas. A total of 71 public health institutions serve the population, including 64 health centers, seven hospitals, and 30 private medium clinics. All of these hospitals offer obstetrical services for mothers. The zonal health office\u0026apos;s report indicates that overall, 9,364 births were made at the chosen hospital each year. The North Shewa zone\u0026apos;s main city Fiche town is home to Salale university comprehensive specialized hospital, which performs about 2,487 births annually. Similarly, Sendafa hospital, M/Turi hospital, G/Meskel hospital , and Chancho hospital oversees around 2004, 1317 and 1645 deliveries annually, 2234 deliveries annually respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;A \u0026nbsp;facility based prospective case-control was conducted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eSource Population\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll newborn mothers who gave birth\u0026nbsp;at selected\u0026nbsp;North Shewa Zone public hospitals will be the source population.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll\u0026nbsp;selected newborn mothers who gave birth\u0026nbsp;at\u0026nbsp;North Shewa Zone public hospitals\u0026nbsp;during the study period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCases\u003c/strong\u003e: All newborns with a low fifth-minute APGAR score (APGAR\u0026lt;7) at the randomly\u003cbr\u003e\u0026nbsp;selected hospitals of the North Shewa Zone that fulfilled the inclusion criteria.\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eControls:\u003c/strong\u003e All newborns with a fifth-minute APGAR score (APGAR\u0026gt;=7) at the randomly selected hospitals of North Shewa Zone that fulfilled the inclusion criteria.\u003c/p\u003e\n\u003ch2\u003eInclusion and Exclusion Criteria\u003c/h2\u003e\n\u003cul\u003e\n \u003cli\u003eAll babies delivered after 28 weeks of gestation \u0026amp; during the study period\u0026nbsp;at North shewa public health facility were included in the study.\u0026nbsp;Charts with incomplete documentation,\u0026nbsp;Newborns referred from other health facilities, Newborns with gross congenital anomalies incompatible with life. Such as anencephaly, severe hydrocephaly, and Gastroschisis, Preterm, Multiple pregnancies except twin pregnancies were excluded from the study\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2\u003eDetermination of Sample Size\u003c/h2\u003e\n\u003cp\u003eTo determine the required sample size for this study Epi-info version 7.2.2.12 stat calculation software was used for variables that have significant associations with a low fifth-minute \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; APGAR score. Mothers who had a history of khat use, maternal APH in the current pregnancy, Maternal PIH in the current pregnancy, MSAF, and birth injury are considered to calculate the required sample size. From these maternal gravidity is chosen as an independent variable hence it gives us the maximum sample size as compared to other predictor variables.\u003c/p\u003e\n\u003cp\u003eThe sample size was determined using a formula for two population proportions and calculated using Epi-info version 7.2.2.12 stat calculation software\u0026nbsp;by considering that the percent of controls exposed (having Grandmultiparity history) were 5.4% whereas 12.09% of cases exposed (main exposure variable) which is estimated from other studies\u003csup\u003e21\u003c/sup\u003e, 95% CI, 80% power of the study and control to case ratio of 2:1. Accordingly, after adding 10% for non-response rate 147 cases and 294 controls (a total sample size of 441) are planned to be involved in this study.\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSample size calculation for unmatched case-control study by open Epi software\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFactors considered for\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent of\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent of cases\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eo\u003c/span\u003e of cases\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eo\u003c/span\u003e of\u003c/p\u003e\n \u003cp\u003eControls\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecalculating sample size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrols exposed\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith exposure (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMSAF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePregnancy induced HTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrandmultiparity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMothers who had history of khat use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch3\u003eSampling Procedure\u003c/h3\u003e\n\u003cp\u003eFrom the 7 functional public hospitals in North Shewa; using the rule of thumb (\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30%) five public hospitals were selected through a simple random sampling technique by lottery method. According to the 2015 E.C semi-annual delivery report of randomly selected health institutions, the lowest monthly proportion of institutional delivery was taken from delivery registration logo book\u003c/p\u003e\n\u003cp\u003eAccordingly, the sample size was proportionally allocated for hospitals for each hospital by fixing one month average delivery flow. All cases and subsequent two eligible controls in the study sites were included in the study. A consecutive sampling technique was employed to recruit cases, while a systematic random sampling technique every two intervals was used to select controls. Non-respondents for controls were replaced by the subsequent controls delivered to make the case-to-control ratio even.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u0026nbsp;\u003cspan class=\"mathinline\"\u003e\\(\\:K=\\frac{N}{n}\\)\u003c/span\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\:K=\\frac{660}{294}\\)\u003c/span\u003e\u003c/span\u003e\u0026asymp; 2 Where, K= \u003cstrong\u003ef\u003c/strong\u003erequency interval\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;the total number of the population n\u0026thinsp;=\u0026thinsp;the required number in the sample\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eShow how the sample allocation was calculated for each randomly selected hospitals in North Shoa Zone, Oromia, Ethiopia, 2023\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInstitutional name\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eThe average\u003c/p\u003e\n \u003cp\u003eMonthly delivery report\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProportion\u003c/p\u003e\n \u003cp\u003eof neonate delivered\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSample allocated\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of controls\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG/meskel Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSalale university comprehensive specialized Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM/Turi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChancho Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSendafa hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e294\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eSampling techniques\u003c/h2\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eData Collection Procedure \u0026amp; Quality Assurance:\u003c/h2\u003e\n \u003cp\u003eA pretest was conducted on 5% of the sample size at Kuyu hospital which is other than the selected hospitals to assess the reliability of data collection instruments. Based on the pretest result, corrective measures were taken on the questionnaire. Before the actual data collection, Training was given to data collectors \u0026amp; supervisors on how to measure the weight of the baby, APGAR score, \u0026amp; on how to take informed consent. The data collectors were clarifed the study\u0026apos;s intent and receive verbal consent from the respondents. Data was collected by Eight trained Bsc midwives working in delivery wards of each selected public hospital, and two second-degree holding supervisors from the health discipline, respectively.\u003c/p\u003e\n \u003cp\u003eThe data was collected through a face-to-face interview using a structured \u0026amp; pretested questionnaire, a mother\u0026apos;s medical records review as well as by using an observational checklist. Calibrated Seca scale \u0026amp; observational checklist was used to assess fetal birth weight \u0026amp; APGAR score respectively. Information which could not be obtained by interview, like common medical conditions during current pregnancy, obstetrics factors, intra partum events, and newborn related information, was extracted from maternal records at the postnatal ward.\u003c/p\u003e\n \u003cp\u003eQuestionnaire was primarily prepared in the English language and translated into Local language by professional who is familiar on this field and fluent in the two languages and back-translated to English language by another expert, who is not familiar with the original questionnaires in order to guarantee its consistency. To assure the completeness of the questionnaire, the collected data was checked daily during data collection.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eData Processing \u0026amp; Analysis\u003c/h2\u003e\n \u003cp\u003eFirstly, the collected data was cleaned, coded, and checked for missing values \u0026amp; completeness before actual analysis. Then after entered using Epi data version 3.1 and then exported to statistical software and SPSS version 26.0 statistical packages for analysis. To assess the association between predictor variables with the dependent variable, first Binary logistic regression analysis was used. Variables with a significant association at P\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in the binary analysis were entered into multivariable logistic regression analysis using the stepwise forward variable elimination technique method to determine the determinants of the low fifth-minute APGAR score and those variables with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered to be statistically significant.\u003c/p\u003e\n \u003cp\u003eMulticolinearity was checked by variance inflation factorsof less than 10%. Hosmer- Lemeshow tests for goodness of fit was carried out(p\u0026thinsp;=\u0026thinsp;0.472). Finally, the analyzed data was summarized as Frequency, percentage, mean, and standard deviation. Significance was determined using crude and adjusted odds ratios with 95% confidence intervals.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Variables\u003c/h2\u003e\n \u003cp\u003eThe variables to be included in this questionnaire are both independent and dependent variables for which an association is going to be assessed among cases as well as controls.\u003c/p\u003e\n \u003ch3\u003eDependent variable\u003c/h3\u003e\n \u003cp\u003eLow fifth-minute APGAR score\u003c/p\u003e\n \u003ch3\u003eIndependent variables\u003c/h3\u003e\n \u003cp\u003e\u003cstrong\u003eSocio-demographic Factors:\u0026nbsp;\u003c/strong\u003eAge, Sex, Level of education, marital status, residence, Parents in come, Occupation.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal medical/obstetrics factors:\u0026nbsp;\u003c/strong\u003emode of delivery, fetal presentation, MSAF, ANC contact, the onset of labor, instrumental delivery, prolonged second stage of labor, DM, Anemia,hyperemesis gravidarum,cardiac disease and PIH\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNeonatal-related factors:\u003c/strong\u003e sex, birth weight, gestation at birth\u0026nbsp;\u003c/p\u003e\n \u003ch2\u003eOperational Definition\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eFetal gestational age:\u0026nbsp;\u003c/strong\u003egestational age of the fetus at the time of delivery\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHigh APGAR Score\u003c/strong\u003e(Controls): A similar group of newborns with APGAR scores of 7 or above at five minute of delivery \u003csup\u003e22\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLow APGAR score\u003c/strong\u003e (Cases): Newborns who delivered with APGAR scores below 7 at five minute of delivery \u003csup\u003e22\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFifth minute:\u003c/strong\u003e 5 minute from the \u0026nbsp;fully delivery of newborn \u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003ch2\u003e5.1 Socio-demographic characteristics study participants\u003c/h2\u003e\u003cp\u003eA total of 294 controls and 147 cases were involved in the study. All 411 mothers who were asked for an interview was contacted for the research making the response rate 100%. The mothers' ages ranged from 18–43 with mean and standard deviation of (26.8 ± 5.7) respectively. The age group between 20 and 35 years old accounted for around two third of the age distribution of mothers who were cases and controls (62.5%). The independent sample t-test indicates that there is no statistically significant difference in the mean age between the cases and controls (P-value = 0.498).\u003c/p\u003e\u003cp\u003eThe percentage of housewives among the mothers in the cases was almost similar with the percentage in the controls with the difference is not siginficant (74.8% vs. 74.4%, p = 0.672).\u003c/p\u003e\u003cp\u003eRegarding residence there were a relatively greater percentage of mothers of cases(62.5%) who lived in urban than controls(60.6%). However The independent sample t-test indicates that there is no statistically significant difference(p = 0.075). About 74.8% of the cases and 77.1% of controls were married with no statistically difference between them(p = 0.321).\u003c/p\u003e\u003cp\u003eThe educational background shows there is slight difference between cases who did not attend formal education(34%) as compared to controlswho did not attend formal education(37.4%) but the difference is not statistically significant(p = 0.179). There is not a significant difference among oromo ethinic group of cases (74.8%) and controls (78.2%) with p –value = 0.548. About 13.6% of the cases and 13.2% of controls were muslim religious follower with no statistically difference between them(p = 0.081).\u003c/p\u003e\u003cp\u003eWomen khat chewing history among cases(8.2%) and controls(8.1%) were no statistically significant(p = 0.057). there is no statistically significant difference among women who had Physical and emotional support during labor and delivery of cases(65.8%) versus controls(68%) at p value = 0.086 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" 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\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\u003eSocio-demographic characteristics of mothers of cases and controls who gave birth at public hospitals of North Shoa Zone, Oromia, Ethiopia;2023(n = 441)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eQUESTIONS\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eLow APGAR score at 5th minutes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge of the mother?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(6.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(6.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29(6.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20–35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92(62.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e204(69.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e296(67)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(24.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70(23.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e106(24)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58(39.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110(37.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e168(38)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89(60.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e184(62.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e273(62)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esingle\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(1.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10(2.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110(74.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e230(78.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e340(77.1)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edivorced\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(7.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(8.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35(8)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(13.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36(12.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56(12.7)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOromo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85(57.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e171(58.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e256(58)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30()20.4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60(20.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90(20.4)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTigre\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(9.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28(9.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42(9.5)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGuraghe\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(12.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35(11.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53(12)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthodox\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70(47.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e140(47.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e210(47.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(36.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108(36.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e162(36.7)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(13.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39(13.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59(13.3)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(2.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10(2.2)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational status?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(34)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110(37.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e160()36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary education\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(34)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90(30.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e140(32)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary education (9–12)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(17)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50(17)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75(17)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege and above\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22()14.9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44(14.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66(15)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eOccupation?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse wife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110(74.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e220(74.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e330(74.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employee\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(4.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(6.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27()6.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate employee\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(4.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16(3.6)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(19)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40(13.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68(15.4)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKhat chewing history?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(8.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(8.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36(8.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135(91.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e270(91.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e405(91.8)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePhysical and emotional support during labor and delivery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97(65.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200(68)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e297(67.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(34.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94(32)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e144(32.6)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003e5.2 Obstetrics characteristics of mothers\u003c/h2\u003e\u003cp\u003eThere was a significant difference (p = 0.093) between the proportion of mothers of cases who had no ANC contact and that of controls (65.9% vs. 68%). There was no significant difference(0.342) between the control and case groups in terms of the percentage of women who were Primigravida 10.2% vs 10.2%, Multigravida 57.8% vs 61.2%, and Grand multigravida 32% vs 28.5% respectively. In comparison to controls, cases were more likely to experience antepartum hemorrhage, and delivered from twin pregnancy and premature membrane rupture Type of the Pregnancy (7.4% versus 7.5%;P = 0.023), and (13.6% versus 11.9%;p = 0.002) respectively. The percentage of women who had PIH in the current pregnancy did not change significantly between the case and control groups (14.3% versus 11.9% = 0.074).\u003c/p\u003e\u003cp\u003eAmong controls compared to cases, the proportion of women who had Duration of PROM \u0026gt; 12 hours, and cord prolapse was not significantly greater (19.1% versus 11.6%; P = 0.084), and ( 11.5% versus 2.3%;P = 0.071) respectively. The percentage of women who had PROM in the current pregnancy did not change significantly between the case and control groups (38.7% versus 32%; P = 0.192). Nevertheless, the chi-square test p-value of 0.093 indicates that there is no statistically significant difference in presence of chorioamniotitis between cases and controls (25% versus 15%).Among controls compared to cases, the proportion of women who undergone Induced onset of labor, and augumented with oxytocin was not significantly greater(19.8% versus 13%; P = 0.079), and (24% versus 15%; P = 0.142) respectively\u003c/p\u003e\u003cp\u003eOnly 18.3%of mothers of controls and 15%of mothers of cases had Prolonged second stage of labor, yet there is no statistically significant difference between the two groups (chi-square test-p-value = 0.065). Meconium-stained liquor, Caesarean section mode of delivery, Anemia were vary between controls and cases in a statistically significant way (20.4%, versus 13%; P = 0.004), (19.8% versus 19.8%; P = 0.036), and (14.2% versus 10.2%;P = 0.024) for the Chi-square test, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" 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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetric characteristics of mothers of cases and controls who gave birth public hospitals of North Shoa Zone, Oromia, Ethiopia;2023(n = 441)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eLow 5th minute APGAR score\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eControl s\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGravidity of the mother?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimigravida\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(10.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e30(10.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45(10.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultigravida\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85(57.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e180(61.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e265(60)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrand multigravida\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47(32)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e84(28.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e131(29.8)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eParity of the mother?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimiparous\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(7.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e30(10.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41(9.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultiparous\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89(60.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e190(64.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e279(63.2)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrand multiparous\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47(32)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e74(25.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e121(27.4)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eANC visit\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97(65.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e200(68)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e297(67.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50()34.1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e96(32)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e146(32.7)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNumber of ANC visit?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 time\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(17)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e55(18.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e80(18.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2–3 times\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(14.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e80(27.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e102(23)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=4 times\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(27.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e65(22)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e105(23.8)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of the\u003c/p\u003e \u003cp\u003ePregnancy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingleton\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127(86.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e259(88)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e386(81.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwins\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(13.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e35(11.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55(12.5)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAPH\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(7.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e22(7.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33(7.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136(92.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e272(92.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e408(92.5)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePIH in the current pregnancy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(14.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e35(11.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56(12.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126(85.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e259(88)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e385(87.3)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePROM\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(38.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e94(32)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e151(34.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90(61.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e200(68)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e290(65.8)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of PROM\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 12 hours\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119(80.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e260(88.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e379(86)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e≥\u003c/span\u003e 12 hours\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(19.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e34(11.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62(14)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs there chorioamniotis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(25)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e44(15)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e81(18.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110(75)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e250(75)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e360(81.6)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eThe onset of labor\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpontaneous\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118(80.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e256(87)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e374(84.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInduced\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(19.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e38(13)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67(15.2)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003elabor Augmented\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(24)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e44(15)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e79(18)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112(76)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e250(75)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e362(82)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProlonged second stage of labor\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(18.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e44(15)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71(16)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120(81.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e250(75)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e370(84)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMeconium-stained liquor\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(20.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e38(13)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68(15.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117(79.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e256(87)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e373(84.6)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSVD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98(66.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e200(68)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e298(67.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperative vaginal Delivery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e20(13.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36(12.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56(12.6)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCaesarean section\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e29(19.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58(19.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87(19.7)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e21(14.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30(10.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51(11.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e126(85.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e264(89.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e390(88.4)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCord prolapse\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e17(11.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(2.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24(5.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e130(88.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e287(98.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e417(94.5)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003e5.3 Common medical illiness related factors\u003c/h2\u003e\u003cp\u003eThe percentage of women who had diabetes mellitus did not change significantly between the case and control groups (85.7% vs. 88%, p = 0.057). The percentage of women who had 11.5 versus 2.3% but the difference was not statistically significantly between the case and control groups (p = 0.749). About (38.7%) of cases and (32%) controls had history of hyperemesis gravidarum but the difference was not statistically significant(p = 0.076). The percentage of women who had HIV/AIDS did not change significantly between the case and control groups (32% vs. 30.6%, p = 0.241). The percentage of women who had 11.5 versus 2.3% but the difference was not statistically significantly between the case and control groups (p = 0.749). About (18.3%) of cases and (15%) controls had history of hepatitis B virus but the difference was not statistically significant(p = 0.083)(Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" 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\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCommon medical illiness related factors of cases and controls who gave birth public hospitals of North Shoa Zone, Oromia, Ethiopia;2023(n = 441)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResponse\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5th minute APGAR score\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126(85.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e259(88)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e385(87.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(14.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35(11.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56(12.7)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCardiac disease\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(11.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(2.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24(5.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130(88.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e287(98.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e417(94.5)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHyperemesis gravidarum\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(38.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94(32)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e151(34.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90(61.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200(68)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e290(65.8)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHIV status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReactive\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47(32)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90(30.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e137(31)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon reactive\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100(68)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e204(69.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e304(69)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHepatatis B virus status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReactive\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(18.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44(15)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71(16)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon reactive\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120(81.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e250(75)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e370(84)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003e5.4 Fetal/neonatal characteristics\u003c/h2\u003e\u003cp\u003eWhen it came to newborn sex, the percentage of female was 58.5% among cases and 54.4% among controls, respectively. This difference between cases and controls is not statistically significant (p-value = 0.547). Sixty seven percent of the cases were term, as compared to eighty-one percent of the controls(p = 0.071). Although the difference was not statistically significant(p = 0.176), About 68% of cases among infants had a vertex presentation, compared to 69.4% of controls. Compared to controls, cases had greater proportions of low birth weight (16.3% vs. 16.4%, p = 0.019). The observed birth weight difference between cases and controls is statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" 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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of newborns who delivered at public hospitals of North Shoa Zone, Oromia, Ethiopia; 2023 (n = 441)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eLow 5th minute APGAR score\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFetal Sex\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e86(58.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e160(54.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e246(55.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e61(41.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e134(45.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e195(44.3)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGestational age at birth?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTerm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e99(67.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e240(81.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e339(76.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-term\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e48(32.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54(18.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e102(24.2)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFetal presentation at birth?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreech\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e47(32)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90(30.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e137(31)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCephalic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100(68)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e204(69.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e304(69)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFetal weight at birth?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow birth weight\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(16.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e48(16.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72(16.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMacrocosmic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(15.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e26(8.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49(11.1)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90(61.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e220(74.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e310(70.5)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003e5.4 Determinant factors of 5th minute low Apgar score\u003c/h2\u003e\u003cp\u003eThe findings of the binary logistic regression analysis showed that the low Apgar score was significantly correlated with the following factors: antepartum hemorrhage (APH), meconium-stained amniotic fluid (MSAF), mode of delivery, anemia, fetal sex, gestational age at birth, Pregnancy type, and fetal weight at birth. All significant variables from binary logistic regression were accounted for in multivariable logistic regression. The findings indicated that women delivered from twin pregnancy had about 1.7 times the odds of having a poor five-minute Apgar score as compared to newborns delivered from single pregnancy [AOR = 1.7, 95% CI: 1.23–2.17]. Compared to a normal 5th minute Apgar score, women who had no prenatal care contactwere 1.6 times more likely to have a fifth minute low Apgar score [AOR = 1.6, 95% CI: 1.02–2.18].Furthermore, compared to normal 5th minute Apgar, there was a 2.4fold increase in the likelihood of a poor Apgar score for babies born to anemic women [AOR = 2.4, 95% CI: 1.76–3.04]. Compared to their peers, neonates who delivered with a low Apgar score in the fifth minute had a 2.4 times higher risk of having low birth weight [AOR = 2.4, 95% CI: 1.54 3.08] (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" 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\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBinary and multivariable logistic regression analysis on determinant factors of low Apgar score among newborns who delivered at public hospitals of North Shoa Zone, Oromia, Ethiopia;2023 (n = 441)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5th minute low Apgar score\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGestational age at birth\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTerm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99(67.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e240(81.6)\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=\"c2\"\u003e \u003cp\u003ePost-term\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48(32.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54(18.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.1(1.10–3.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.8(0.87–1.39)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFetal birth weight\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow birth weight\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(16.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48(16.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2(1.04–2.43)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.4(1.54–3.08)*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMacrosomic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(15.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(8.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.1(0.97–3.23)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.9(0.67–3.13)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90(61.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e220(74.8)\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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eANC Visit\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97(65.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200(68)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.93(0.27–1.94)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.6(1.02–2.18)*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50()34.1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96(32)\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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAPH\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(7.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(7.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(0.74–1.48)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.2(0.63–1.77)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136(92.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e272(92.5)\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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePregnancy type\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127(86.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e259(88)\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=\"c2\"\u003e \u003cp\u003eTwin\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(13.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35(11.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1(1.07–2.14)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.7(1.23–2.17)*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMSAF\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(20.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38(13)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.7(0.17–3.23)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9(0.64–1.16)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117(79.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e256(87)\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\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSVD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98(66.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200(68)\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=\"c2\"\u003e \u003cp\u003eOperative vaginal Delivery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(13.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36(12.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2(0.58–1.96)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1(0.83–1.37)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCaesarean section\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(19.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(19.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.02(0.64–1.28)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3(0.78–1.82)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(14.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(10.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4(1.14–2.29)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.4(1.76–3.04)*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126(85.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e264(89.8)\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/table\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eApgar score can be influenced by various factors that\u0026nbsp;occur before and during pregnancy including the physical and emotional support during labor and delivery.\u0026nbsp;Therefore, this study identified the determinant factors\u0026nbsp;for a low Apgar score which is important for proper, immediate, and sustainable intervention to improve maternal for better pregnancy outcomes.\u0026nbsp;The determinants that were independently associated with the low APGAR at five minutes were no ANC follow up, anemia, and birth weight.\u003c/p\u003e\n\u003cp\u003eFifth minute low Apgar score was more likely on newborns who delivered from anemic mothers compared to\u0026nbsp;normal 5th minute Apgar score. This study is consistent\u0026nbsp;with studies done in Sweden, Brazil, the USA, and Gondar\u0026nbsp;\u003csup\u003e13,21,24\u003c/sup\u003e. This similarity is due to the fact that,\u0026nbsp;anemia during pregnancy puts infants at increased risk\u0026nbsp;of immediate birth asphyxia and long-term permanent\u0026nbsp;cognitive damage and mortality\u003csup\u003e23\u003c/sup\u003e. Anemia in pregnancy is more prevalent in the developing world, where\u0026nbsp;under nutrition and infections are more frequent which\u0026nbsp;complicates pregnancy outcome. However, a study done\u0026nbsp;in Amhara region Ethiopia and Japan indicated that\u0026nbsp;anemia during pregnancy is not a determinant factor for\u0026nbsp;birth asphyxia/low Apgar score\u0026nbsp;\u003csup\u003e13,21,22\u003c/sup\u003e. This difference\u0026nbsp;could be due to high prevalence of a history of antepartum hemorrhage in this study and difference in study\u0026nbsp;setting. This finding suggests that health care providers\u0026nbsp;should take into account the potential risk of anemia\u0026nbsp;during pregnancy while assessing clinical condition of\u0026nbsp;the mother.\u003c/p\u003e\n\u003cp\u003eThe risk of the low Apgar score was higher in newborns whose mothers had no antenatal care contact\u0026nbsp;compared to normal 5th minute Apgar. This finding is\u0026nbsp;similar to studies done in Sweden\u0026nbsp;\u003csup\u003e14,21\u003c/sup\u003e. This could be\u0026nbsp;the fact that supplementation, treatments, birth preparedness and readiness and counseling for a danger\u0026nbsp;sign of pregnancy is given during antenatal care follow up. Medical care for women with obstetric complications\u0026nbsp;begins with the recognition of danger signs. Delays in\u0026nbsp;recognizing danger signs, in seeking, reaching, and\u0026nbsp;obtaining appropriate maternity care are key elements in\u0026nbsp;maternal and perinatal health. The other possibility\u0026nbsp;could be because mothers who had no ANC visits will\u0026nbsp;not gain a screening opportunity for certain risk factors\u0026nbsp;like, anemia during pregnancy and low birth weight\u0026nbsp;which were the risk factors for the low Apgar score in\u0026nbsp;this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLow at Apgar Fifth minute score was more likely on newborns delivered from twin pregnancy when compared to\u0026nbsp;newborns delivered from single pregnancy\u003csup\u003e\u0026nbsp;14\u003c/sup\u003e. This could be related to being delivered from twin pregnancy prone the neonates to the risk of low birth weight, preterm delivery, exposed to anesthesia if the delivery is undergone by ceseaean section. Besides women with twin pregnancy is at the risk of Anemia during pregnancy as increased iron demand.\u003c/p\u003e\n\u003cp\u003eThis finding also indicates that the antenatal\u0026nbsp;care follow up efficiently will help to mitigate the problem of low Apgar score Low birth weight was a major determinant factor that\u0026nbsp;was significantly associated with a low Apgar score in the\u0026nbsp;present study. Those newborns who delivered with a 5\u003csup\u003eth\u003c/sup\u003e minute low Apgar score were higher odds of having low\u0026nbsp;birth weight compared to their counterparts. This finding\u0026nbsp;is also consistent with the studies conducted in Ethiopia,\u0026nbsp;Iran, and Ghana\u0026nbsp;\u003csup\u003e21,23,34\u003c/sup\u003e. This could be explained by the fact that small babies might suffer from difficult birthing, impaired thermoregulation, hypoglycemia, polycythemia and might develop difficulty in cardiopulmonary transition and perinatal asphyxia, which could further affect Apgar score.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA low Apgar score was shown to be associated with a number of characteristics , including \u0026nbsp;not receiving ANC followup, having anemia during pregnancy, \u0026nbsp;having low birth weight, and twin pregnancy. Therefore, it is recommended that obstetric care providers firmly adhere to advise and counseling on the importance of ANC follow up. In addition, they should provide widespread health education on factors such as low birth weight, and twin pregnancy as they increase the likelihood of low fifth minute Apgar score.\u0026nbsp;Effective health education during\u003cbr\u003e\u0026nbsp;pre pregnancy about anemia during pregnancy and Antepartuem period will aid in identifying high-risk pregnancies that could causes low fifth minutes Apgar score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring labor and delivery, it\u0026nbsp;was\u0026nbsp;advised\u0026nbsp;to\u0026nbsp;increase\u0026nbsp;access to compassion ship\u0026nbsp;in addition to\u0026nbsp;the\u0026nbsp;normal treatment\u0026nbsp;of\u0026nbsp;employing\u0026nbsp;electronic fetal monitoring.Effective health education,\u0026nbsp;particularly\u0026nbsp;that\u0026nbsp;which promotes\u0026nbsp;a healthy\u0026nbsp;lifestyle before\u0026nbsp;to conception and\u0026nbsp;antenatal\u0026nbsp;care, will\u0026nbsp;aid\u0026nbsp;in the\u0026nbsp;identification of\u0026nbsp;high risk pregnancy that results in a low fifth minutes APGAR score. Pregnant mothers who\u0026nbsp;run\u0026nbsp;the risk of\u0026nbsp;giving birth\u0026nbsp;to\u0026nbsp;children\u0026nbsp;with low Apgar scores should\u0026nbsp;be screened, counseled,\u0026nbsp;and\u0026nbsp;given\u0026nbsp;access to\u0026nbsp;vital\u0026nbsp;health\u0026nbsp;information on the\u0026nbsp;factors\u0026nbsp;that\u0026nbsp;contribute\u0026nbsp;to\u0026nbsp;low\u0026nbsp;Apgar\u0026nbsp;scores.\u0026nbsp;Create\u0026nbsp;Public\u0026nbsp;awareness\u0026nbsp;and provide health\u0026nbsp;education for women come to health facility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation of study\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study lacked access to data on a number of previously documented determinant factors of low Apgar score, including analgesia during labor and delivery, uterine rupture, abnormal heart rate in fetal tissue, diabetes mellitus, antipsychotic medication, thrombocytopenia, and thyroid disorders. The results may not apply to preterm, severe congenital malformations, or numerous pregnancies because the study was limited to term and post-term pregnancies. \u0026nbsp;There might be intra-observer variability as a result of the research design.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"577\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eANC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eAntenatal Care\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003e\u0026nbsp;APGAR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eAmerican pediatrics growth assessment record\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eAPH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eAntepartum hemorrhage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eAdjusted odd ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eARR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eAdjusted relative risk\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eASD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eAtrial septal defect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eBody mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eBSc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eBachelor of science\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eConfidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eCaesarian Section\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eDiabetes mellitus\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eEDHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eEthiopian demographic health survey\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eETB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eEthiopian Birr\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eHEG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eHyperemesis gravidarum\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eHIE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eHypoxic ischemic necrosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eHuman immune virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eLBW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eLow birth weight\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eNMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eNeonatal mortality rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eMedical doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eMSAF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eMeconium stained amniotic fluid\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eMSc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eMasters of Science\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003ePIH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003ePregnancy induced hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003ePROM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003ePremature rupture of membrane\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eSDG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eSustainable development goal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eSPSS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eStatistical package for social science\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eU5MR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eUnder five mortality rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eUS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eUnited states\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3692%;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.6308%;\"\u003e\n \u003cp\u003eWorld health organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the Salale University, College of Health Science for the approval of the ethical clearance. They are also thankful to the North Shoa Zonal Health Office and the public hospitals in North Shoa Zone for their agreement to do this study in the hospitals. Finally, we would like to thank the study participants and data collectors for their cooperation throughout the study period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributorions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Teshome Ketema Sime(TKS).\u003c/p\u003e\n\u003cp\u003eData curation: Buta Adugna, Teshome Ketema, Yilma Jangule.\u003c/p\u003e\n\u003cp\u003eFormal analysis: Teshome Ketema, Yilma Jangule.\u003c/p\u003e\n\u003cp\u003eFunding acquisition: Teshome Ketema.\u003c/p\u003e\n\u003cp\u003eInvestigation: Teshome Ketema, Yilma Jangule.\u003c/p\u003e\n\u003cp\u003eMethodology: Teshome Ketema, Buta Adugna.\u003c/p\u003e\n\u003cp\u003eProject administration: Teshome Ketema, Yilma Jangule\u003c/p\u003e\n\u003cp\u003eResources: Teshome Ketema, Buta Adugna.\u003c/p\u003e\n\u003cp\u003eSoftware: Buta Adugna, Yilma Jangule, Teshome Ketema.\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; original draft: Yilma Jangule, Teshome Ketema.\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; review \u0026amp; editing: Buta Adugna, Yilma Jangule, Teshome Ketema.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient and public involvement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent obtained directly from patient(s).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to the data collection period, ethical clearance and approval were obtained from the Salale University ethical board, with reference number IRB/902/14. A letter of support was provided to the administrative office of each selected hospital, and permission was granted to conduct the study. Written informed consent was obtained from each study participant after explaining the study\u0026apos;s purpose, procedures, benefits, duration, and any potential risks in the local language. Participants were assured of their right to withdraw from the study at any time. This study was conducted in accordance with the principles of the Declaration of Helsinki. All information collected from participants was treated confidentially, with identifiers removed to protect their privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProvenance and peer review\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot commissioned; externally peer reviewed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available upon reasonable request. The datasets used and/or analyzed during the current study can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFMOH. Neonatal Intensive Care Unit ( NICU ) Training Participants \u0026rsquo; Manual. Fmoh. 2021;(November):194. \u003c/li\u003e\n\u003cli\u003eHodgins C. Apgar score. J Obstet Gynecol Neonatal Nurs. 1997;26(1):15\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eRosa-Mangeret F, Benski AC, Golaz A, Zala PZ, Kyokan M, Wagner N, et al. 2.5 Million Annual Deaths\u0026mdash;Are Neonates in Low-and Middle-Income Countries Too Small to Be Seen? A Bottom-Up Overview on Neonatal Morbi-Mortality. Trop Med Infect Dis. 2022;7(5):1\u0026ndash;21. \u003c/li\u003e\n\u003cli\u003eSharrow D, Hug L, You D, Alkema L, Black R, Cousens S, et al. Global, regional, and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet Glob Heal [Internet]. 2022;10(2):e195\u0026ndash;206. Available from: http://dx.doi.org/10.1016/S2214-109X(21)00515-5\u003c/li\u003e\n\u003cli\u003eGillette E, Boardman JP, Calvert C, John J, Stock SJ. Associations between low Apgar scores and mortality by race in the United States: A cohort study of 6,809,653 infants. PLoS Med [Internet]. 2022;19(7):1\u0026ndash;15. Available from: http://dx.doi.org/10.1371/journal.pmed.1004040\u003c/li\u003e\n\u003cli\u003eModabbernia A, Sandin S, Gross R, Leonard H, Gissler M, Parner ET, et al. Apgar score and risk of autism. Eur J Epidemiol [Internet]. 2019;34(2):105\u0026ndash;14. Available from: https://doi.org/10.1007/s10654-018-0445-1\u003c/li\u003e\n\u003cli\u003eGudayu TW. Proportion and factors associated with low fifth minute Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia. Afr Health Sci. 2017;17(1):1\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eOdd DE, Rasmussen F, Gunnell D, Lewis G, Whitelaw A. A cohort study of low Apgar scores and cognitive outcomes. Arch Dis Child Fetal Neonatal Ed. 2008;93(2):115\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eLi F, Wu T, Lei X, Zhang H, Mao M, Zhang J. The Apgar Score and Infant Mortality. PLoS One. 2013;8(7):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eEnsing S, Schaaf JM, Abu-Hanna A, Mol BWJ, Ravelli ACJ. Recurrence risk of low Apgar score among term singletons: A population-based cohort study. Acta Obstet Gynecol Scand. 2014;93(9):897\u0026ndash;904. \u003c/li\u003e\n\u003cli\u003eTavares VB, Souza J De, Vinicius M, Affonso DG, Souza E, Rocha D, et al. Factors associated with 5 ‑ min APGAR score , death and survival in neonatal intensive care : a case ‑ control study. BMC Pediatr [Internet]. 2022;1\u0026ndash;11. Available from: https://doi.org/10.1186/s12887-022-03592-9\u003c/li\u003e\n\u003cli\u003eProvince S. Journal of Pregnancy and Traditional beliefs and Practices in Newborn Care among Mothers in. 2021;4(1):1\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eHaddad B, Mercer BM, Livingston JC, Talati A, Sibai BM. Outcome after successful resuscitation of babies born with Apgar scores of 0 at both 1 and 5 minutes. Am J Obstet Gynecol. 2000;182(5):1210\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eGebremedhin MM. Determinants of low APGAR score in newborns delivered at Lemlem Karl general hospital , Northern Ethiopia , 2018 : a case control study. Res Sq. 2018;2:1\u0026ndash;17. \u003c/li\u003e\n\u003cli\u003eYeshaneh A, Kassa A, Kassa ZY, Adane D, Fikadu Y, Wassie ST, et al. The determinants of 5th minute low Apgar score among newborns who delivered at public hospitals in Hawassa City, South Ethiopia. BMC Pediatr. 2021;21(1):1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eAjibo BD, Wolka E, Aseffa A, Nugusu MA, Adem AO, Mamo M, et al. Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study. BMC Pregnancy Childbirth. 2022;22(1):1\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eMgaya AH, Massawe SN, Kidanto HL, Mgaya HN. Grand multiparity: Is it still a risk in pregnancy? BMC Pregnancy Childbirth. 2013;13. \u003c/li\u003e\n\u003cli\u003eGetachew B, Etefa T, Asefa A, Terefe B, Dereje D. Determinants of Low Fifth Minute Apgar Score among Newborn Delivered in Jimma University Medical Center, Southwest Ethiopia. Int J Pediatr (United Kingdom). 2020;2020. \u003c/li\u003e\n\u003cli\u003eObsa MS, Shanka GM, Menchamo MW, Fite RO, Awol MA. Factors Associated with Apgar Score among Newborns Delivered by Cesarean Sections at Gandhi Memorial Hospital, Addis Ababa. J Pregnancy. 2020;2020. \u003c/li\u003e\n\u003cli\u003eCnattingius S, Johansson S, Razaz N. Apgar Score and Risk of Neonatal Death among Preterm Infants. N Engl J Med. 2020;383(1):49\u0026ndash;57. \u003c/li\u003e\n\u003cli\u003eDesalew A, Sintayehu Y, Teferi N, Amare F, Geda B, Worku T, et al. Cause and predictors of neonatal mortality among neonates admitted to neonatal intensive care units of public hospitals in eastern Ethiopia: A facility-based prospective follow-up study. BMC Pediatr. 2020;20(1):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eMurata T, Yasuda S, Imaizumi K, Isogami H, Fukuda T, Kyozuka H, et al. Association of labour duration in spontaneous deliveries with low neonatal Apgar scores and foetal acidosis : the Japan Environment and Children \u0026rsquo; s Study. 2022;1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eKiyani AN, Khushdil A, Ehsan A. Perinatal factors leading to birth asphyxia among term newborns in a tertiary care hospital. Iran J Pediatr. 2014;24(5):637\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eE.T. D, A.T. O, B.K. O. Stillbirths and very low Apgar scores among vaginal births in a tertiary hospital in Ghana: A retrospective cross-sectional analysis. BMC Pregnancy Childbirth [Internet]. 2014;14(1):1\u0026ndash;8. Available from: http://www.biomedcentral.com/1471-2393/14/289%5Cnhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS\u0026amp;PAGE=reference\u0026amp;D=emed12\u0026amp;NEWS=N\u0026amp;AN=2014876780\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"5th minute, Newborn, Apgar score, Determinant, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-5330388/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5330388/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Globally, 2.6 million children under the age of five and around 7,000 newborns died in the first month of birth, with the majority of these deaths occurring in the first few weeks. Neonatal mortality has a significant influence on under-five mortality\u003csup\u003e.\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e The study aimed to assess the determinants of low fifth-minute APGAR score among newborn delivered at hospitals in north shewa, Oromia, Ethiopia, 2023\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign and settings: \u003c/strong\u003eA facility based unmatched case-control study was conducted among 411 newborns was conducted from March 30 to April 30, 2023, in North Shoa Zone public hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants: \u003c/strong\u003e147\u003cstrong\u003e \u003c/strong\u003eNewborns with 5\u003csup\u003eth\u003c/sup\u003e APGAR score less than 7 were considered as cases whereas 293 Newborns presented with 5\u003csup\u003eth\u003c/sup\u003e APGAR score greater than 7 were considered as controls. A consecutive sampling technique was employed to recruit cases, while a systematic random sampling technique was used to select controls. A pretested structured questionnaire through a face-to-face interview, a mother's medical records review, and observational checklist were used to collect data. The AOR with a 95 % confidence level were performed. Finally, variables with P \u0026lt; 0.05 were considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measures\u003c/strong\u003e: The medical charts of participants were used to recruit cases and controls\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Anemia [AOR\u0026nbsp;=\u0026nbsp;2.4,\u0026nbsp;95%\u0026nbsp;CI:\u0026nbsp;1.76–3.04], low birth weight [AOR\u0026nbsp;=\u0026nbsp;2.4,\u0026nbsp;95%\u0026nbsp;CI:\u0026nbsp;1.54–3.08], twin pregnancy [AOR\u0026nbsp;=\u0026nbsp;1.7,\u0026nbsp;95%\u0026nbsp;CI:\u0026nbsp;1.23–2.17], and absence of ANC follow up[AOR\u0026nbsp;=\u0026nbsp;1.6,\u0026nbsp;95%\u0026nbsp;CI:\u0026nbsp;1.02–2.18] were revealed as significant predictors of low Apgar score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e A low fifth minute Apgar score was associated with low birth weight, antepartum hemorrhage, twin pregnancy, and not receiving ANC follow-up. It will be easier to identify high-risk pregnancies that result in low Apgar scores if pregnant women get effective health education on anemia during pregnancy,twin pregnancy,low birth weight and ANC before getting pregnant.\u003c/p\u003e","manuscriptTitle":"Determinants of low fifth-minute APGAR score among newborn : A case control study conducted in north shewa Zone public hospitals, Central Ethiopia:2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-15 12:07:30","doi":"10.21203/rs.3.rs-5330388/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"89ff8c5c-e618-4d21-a2ab-5045e313bb3f","owner":[],"postedDate":"November 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-31T09:38:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-15 12:07:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5330388","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5330388","identity":"rs-5330388","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}