Magnitude and factors associated with malpractice claims among members of the Ethiopian Society of Obstetricians and Gynecologists: Cross sectional survey

Magnitude and factors associated with malpractice claims among members of the Ethiopian Society of Obstetricians and Gynecologists: Cross sectional survey | 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 Magnitude and factors associated with malpractice claims among members of the Ethiopian Society of Obstetricians and Gynecologists: Cross sectional survey ABDI TOLERA, FEYERA BEKESHA This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7368041/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Obstetrics is a medical specialty that is widely perceived by health professionals to be associated with a high risk of litigation. An increase in litigation against obstetrics and gynecology professionals, compared with other medical departments, is becoming an issue in medicine. Objective To assess the magnitude of malpractice claims and the common causes or factors that lead to these malpractice claims among Ethiopian Society of Obstetricians and Gynecologists members. Methods A cross-sectional survey was conducted from October 1, 2024, to May 31, 2025, among members of the Ethiopian Society of Obstetricians and Gynecologists (ESOG). The Google form questionnaire was shared to all the members through the society. SPSS version 26 was used for analysis. The degree of association was measured by using the odds ratio with 95% CI, and significance was declared at a p value of < 0.05. Ethical considerations included informed consent, confidentiality, and ethical clearance from the Ethiopian Medical Association. Results A total of 462 members of the Ethiopian Society of Obstetricians and Gynecologists (ESOG) participated in the study. Most were male (86.6%), and the predominant age group was 40–50 years (35.3%). Among the 462 respondents, 54 (11.7%) reported experiencing at least one malpractice claim during their career. The most common adverse outcomes leading to malpractice litigation were perinatal death (53.7%) and maternal death (48.1%). Among those who faced malpractice claims, 79.6% lacked knowledge about insurance coverage. Conclusions and recommendations: The rate of malpractice claims is nearly 1 in 9, and there is a lack of legal and insurance protection for healthcare providers. Therefore, it is crucial to strengthen the registry for malpractice claims and encourage nationwide access to affordable malpractice insurance for Obstetrics and Gynecology professionals. Malpractice ESOG Ob-Gyn Ethiopia ethics committee 1. Introduction Medical liability claims are believed to have become such an invariable part of practice that some clinicians have advocated that a practice in mock trials be incorporated as part of medical education. The practice of medicine ethically may not stop consumers from suing a doctor. In most of the literature, obstetrics, gynecology, anesthesia and orthopedics are identified as high-risk areas for malpractice claims [ 1 , 5 ]. Medical malpractice claims may arise when health professionals, through an error or omission in diagnosis, treatment, aftercare or health management, cause an injury and/or death in a patient [ 1 – 2 , 5 ]. The definition of error or omission is based upon the deviation of the health professional from a generally accepted standard of care. However, an injury or inadvertent complication that is the result of medical treatment is not malpractice if the health professional administering the treatment properly advised the patient about the potential risks, obtained consent, and exercised appropriate/standard care in providing the treatment [ 2 , 4 ]. Furthermore, it is not infrequent for the perception of malpractice to underlie legal litigation, which often implies poor communication between the obstetrician and the patient or her attendant. To be considered medical malpractice, the claim should have the following characteristics: (i) violation of the standard of care, (ii) the injury was caused by negligence, and (iii) the sustained injury resulted in significant damage. (2,6,8) A perfect baby and a healthy mother are the expectations of all parents, and a perfect outcome is the mission of obstetrics. Like in any other medical field, obstetric malpractice can cause morbidity and mortality that may engender litigation. In obstetrics, both the life of the mother and the fetus are at stake. For that reason, because of complications with both the mother and the fetus, the possibility of complications is greater than with other medical specialties. Thus, obstetrics and gynecology are among the medical fields with the highest rates of litigation. Globally, an increasing trend toward litigation in obstetrics practice has resulted in high indemnity costs to obstetricians, with consequent frustration and overall danger to the future of obstetrics practice. [ 2 – 4 , 6 ]. Although Ethiopia has no formal professional or health institution liability insurance, similar scenarios of medical malpractice claims have been reported, especially with increasing education, human rights awareness, and overall socioeconomic emancipation of the people of the country [ 1 , 8 ]. Mob attacks on hospital staff and doctors by meddlers for any financial negotiation in cases of any undesired outcome have become a regular media coverage in Ethiopia. These activities also involve “third parties”, such as the father of the unborn (and the newborn) baby, who might be upset and interested in pursuing a lawsuit against the physician, nurse, and/or hospital for bad outcomes (especially in obstetrics) related to health care services [ 5 , 7 ]. Litigations may arise from any obstetric complications resulting in disability or death in the infant or the mother. According to most Western studies, the four most common clinical causes of medical litigation in obstetrics and gynecology are morbidities resulting from fetal distress, uterine rupture after a vaginal birth in a woman with a previous cesarean section, shoulder dystocia, and fetal or neonatal death. Litigation in most cases is driven by bad outcomes and not by malpractice [ 2 , 7 ]. When ethical concerns are not resolved properly, the result can be errors or unnecessary and potentially costly decisions that can be bad for patients/clients, health professionals, health facilities, and society at large [ 3 – 6 ]. In addition, failure to maintain an effective medical ethics regulation program can seriously jeopardize health facilities' reputation and harm the health profession. [ 10 ] Because of the threat of litigation and the rising costs of medical liability insurance, clinicians consider professional liability to be the major pressure on an otherwise satisfying career [ 2 , 10 ]. The fear of litigation also causes psychological stress, morbidity and even mortality to doctors. As a result, malpractice claims have become a major threat to the provision of maternal and perinatal health care services [ 1 , 11 ]. This may compel doctors to practice defensive medicine, increasing pressure on the health care system [ 10 ]. Simply responding to each ethics question as it arises is not enough to resolve the problem. The implementation of ethical norms and principles requires a systematic approach to proactively identify priorities and address concerns about professional ethics and issues of malpractice claims at the health facility level, preferably among responsible health professionals and clients [ 1 , 5 , 12 , 13 ]. Most obstetrician/gynecologists in Ethiopia may, by experience, personally know the common clinical causes of medical litigation in obstetrics, which has an impact on the country’s health care system in general and professionals in particular [ 2 , 11 ]. However, there are no adequate data or research conducted in Ethiopia or other sub-Saharan countries on this issue [ 1 , 6 ]. Therefore, this study aims to determine the magnitude of the problems related to malpractice claims and the common clinical causes or factors that lead to malpractice claims among members of the Ethiopian Society of Obstetricians and Gynecologists practicing their profession at any institution. Professional malpractice claims against healthcare professionals in general, especially those against obstetricians/gynecologists, remain among the leading causes of psychological and financial burden in Ethiopia. Thus, the contribution of this research to the programming of a better handling of ethical issues and malpractice claims for the protection of health professionals and the healthcare system cannot be overemphasized. 2. Objectives General objective The overall objective of this study is to assess the magnitude of malpractice claims and the common causes or factors that lead to these malpractice claims among ESOG members. Specific objectives To investigate the common causes of obstetric-related malpractice claims among ESOG members Estimating the magnitude of malpractice claims among ESOG members To identify the possible driving factors of why patients sue obstetricians 3. Methodology 3.1. Study period This study was conducted over 8 months, from October 1, 2024, to May 31, 2025. 3.2. Study area The proposed study was conducted among gynecologists and obstetricians who are members of the Ethiopian Society of Obstetricians and Gynecologists (ESOG). The ESOG was established in 1992 in response to the Safe Motherhood Initiative as a collective professional expression of concern for high maternal and perinatal mortality and morbidity and poor SRH status in the country. The main aim of this study was to increase the contribution of obstetricians and gynecologists to improving the access to and quality of SRH services in Ethiopia. Consequently, over the last 30 years, the ESOG has undertaken several remarkable SRH activities by engaging its members, working hand in hand with the Federal Ministry of Health, and networking with other partners working in the area of SRH. The organization focuses on issues such as safe motherhood, mother-to-child transmission of HIV/AIDS, postpartum hemorrhage, care for survivors of sexual assault, quality SRH and family planning services, comprehensive abortion care, comprehensive emergency obstetric and newborn care services, and the introduction of national standards and guidelines in support of these areas. 3.3. Study design An anonymous, Google form questionnaire was shared through the ESOG’s email and telegram channel with all the members of the ESOG; then, a cross-sectional survey was conducted from October 1,2024, to May 31,2025. 3.4. Populations Source population The source population included all registered obstetricians/gynecologists practicing their profession in government hospitals, hospital-based medical schools, private health institutions or maternal and child healthcare-related NGOs. Study population The study population included all registered obstetricians/gynecologists practicing their profession in government hospitals, hospital-based medical schools, private health institutions or maternal and child healthcare-related NGOs and current members of the ESOG. 3.5. Inclusion and exclusion criteria Inclusion criteria Obstetrician/gynecologists were eligible for enrollment if they; · Are registered and licensed according to the Ethiopian Food, Medicine and Healthcare Administration and Control Authority (EFMHACA) · Involved in clinical healthcare services as obstetricians and gynecologists · Current member of the ESOG Exclusion criteria Obstetrician/gynecologists with any of the following conditions were excluded from the study: · Not registered and licensed according to EFMHACA · Out of obstetrics/gynecology in clinical practice for more than 1 year 3.6. Sample Size Determination and Sampling Procedure The sample size was determined by using a single population proportion formula considering the following assumption: [4] n = [( Zα /2) 2 P(1-P)]/ d 2 , where: n =sample size, Zα /2= value from the standard normal distribution corresponding to the desired confidence level (Z=1.96 for 95% CI), P=50% was estimated since no study was conducted in Ethiopia that addressed the objective of this study. d =5% margin of error (0.0025) Therefore, adding a 10% nonresponse rate, the final sample size was determined to be n=423. The Ethiopian Society of Obstetricians and Gynecologists (ESOG) has nearly 800 members. A simple random sampling technique was employed to obtain the required sample size from all the members of the ESOG, and then the sample size, i.e., 423, was obtained accordingly. 3.7. Study variables Independent variables I. Sociodemographic background · Age · Gender · Marital status II. Year of service as obstetrician/gynecologist/professional experience · Less than 10 years · 10-20 years · More than 20 years III. Type of facility/healthcare institution you are serving in · Government · Private · MCH-related NGOs Dependent variables · The number of claims experienced 3.8. Data collection After an anonymous Google form questionnaire was sent to all the members through the ESOG’s email, telegram and WhatsApp channels, the two authors occasionally checked the responses of the members. The purpose of the study was explained and assured the respondents of complete anonymity. No names were required on the questionnaire. An ‘opt-out’ form was included to give nonrespondents a chance to voice any objections to the study. To increase the response rate among the members, we reposted the questionnaire multiple times through the ESOG’s telegram channel until the required sample size was obtained. At the end of the 8 th month, the response rates of the members were checked, and a total of 462 respondents were recorded. We ensured the confidentiality of the participants. We have not collected or stored any identifying information about the ESOG members who participated in the survey. 3.9. Data quality assurances Pretesting of the questionnaire was conducted by ten obstetrician/gynecologists before the study period, and appropriate modifications were applied. The participants were informed that the confidentiality of the information collected and the test results would be ensured. 3.10. Operational definition · Adverse outcome (AO) — Undesired clinical outcome without implying cause. AOs may be due to (a) the underlying pathologic disease process, (b) complications of treatment, (c) medical errors, or (d) the perception of a disappointing result. · Claim – The filing of a lawsuit, notice of intent to file a lawsuit or to arbitrate, a demand for money or service, or an occurrence involving injury or disability of which the insured becomes aware and which, in the opinion of the names insured, may result in the filing of a lawsuit or the receipt of a demand for money. · Complication—A known risk of a specified procedure, operation, medication, therapy, or treatment plan. · Incident – An event or happening that causes unanticipated harm to a patient. · Indemnity – Reimbursement made to an injured party. · Insurance – A contractual relationship that exists when one party (insurance carrier), in consideration of a fixed sum (premium), agrees to reimburse another (an insured or policy holder) for any losses, up to the limits of the policy, caused by designated contingencies. · Injury – Bodily injury, sickness, or disease sustained by any person who occurs during the policy period, including pain and suffering, mental anguish, loss of income or death at any time resulting from the injury. · Liability – Obligation that a person has incurred or might incur through any breach of a legally enforces duty: responsibility for conduct falling below a certain standard that is the causal connection of the plaintiff’s injury. · Litigation – The process of resolving a dispute in a court of law to determine factual and legal issues and the rights and duties between the parties to the controversy and to award damages or other relief. · Medical error—Failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. · Morbidity- Morbidity is the state of being symptomatic or unhealthy as a result of a disease or an injury. · Standard of Care – A term used in the legal definition of medical malpractice. A physician is required to adhere to the standards of practice of reasonably competent physicians in the same or similar circumstances, with comparable training and experience. 3.11. Data processing and analysis After data collection, Google Form data cleaning was performed, and all the data were statistically evaluated via SPSS (Statistical Package for Social Sciences version 26). The quantitative data are presented as the means ± SDs. For the comparison of the male and female groups' means, independent samples Student’s t tests and chi-square tests were used. The findings were compared with those of other related studies on the magnitude and clinical causes of malpractice claims in any region of the world. Variables that were associated with the outcome variable in the bivariate analyses at the 0.25 p value were entered into the multiple logistic regression model. A P value of 0.05 was considered statistically significant. Adjusted odds ratios together with corresponding 95% confidence intervals were used to interpret the findings. 3.12. Result dissemination plan The manuscript of the final paper was prepared so that the results and recommendations that are forwarded by this study become practical and benefit all clinicians, health professional associations and healthcare system bureaucrats. The paper will be sent for publication in peer journal review. Presentation of the research outputs may take place if requested by any health professional organizations on any occasion, such as annual conferences and any other concerned stakeholders. 3.13. Ethical consideration The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. An ethical clearance and permission letter were obtained from the Ethiopian Medical Association Ethical Review Committee to conduct the survey. Permission to conduct the study was obtained from the Ethiopian Society of Obstetricians and Gynecologists’ Executive Board. Confidentiality was maintained during data collection, analysis, and interpretation. No participant's name was used; the information obtained was used only for research purposes. 4. Results 4.1. Sociodemographic characteristics A total of 462 members of the Ethiopian Society of Obstetricians and Gynecologists (ESOG) participated in the study. Most were male (86.6%), and the predominant age group was 40–50 years (35.3%). The majority were married (80.1%), had less than 20 years of experience (87.9%), and worked primarily in government health institutions (77.1%). In terms of administrative location, 28.6% were based in zonal hospitals, 26.4% in regional capitals, and 20.1% in Addis Ababa. 4.2. Magnitude of OBGYN-related Malpractice Claims Among the 462 respondents, 54 (11.7%) reported experiencing at least one malpractice claim during their career. The remaining 408 (88.3%) had not faced any claims. Table 1 The most common adverse outcomes leading to litigation were Claim Frequency (n = 54) Percentage (%) Perinatal death 29 53.7% Maternal death 26 48.1% Death of both mother and baby 16 29.6% Unplanned, non-consented hysterectomy 15 27.8% Permanent injury to the baby 9 16.7% Table 2 The most commonly cited clinical causes of litigation included Cause of Litigation Frequency (n = 54) Percentage (%) Delayed intervention for PPH 19 35.2% Complications from uterine rupture 12 22.2% Preeclampsia-Eclampsia Syndrome 11 20.4% Intraoperative injury to GI/GU systems 9 16.7% Improper use of forceps or vacuum 11 20.4% Poor monitoring during delivery 8 14.8% Surgical wound infection 13 24.1% Inadequate or missing informed consent 5 9.3% Birth asphyxia 10 18.5% Shoulder dystocia 3 5.6% Neonatal trauma during delivery 9 16.7% Undetected congenital anomaly 10 18.5% 4.3. Factors associated with OBGYN-related malpractice claims Table 3 Malpractice claim in chi-square analysis Variable Malpractice Claim (Yes) Malpractice Claim (No) p-value Sex 0.043* Female 12 (22.2%) 50 (12.3%) Male 42 (77.8%) 358 (87.7%) Administrative location < 0.001 Addis Ababa 25 (46.3%) 68 (16.7%) Regional Capital 12 (22.2%) 110 (27%) Zonal Hospital 10 (18.5%) 122 (29.9%) Others 7 (13%) 108 (26.5%) Health institution type 0.134 Government 37 (68.5%) 319 (78.2%) Private 13 (24.1%) 56 (13.7%) MCH in NGO 4 (7.4%) 33 (8.1%) Psychological effect < 0.001 Very worrisome 27 (50%) 79 (19.4%) Worrisome 23 (42.6%) 274 (67.2%) Not worrisome 4 (7.4%) 55 (13.5%) Knowledge about insurance < 0.001 Yes 5 (9.3%) 7 (1.7%) No 43 (79.6%) 270 (66.2%) Not sure 6 (11.1%) 131 (32.1%) Belief in the necessity of insurance < 0.001 Very necessary 31 (57.4%) 80 (19.6%) Necessary 23 (42.6%) 318 (77.9%) Not necessary 0 (0%) 10 (2.5%) Significant associations with malpractice claims (p < 0.05) were observed for Gender : Female providers had a higher claim rate than males did (22.2% vs 12.3%, p = 0.043). Administrative location : Providers in Addis Ababa were more likely to face claims (46.3% vs 16.7%, p < 0.001). Psychological impact : Those who described themselves as “very worrisome” had significantly more claims (50% vs 19.4%, p < 0.001). Knowledge and attitudes toward professional liability insurance : Respondents who rated insurance as "very necessary" had more claims (57.4% vs 19.6%, p < 0.001). Additionally, most providers with past claims lacked knowledge about insurance coverage (79.6%). Table 4 Binary Logistic Regression Analysis and result Variable Category (vs Reference) Adjusted OR 95% CI p-value Sex Male vs Female 1.91 0.83–4.40 0.128 Administrative place Addis Ababa (ref) — — — Regional Capital vs Addis Ababa 3.36 1.41–7.98 0.006 Zonal Hospital vs Addis Ababa 0.86 0.30–2.48 0.775 Other vs Addis Ababa 1.21 0.48–3.06 0.691 Health institution type Government (ref) — — — Private vs Government 0.65 0.28–1.48 0.300 MCH in NGO vs Government 0.82 0.22–3.08 0.765 Psychological effect Very worrisome (ref) — — — Worrisome vs Very worrisome 1.67 0.51–5.48 0.401 Not worrisome vs Very worrisome 1.51 0.69–3.31 0.302 Insurance company knowledge No insurance (ref) — — — Knowledge about insurance vs No 0.24 0.06–0.89 0.033 Uncertain about insurance vs No 0.08 0.02–0.40 0.002 Belief in necessity Very necessary (ref) — — — Necessary vs Very necessary 0.24 0.11–0.52 < 0.001 Not necessary vs Very necessary — — Key Predictors After Adjustment Working in Addis Ababa (AOR = 3.36, 95% CI: 1.41–7.98, p = 0.006) Insurance knowledge Aware of company: AOR = 0.24 (95% CI: 0.06–0.89, p = 0.033) Uncertain about company: AOR = 0.08 (95% CI: 0.02–0.40, p = 0.002) Belief in insurance necessity (rated as "necessary"): AOR = 0.24 (95% CI: 0.11–0.52, p < 0.001) 5. Discussion This is the first study conducted to assess the magnitude of malpractice claims and the common causes or factors that lead to these malpractice claims among Ethiopian obstetricians and gynecologists. Nearly 1 in 9 of the surveyed obstetricians and gynecologists reported facing a malpractice claim during their career. The reported rate (11.7%) seems lower than that reported by many high-income countries, where claims in this field of specialty can reach 20–30%. Nevertheless, the growing number of cases of professional malpractice claims filed against physicians in Ethiopia, especially in cities such as Addis Ababa, suggests a shift driven by rising public awareness, greater media attention, and a lack of legal and insurance protection for healthcare providers. The two most common adverse outcomes triggering OB/GYN-related malpractice claims filed by Ethiopian obstetricians and gynecologists were perinatal death (53.7%) and maternal death (48.1%). These high-stakes events, especially when both mothers and babies are lost, are tragedy to affected families. It also carries a deep emotional and professional toll for doctors, especially when litigations are filed. As shown in Table 2 , the most commonly cited clinical causes of litigation are delayed intervention for PPH (35.2%), surgical wound infection (24.1%), complications from uterine rupture (22.2%), improper use of forceps or vacuum for delivery (20.4%), preeclampsia-eclampsia syndrome (20.4%), etc. Similar trends have been observed in studies from Saudi Arabia and Nigeria, where complications such as uterine rupture, postpartum hemorrhage, and fetal asphyxia are also frequent causes of litigation. [ 14 , 15 , 16 ] Psychological distress was notably greater among those who had faced a claim. Half described the experience as "very worrisome," echoing global findings on how malpractice allegations affect clinicians’ mental health and confidence [ 17 ]. This issue points to a need for stronger legal safeguards and mental health support for providers. This, in turn, helps improve and maintain the well-being of maternal and perinatal healthcare in particular and the well-being of the whole community in general [ 18 , 21 , 22 ]. Female clinicians had a greater proportion of claims in the unadjusted analysis, although the link disappeared after controlling for other factors. This may reflect gender-based differences in patient expectations or provider patient dynamics. Qualitative studies would help unpack these patterns. One of the most concerning findings was the lack of insurance coverage for healthcare providers addressing the issues of malpractice claims in Ethiopia. While malpractice claims against OB/GYNs are increasing, there is a notable lack of malpractice insurance for mitigating financial and moral risk for healthcare providers. Only a negligible proportion of providers with prior claims were insured, and those who had coverage were significantly less likely to face legal action. Many OB/GYN healthcare providers also express concerns about fairness in legal proceedings related to malpractice. This gap puts practitioners at personal and financial risk [ 18 , 19 ]. The strong link between prior claims and belief in the need for insurance likely reflects lived experience with the system's shortcomings. Providers based in Addis Ababa were far more likely to face claims. This urban–rural gap could stem from higher patient expectations, more access to legal advice, and greater media scrutiny in urban settings. 6. Limitations This study relied on self-reported data, which may be affected by recall bias or underreporting due to fear of judgment. The lack of a national registry for malpractice cases made crosscheck responses impossible. Additionally, the sample was limited to members of the Ethiopian Society of Obstetricians and Gynecologists, so the findings may not reflect the experiences of all practicing specialists nationwide. 7. Conclusion The findings of this study indicate that cases of professional malpractice claims are widespread among surveyed Ethiopian obstetricians and gynecologists. Although further studies are needed to objectively estimate its effect on the health care system of the country, policymakers and all concerned stakeholders need to develop strategies to address the problems associated with professional malpractice claims. Perinatal death and maternal death constitute more than half of the causes of professional malpractice claims filed against Ethiopian obstetricians and gynecologists. We believe that this type of professional malpractice claims places a major psychological and financial burden on healthcare providers engaged in maternal and perinatal healthcare. It also has a major negative impact on the health care system, leading to defensive medicine practices and a significant contribution to the abandonment of the profession. 8. Recommendations On the basis of the findings of the present study, the following recommendations are suggested to all health professional associations, policy makers and all other stakeholders who are engaged in maternal and child healthcare systems. Establishing stronger legal safeguards and mental health support for maternal and perinatal healthcare providers Advocate for the establishment of professional liability insurance Establishing a stronger ethical and legal frame on how to engage the media when suspected malpractice is reported Empower all healthcare institutions with the necessary manpower and logistics needed for emergency maternal and perinatal healthcare Declarations Ethics approval and consent to participate - The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical clearance was obtained from the Ethiopian Medical Association Ethical Review Committee. Written informed consent was obtained from all participants. Consent for publication - Not applicable. Competing interests - The authors declare no competing interests. Funding - Self-sponsored. Availability of data and materials - Available from the corresponding author upon reasonable request. Acknowledgements Ethiopian Society of Obstetricians and Gynecologists Ethiopian Medical Association Ethical Review Committee for follow up and review of the paper Authors' information and Authors' contributions Full name of investigators Dr Abdi Dereje Tolera Dr Feyera Dubale Bekesha Full title of the research project Magnitude and Factors Associated with malpractice claims Among Members of Ethiopian Society of Obstetricians and Gynecologists Duration of the project October 1,2024 to May 31,2025 Study Area ESOG Total Cost of the project 106,500 ETB Source(s) of Funding Self-sponsored Address of investigator Tel: - +251 913101471 – Abdi Dereje Tolera +251918798134 – Fayera Dubale Bekesha Email: [email protected] [email protected] ORCHID ID - 0009-0009-1705-7453 – Abdi Dereje Tolera Authors' contributions Both authors (Abdi Tolera and Feyera Bekesha) contributed equally to the conception, study design, data collection, data analysis, interpretation of results, manuscript drafting, and approval of the final manuscript. 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College","correspondingAuthor":false,"prefix":"","firstName":"FEYERA","middleName":"","lastName":"BEKESHA","suffix":""}],"badges":[],"createdAt":"2025-08-13 20:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7368041/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7368041/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92461523,"identity":"bf2ae5f0-7ba4-416d-a74a-6958d8240219","added_by":"auto","created_at":"2025-09-30 03:55:19","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":63080,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptonMalpracticeclaim.docx","url":"https://assets-eu.researchsquare.com/files/rs-7368041/v1/de9baa38301514eaa672762b.docx"},{"id":92461138,"identity":"cedc948f-2fb4-4615-bdc4-deca6513ff8f","added_by":"auto","created_at":"2025-09-30 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04:03:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1198863,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7368041/v1/0234fe75-70e3-4b48-a756-d53badca1ebc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Magnitude and factors associated with malpractice claims among members of the Ethiopian Society of Obstetricians and Gynecologists: Cross sectional survey","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eMedical liability claims are believed to have become such an invariable part of practice that some clinicians have advocated that a practice in mock trials be incorporated as part of medical education. The practice of medicine ethically may not stop consumers from suing a doctor. In most of the literature, obstetrics, gynecology, anesthesia and orthopedics are identified as high-risk areas for malpractice claims [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMedical malpractice claims may arise when health professionals, through an error or omission in diagnosis, treatment, aftercare or health management, cause an injury and/or death in a patient [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The definition of error or omission is based upon the deviation of the health professional from a generally accepted standard of care. However, an injury or inadvertent complication that is the result of medical treatment is not malpractice if the health professional administering the treatment properly advised the patient about the potential risks, obtained consent, and exercised appropriate/standard care in providing the treatment [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Furthermore, it is not infrequent for the \u003cem\u003eperception\u003c/em\u003e of malpractice to underlie legal litigation, which often implies poor communication between the obstetrician and the patient or her attendant. To be considered medical malpractice, the claim should have the following characteristics: (i) violation of the standard of care, (ii) the injury was caused by negligence, and (iii) the sustained injury resulted in significant damage. (2,6,8)\u003c/p\u003e\u003cp\u003eA perfect baby and a healthy mother are the expectations of all parents, and a perfect outcome is the mission of obstetrics. Like in any other medical field, obstetric malpractice can cause morbidity and mortality that may engender litigation. In obstetrics, both the life of the mother and the fetus are at stake. For that reason, because of complications with both the mother and the fetus, the possibility of complications is greater than with other medical specialties. Thus, obstetrics and gynecology are among the medical fields with the highest rates of litigation. Globally, an increasing trend toward litigation in obstetrics practice has resulted in high indemnity costs to obstetricians, with consequent frustration and overall danger to the future of obstetrics practice. [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough Ethiopia has no formal professional or health institution liability insurance, similar scenarios of medical malpractice claims have been reported, especially with increasing education, human rights awareness, and overall socioeconomic emancipation of the people of the country [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Mob attacks on hospital staff and doctors by meddlers for any financial negotiation in cases of any undesired outcome have become a regular media coverage in Ethiopia. These activities also involve \u0026ldquo;third parties\u0026rdquo;, such as the father of the unborn (and the newborn) baby, who might be upset and interested in pursuing a lawsuit against the physician, nurse, and/or hospital for bad outcomes (especially in obstetrics) related to health care services [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLitigations may arise from any obstetric complications resulting in disability or death in the infant or the mother. According to most Western studies, the four most common clinical causes of medical litigation in obstetrics and gynecology are morbidities resulting from fetal distress, uterine rupture after a vaginal birth in a woman with a previous cesarean section, shoulder dystocia, and fetal or neonatal death. Litigation in most cases is driven by bad outcomes and not by malpractice [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhen ethical concerns are not resolved properly, the result can be errors or unnecessary and potentially costly decisions that can be bad for patients/clients, health professionals, health facilities, and society at large [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In addition, failure to maintain an effective medical ethics regulation program can seriously jeopardize health facilities' reputation and harm the health profession. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eBecause of the threat of litigation and the rising costs of medical liability insurance, clinicians consider professional liability to be the major pressure on an otherwise satisfying career [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The fear of litigation also causes psychological stress, morbidity and even mortality to doctors. As a result, malpractice claims have become a major threat to the provision of maternal and perinatal health care services [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This may compel doctors to practice defensive medicine, increasing pressure on the health care system [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSimply responding to each ethics question as it arises is not enough to resolve the problem. The implementation of ethical norms and principles requires a systematic approach to proactively identify priorities and address concerns about professional ethics and issues of malpractice claims at the health facility level, preferably among responsible health professionals and clients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMost obstetrician/gynecologists in Ethiopia may, by experience, personally know the common clinical causes of medical litigation in obstetrics, which has an impact on the country\u0026rsquo;s health care system in general and professionals in particular [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, there are no adequate data or research conducted in Ethiopia or other sub-Saharan countries on this issue [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, this study aims to determine the magnitude of the problems related to malpractice claims and the common clinical causes or factors that lead to malpractice claims among members of the Ethiopian Society of Obstetricians and Gynecologists practicing their profession at any institution.\u003c/p\u003e\u003cp\u003eProfessional malpractice claims against healthcare professionals in general, especially those against obstetricians/gynecologists, remain among the leading causes of psychological and financial burden in Ethiopia. Thus, the contribution of this research to the programming of a better handling of ethical issues and malpractice claims for the protection of health professionals and the healthcare system cannot be overemphasized.\u003c/p\u003e"},{"header":"2. Objectives","content":"\u003cp\u003e\u003cb\u003eGeneral objective\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe overall objective of this study is to assess the magnitude of malpractice claims and the common causes or factors that lead to these malpractice claims among ESOG members.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSpecific objectives\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTo investigate the common causes of obstetric-related malpractice claims among ESOG members\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEstimating the magnitude of malpractice claims among ESOG members\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTo identify the possible driving factors of why patients sue obstetricians\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"3. Methodology","content":"\u003ch2 id=\"_Toc206109881\"\u003e\u003cstrong\u003e3.1. \u0026nbsp; \u0026nbsp;Study period\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study was conducted over 8 months, from October 1, 2024, to May 31, 2025.\u003c/p\u003e\n\u003ch2 id=\"_Toc206109882\"\u003e\u003cstrong\u003e3.2. \u0026nbsp; \u0026nbsp;Study area\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe proposed study was conducted among gynecologists and obstetricians who are members of the Ethiopian Society of Obstetricians and Gynecologists (ESOG). The ESOG was established in 1992 in response to the Safe Motherhood Initiative as a collective professional expression of concern for high maternal and perinatal mortality and morbidity and poor SRH status in the country. The main aim of this study was to increase the contribution of obstetricians and gynecologists to improving the access to and quality of SRH services in Ethiopia. Consequently, over the last 30 years, the ESOG has undertaken several remarkable SRH activities by engaging its members, working hand in hand with the Federal Ministry of Health, and networking with other partners working in the area of SRH. The organization focuses on issues such as safe motherhood, mother-to-child transmission of HIV/AIDS, postpartum hemorrhage, care for survivors of sexual assault, quality SRH and family planning services, comprehensive abortion care, comprehensive emergency obstetric and newborn care services, and the introduction of national standards and guidelines in support of these areas.\u003c/p\u003e\n\u003ch2 id=\"_Toc206109883\"\u003e\u003cstrong\u003e3.3. \u0026nbsp; \u0026nbsp;Study design\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAn anonymous, Google form questionnaire was shared through the ESOG\u0026rsquo;s email and telegram channel with all the members of the ESOG; then, a cross-sectional survey was conducted from October 1,2024, to May 31,2025.\u003c/p\u003e\n\u003ch2 id=\"_Toc206109884\"\u003e\u003cstrong\u003e3.4. \u0026nbsp; \u0026nbsp;Populations\u003c/strong\u003e\u003c/h2\u003e\n\u003cp id=\"_Toc177469954\"\u003e\u003cstrong\u003eSource population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe source population included all registered obstetricians/gynecologists practicing their profession in government hospitals, hospital-based medical schools, private health institutions or maternal and child healthcare-related NGOs.\u003c/p\u003e\n\u003cp id=\"_Toc177469955\"\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc177469956\"\u003eThe study population included all registered obstetricians/gynecologists practicing their profession in government hospitals, hospital-based medical schools, private health institutions or maternal and child healthcare-related NGOs and current members of the ESOG.\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc206109885\"\u003e\u003cstrong\u003e3.5. \u0026nbsp; \u0026nbsp;Inclusion and exclusion criteria\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp id=\"_Toc177469957\"\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eObstetrician/gynecologists were eligible for enrollment if they;\u003c/p\u003e\n\u003cp\u003e\u0026middot; Are registered and licensed according to the Ethiopian Food, Medicine and Healthcare Administration and Control Authority (EFMHACA)\u003c/p\u003e\n\u003cp\u003e\u0026middot; Involved in clinical healthcare services as obstetricians and gynecologists\u003c/p\u003e\n\u003cp\u003e\u0026middot; Current member of the ESOG\u003c/p\u003e\n\u003cp id=\"_Toc177469958\"\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eObstetrician/gynecologists with any of the following conditions were excluded from the study:\u003c/p\u003e\n\u003cp\u003e\u0026middot; Not registered and licensed according to EFMHACA\u003c/p\u003e\n\u003cp\u003e\u0026middot; Out of obstetrics/gynecology in clinical practice for more than 1 year\u003c/p\u003e\n\u003ch2 id=\"_Toc206109886\"\u003e\u003cstrong\u003e3.6. \u0026nbsp; \u0026nbsp;Sample Size Determination and Sampling Procedure\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe sample size was determined by using a single population proportion formula considering the following assumption: [4]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e= [(\u003cem\u003eZ\u0026alpha;\u003c/em\u003e/2)\u003csup\u003e2\u0026nbsp;\u003c/sup\u003eP(1-P)]/\u003cem\u003ed\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003csub\u003e,\u0026nbsp;\u003c/sub\u003ewhere:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e=sample size,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eZ\u0026alpha;\u003c/em\u003e/2= value from the standard normal distribution corresponding to the desired confidence level (Z=1.96 for 95% CI),\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP=50% was\u003c/em\u003e\u003cem\u003e\u0026nbsp;estimated\u003c/em\u003e since no study was conducted in Ethiopia that addressed the objective of this study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ed\u003c/em\u003e=5% margin of error (0.0025)\u003c/p\u003e\n\u003cp\u003eTherefore, adding a 10% nonresponse rate, the final sample size was determined to be n=423.\u003c/p\u003e\n\u003cp\u003eThe Ethiopian Society of Obstetricians and Gynecologists (ESOG) has nearly 800 members.\u003c/p\u003e\n\u003cp\u003eA simple random sampling technique was employed to obtain the required sample size from all the members of the ESOG, and then the sample size, i.e., 423, was obtained accordingly.\u003c/p\u003e\n\u003ch2 id=\"_Toc206109887\"\u003e\u003cstrong\u003e3.7. \u0026nbsp; \u0026nbsp;Study variables\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eIndependent variables\u003c/p\u003e\n\u003cp\u003eI. \u0026nbsp; \u0026nbsp;Sociodemographic background\u003c/p\u003e\n\u003cp\u003e\u0026middot; Age\u003c/p\u003e\n\u003cp\u003e\u0026middot; Gender\u003c/p\u003e\n\u003cp\u003e\u0026middot; Marital status\u003c/p\u003e\n\u003cp\u003eII. \u0026nbsp; \u0026nbsp;Year of service as obstetrician/gynecologist/professional experience\u003c/p\u003e\n\u003cp\u003e\u0026middot; Less than 10 years\u003c/p\u003e\n\u003cp\u003e\u0026middot; 10-20 years\u003c/p\u003e\n\u003cp\u003e\u0026middot; More than 20 years\u003c/p\u003e\n\u003cp\u003eIII. \u0026nbsp; Type of facility/healthcare institution you are serving in\u003c/p\u003e\n\u003cp\u003e\u0026middot; Government\u003c/p\u003e\n\u003cp\u003e\u0026middot; Private\u003c/p\u003e\n\u003cp\u003e\u0026middot; MCH-related NGOs\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Dependent variables\u003c/p\u003e\n\u003cp\u003e\u0026middot; The number of claims experienced\u003c/p\u003e\n\u003ch2 id=\"_Toc206109888\"\u003e\u003cstrong\u003e3.8. \u0026nbsp; \u0026nbsp;Data collection\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAfter an anonymous Google form questionnaire was sent to all the members through the ESOG\u0026rsquo;s email, telegram and WhatsApp channels, the two authors occasionally checked the responses of the members. The purpose of the study was explained and assured the respondents of complete anonymity. No names were required on the questionnaire. An \u0026lsquo;opt-out\u0026rsquo; form was included to give nonrespondents a chance to voice any objections to the study. To increase the response rate among the members, we reposted the questionnaire multiple times through the ESOG\u0026rsquo;s telegram channel until the required sample size was obtained.\u003c/p\u003e\n\u003cp\u003eAt the end of the 8\u003csup\u003eth\u003c/sup\u003e month, the response rates of the members were checked, and a total of 462 respondents were recorded.\u003c/p\u003e\n\u003cp\u003eWe ensured the confidentiality of the participants. We have not collected or stored any identifying information about the ESOG members who participated in the survey.\u003c/p\u003e\n\u003ch2 id=\"_Toc206109889\"\u003e\u003cstrong\u003e3.9. \u0026nbsp; \u0026nbsp;Data quality assurances\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003ePretesting of the questionnaire was conducted by ten obstetrician/gynecologists before the study period, and appropriate modifications were applied.\u003c/p\u003e\n\u003cp\u003eThe participants were informed that the confidentiality of the information collected and the test results would be ensured.\u003c/p\u003e\n\u003ch2 id=\"_Toc206109890\"\u003e\u003cstrong\u003e3.10.\u0026nbsp;Operational definition\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u0026middot; Adverse outcome (AO) \u0026mdash; Undesired clinical outcome without implying cause. AOs may be due to (a) the underlying pathologic disease process, (b) complications of treatment, (c) medical errors, or (d) the perception of a disappointing result.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Claim \u0026ndash; The filing of a lawsuit, notice of intent to file a lawsuit or to arbitrate, a demand for money or service, or an occurrence involving injury or disability of which the insured becomes aware and which, in the opinion of the names insured, may result in the filing of a lawsuit or the receipt of a demand for money.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Complication\u0026mdash;A known risk of a specified procedure, operation, medication, therapy, or treatment plan.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Incident \u0026ndash; An event or happening that causes unanticipated harm to a patient.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Indemnity \u0026ndash; Reimbursement made to an injured party.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Insurance \u0026ndash; A contractual relationship that exists when one party (insurance carrier), in consideration of a fixed sum (premium), agrees to reimburse another (an insured or policy holder) for any losses, up to the limits of the policy, caused by designated contingencies.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Injury \u0026ndash; Bodily injury, sickness, or disease sustained by any person who occurs during the policy period, including pain and suffering, mental anguish, loss of income or death at any time resulting from the injury.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Liability \u0026ndash; Obligation that a person has incurred or might incur through any breach of a legally enforces duty: responsibility for conduct falling below a certain standard that is the causal connection of the plaintiff\u0026rsquo;s injury.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Litigation \u0026ndash; The process of resolving a dispute in a court of law to determine factual and legal issues and the rights and duties between the parties to the controversy and to award damages or other relief.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Medical error\u0026mdash;Failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Morbidity- Morbidity is the state of being symptomatic or unhealthy as a result of a disease or an injury.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Standard of Care \u0026ndash; A term used in the legal definition of medical malpractice. A physician is required to adhere to the standards of practice of reasonably competent physicians in the same or similar circumstances, with comparable training and experience.\u003c/p\u003e\n\u003ch2 id=\"_Toc206109891\"\u003e\u003cstrong\u003e3.11.\u0026nbsp;Data processing and analysis\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAfter data collection, Google Form data cleaning was performed, and all the data were statistically evaluated via SPSS (Statistical Package for Social Sciences version 26). The quantitative data are presented as the means \u0026plusmn; SDs. For the comparison of the male and female groups\u0026apos; means, independent samples Student\u0026rsquo;s t tests and chi-square tests were used.\u003c/p\u003e\n\u003cp\u003eThe findings were compared with those of other related studies on the magnitude and clinical causes of malpractice claims in any region of the world. Variables that were associated with the outcome variable in the bivariate analyses at the 0.25 p value were entered into the multiple logistic regression model. A P value of 0.05 was considered statistically significant. Adjusted odds ratios together with corresponding 95% confidence intervals were used to interpret the findings.\u003c/p\u003e\n\u003ch2 id=\"_Toc206109892\"\u003e\u003cstrong\u003e3.12.\u0026nbsp;Result dissemination plan\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe manuscript of the final paper was prepared so that the results and recommendations that are forwarded by this study become practical and benefit all clinicians, health professional associations and healthcare system bureaucrats. The paper will be sent for publication in peer journal review. Presentation of the research outputs may take place if requested by any health professional organizations on any occasion, such as annual conferences and any other concerned stakeholders.\u003c/p\u003e\n\u003ch2 id=\"_Toc206109893\"\u003e\u003cstrong\u003e3.13.\u0026nbsp;Ethical consideration\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical principles of the Declaration of Helsinki. An ethical clearance and permission letter were obtained from the Ethiopian Medical Association Ethical Review Committee to conduct the survey. Permission to conduct the study was obtained from the Ethiopian Society of Obstetricians and Gynecologists\u0026rsquo; Executive Board. Confidentiality was maintained during data collection, analysis, and interpretation. No participant\u0026apos;s name was used; the information obtained was used only for research purposes. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"4. Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.1. Sociodemographic characteristics\u003c/h2\u003e\u003cp\u003eA total of 462 members of the Ethiopian Society of Obstetricians and Gynecologists (ESOG) participated in the study. Most were male (86.6%), and the predominant age group was 40\u0026ndash;50 years (35.3%). The majority were married (80.1%), had less than 20 years of experience (87.9%), and worked primarily in government health institutions (77.1%). In terms of administrative location, 28.6% were based in zonal hospitals, 26.4% in regional capitals, and 20.1% in Addis Ababa.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e4.2. Magnitude of OBGYN-related Malpractice Claims\u003c/h2\u003e\u003cp\u003eAmong the 462 respondents, 54 (11.7%) reported experiencing at least one malpractice claim during their career. The remaining 408 (88.3%) had not faced any claims.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe most common adverse outcomes leading to litigation were\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClaim\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerinatal death\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal death\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath of both mother and baby\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnplanned, non-consented hysterectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePermanent injury to the baby\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe most commonly cited clinical causes of litigation included\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCause of Litigation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelayed intervention for PPH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplications from uterine rupture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampsia-Eclampsia Syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraoperative injury to GI/GU systems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImproper use of forceps or vacuum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor monitoring during delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical wound infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInadequate or missing informed consent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth asphyxia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShoulder dystocia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal trauma during delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUndetected congenital anomaly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e4.3. Factors associated with OBGYN-related malpractice claims\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMalpractice claim in chi-square analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMalpractice Claim (Yes)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMalpractice Claim (No)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.043*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (12.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (77.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e358 (87.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdministrative location\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAddis Ababa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (46.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegional Capital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e110 (27%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZonal Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (18.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e122 (29.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108 (26.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth institution type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.134\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGovernment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (68.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e319 (78.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (24.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMCH in NGO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (7.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (8.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery worrisome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79 (19.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorrisome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (42.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e274 (67.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot worrisome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (7.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge about insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (9.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (1.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (79.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e270 (66.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot sure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131 (32.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBelief in the necessity of insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery necessary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (57.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 (19.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNecessary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (42.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e318 (77.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot necessary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (2.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSignificant associations with malpractice claims (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were observed for\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e: Female providers had a higher claim rate than males did (22.2% vs 12.3%, p\u0026thinsp;=\u0026thinsp;0.043).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eAdministrative location\u003c/b\u003e: Providers in Addis Ababa were more likely to face claims (46.3% vs 16.7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePsychological impact\u003c/b\u003e: Those who described themselves as \u0026ldquo;very worrisome\u0026rdquo; had significantly more claims (50% vs 19.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eKnowledge and attitudes toward professional liability insurance\u003c/b\u003e: Respondents who rated insurance as \"very necessary\" had more claims (57.4% vs 19.6%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, most providers with past claims lacked knowledge about insurance coverage (79.6%).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\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\u003eBinary Logistic Regression Analysis and result\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory (vs Reference)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAdjusted OR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale vs Female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.83\u0026ndash;4.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAdministrative place\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAddis Ababa (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegional Capital vs Addis Ababa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.41\u0026ndash;7.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZonal Hospital vs Addis Ababa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.30\u0026ndash;2.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.775\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther vs Addis Ababa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.48\u0026ndash;3.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.691\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHealth institution type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGovernment (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrivate vs Government\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.28\u0026ndash;1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.300\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMCH in NGO vs Government\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.22\u0026ndash;3.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.765\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePsychological effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery worrisome (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorrisome vs Very worrisome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.51\u0026ndash;5.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.401\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot worrisome vs Very worrisome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.69\u0026ndash;3.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.302\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eInsurance company knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo insurance (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge about insurance vs No\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.06\u0026ndash;0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUncertain about insurance vs No\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u0026ndash;0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eBelief in necessity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery necessary (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNecessary vs Very necessary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.11\u0026ndash;0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot necessary vs Very necessary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eKey Predictors After Adjustment\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eWorking in Addis Ababa (AOR\u0026thinsp;=\u0026thinsp;3.36, 95% CI: 1.41\u0026ndash;7.98, p\u0026thinsp;=\u0026thinsp;0.006)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eInsurance knowledge\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAware of company: AOR\u0026thinsp;=\u0026thinsp;0.24 (95% CI: 0.06\u0026ndash;0.89, p\u0026thinsp;=\u0026thinsp;0.033)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eUncertain about company: AOR\u0026thinsp;=\u0026thinsp;0.08 (95% CI: 0.02\u0026ndash;0.40, p\u0026thinsp;=\u0026thinsp;0.002)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eBelief in insurance necessity (rated as \"necessary\"): AOR\u0026thinsp;=\u0026thinsp;0.24 (95% CI: 0.11\u0026ndash;0.52, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThis is the first study conducted to assess the magnitude of malpractice claims and the common causes or factors that lead to these malpractice claims among Ethiopian obstetricians and gynecologists. Nearly 1 in 9 of the surveyed obstetricians and gynecologists reported facing a malpractice claim during their career. The reported rate (11.7%) seems lower than that reported by many high-income countries, where claims in this field of specialty can reach 20\u0026ndash;30%. Nevertheless, the growing number of cases of professional malpractice claims filed against physicians in Ethiopia, especially in cities such as Addis Ababa, suggests a shift driven by rising public awareness, greater media attention, and a lack of legal and insurance protection for healthcare providers.\u003c/p\u003e\u003cp\u003eThe two most common adverse outcomes triggering OB/GYN-related malpractice claims filed by Ethiopian obstetricians and gynecologists were perinatal death (53.7%) and maternal death (48.1%). These high-stakes events, especially when both mothers and babies are lost, are tragedy to affected families. It also carries a deep emotional and professional toll for doctors, especially when litigations are filed.\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the most commonly cited clinical causes of litigation are delayed intervention for PPH (35.2%), surgical wound infection (24.1%), complications from uterine rupture (22.2%), improper use of forceps or vacuum for delivery (20.4%), preeclampsia-eclampsia syndrome (20.4%), etc. Similar trends have been observed in studies from Saudi Arabia and Nigeria, where complications such as uterine rupture, postpartum hemorrhage, and fetal asphyxia are also frequent causes of litigation. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\u003cp\u003ePsychological distress was notably greater among those who had faced a claim. Half described the experience as \"very worrisome,\" echoing global findings on how malpractice allegations affect clinicians\u0026rsquo; mental health and confidence [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This issue points to a need for stronger legal safeguards and mental health support for providers. This, in turn, helps improve and maintain the well-being of maternal and perinatal healthcare in particular and the well-being of the whole community in general [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFemale clinicians had a greater proportion of claims in the unadjusted analysis, although the link disappeared after controlling for other factors. This may reflect gender-based differences in patient expectations or provider patient dynamics. Qualitative studies would help unpack these patterns.\u003c/p\u003e\u003cp\u003eOne of the most concerning findings was the lack of insurance coverage for healthcare providers addressing the issues of malpractice claims in Ethiopia. While malpractice claims against OB/GYNs are increasing, there is a notable lack of malpractice insurance for mitigating financial and moral risk for healthcare providers. Only a negligible proportion of providers with prior claims were insured, and those who had coverage were significantly less likely to face legal action. Many OB/GYN healthcare providers also express concerns about fairness in legal proceedings related to malpractice. This gap puts practitioners at personal and financial risk [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The strong link between prior claims and belief in the need for insurance likely reflects lived experience with the system's shortcomings.\u003c/p\u003e\u003cp\u003eProviders based in Addis Ababa were far more likely to face claims. This urban\u0026ndash;rural gap could stem from higher patient expectations, more access to legal advice, and greater media scrutiny in urban settings.\u003c/p\u003e"},{"header":"6. Limitations","content":"\u003cp\u003eThis study relied on self-reported data, which may be affected by recall bias or underreporting due to fear of judgment. The lack of a national registry for malpractice cases made crosscheck responses impossible. Additionally, the sample was limited to members of the Ethiopian Society of Obstetricians and Gynecologists, so the findings may not reflect the experiences of all practicing specialists nationwide.\u003c/p\u003e"},{"header":"7. Conclusion","content":"\u003cp\u003eThe findings of this study indicate that cases of professional malpractice claims are widespread among surveyed Ethiopian obstetricians and gynecologists. Although further studies are needed to objectively estimate its effect on the health care system of the country, policymakers and all concerned stakeholders need to develop strategies to address the problems associated with professional malpractice claims.\u003c/p\u003e\u003cp\u003ePerinatal death and maternal death constitute more than half of the causes of professional malpractice claims filed against Ethiopian obstetricians and gynecologists. We believe that this type of professional malpractice claims places a major psychological and financial burden on healthcare providers engaged in maternal and perinatal healthcare. It also has a major negative impact on the health care system, leading to defensive medicine practices and a significant contribution to the abandonment of the profession.\u003c/p\u003e"},{"header":"8. Recommendations","content":"\u003cp\u003eOn the basis of the findings of the present study, the following recommendations are suggested to all health professional associations, policy makers and all other stakeholders who are engaged in maternal and child healthcare systems.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eEstablishing stronger legal safeguards and mental health support for maternal and perinatal healthcare providers\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAdvocate for the establishment of professional liability insurance\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEstablishing a stronger ethical and legal frame on how to engage the media when suspected malpractice is reported\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEmpower all healthcare institutions with the necessary manpower and logistics needed for emergency maternal and perinatal healthcare\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e - The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical clearance was obtained from the Ethiopian Medical Association Ethical Review Committee. Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e - Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e - The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e- Self-sponsored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e - Available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEthiopian Society of Obstetricians and Gynecologists\u003c/li\u003e\n \u003cli\u003eEthiopian Medical Association Ethical Review Committee for follow up and review of the paper\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information and Authors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"609\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull name\u0026nbsp;of\u0026nbsp;investigators\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 379px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Dr Abdi Dereje Tolera \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Dr Feyera Dubale Bekesha\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull title of the research project\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 379px;\"\u003e\n \u003cp\u003eMagnitude and Factors Associated with malpractice claims Among Members of Ethiopian Society of Obstetricians and Gynecologists\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration\u0026nbsp;of\u0026nbsp;the\u0026nbsp;project\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 379px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; October 1,2024 to May 31,2025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy\u0026nbsp;Area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 379px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; ESOG\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;Cost of\u0026nbsp;the\u0026nbsp;project\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 379px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 106,500 ETB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource(s)\u0026nbsp;of\u0026nbsp;Funding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 379px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Self-sponsored\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAddress\u0026nbsp;of\u0026nbsp;investigator\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 379px;\"\u003e\n \u003cp\u003eTel: - +251 913101471 \u0026ndash; Abdi Dereje Tolera\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; +251918798134 \u0026ndash; Fayera Dubale Bekesha\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 379px;\"\u003e\n \u003cp\u003eEmail: [email protected] \u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; [email protected]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 379px;\"\u003e\n \u003cp\u003eORCHID ID - 0009-0009-1705-7453 \u0026ndash; Abdi Dereje Tolera\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 379px;\"\u003e\n \u003cp\u003eBoth authors (Abdi Tolera and Feyera Bekesha) contributed equally to the conception, study design, data collection, data analysis, interpretation of results, manuscript drafting, and approval of the final manuscript.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBiruk L, Wamisho. MesafintAbejeTiruneh,Lidiya,EnkubahiryTeklemariam(2011\u0026ndash;2017) Surgical and Medical Error Claims in Ethiopia: Trends Observed From 125 Decisions Made By the Federal Ethics Committee for Health Professionals Ethics Review.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLateefa O, AlDakhil. (2015). Obstetric and gynecologic malpractice claims in Saudi Arabia: Incidence and cause. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.jflm.2016.02.001\u003c/span\u003e\u003cspan address=\"10.1016/j.jflm.2016.02.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSuneet P, Chauhan,Vidya B, Chauhan BD, Cowan, Nancy W, Hendrix, Everett F, Magann JC, Morrison. (2005). Professional liability claims and Central Association of Obstetricians and Gynecologists members: Myth versus reality.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajog.2004.12.058\u003c/span\u003e\u003cspan address=\"10.1016/j.ajog.2004.12.058\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFawzia A, Habib. (2010) Obstetricians' Perception of Medico-legal Problems inAlMadinah Al Munawarah Kingdom of Saudi Arabia,A cross-sectional survey. Journal of Taibah University Medical Sciences 2010; 5 (2): 66\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGlaser LM, Alvi FA, Milad MP. Trends in Malpractice Claims for Obstetric and Gynecologic Procedures, 2005\u0026ndash;2014. Am J Obstet Gynecol. 2017. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajog.2017.05.037\u003c/span\u003e\u003cspan address=\"10.1016/j.ajog.2017.05.037\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eErhanBuken NOB, Bora Buken(. 2004). Obstetric and gynecologic malpractice in Turkey: incidence, impact, causes and prevention. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcfm.2004.01.005\u003c/span\u003e\u003cspan address=\"10.1016/j.jcfm.2004.01.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdinmaJIB. (2016). Litigation and the Obstetrician in Clinical Practice in Nigeria. Ann Med Health Sci Res 2016; 6:74\u0026thinsp;\u0026ndash;\u0026thinsp;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/2141-9248.181847\u003c/span\u003e\u003cspan address=\"10.4103/2141-9248.181847\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVincent C, Bark P, Laura Olivieri. Angela Jones \u0026amp; (2015 London). The impact of litigation on obstetricians and gynecologists. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttdoi.org/10.3109/01443619409027617\u003c/span\u003e\u003cspan address=\"htt10.3109/01443619409027617\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMelberg A, Teklemariam L, Moland KM, HenrietteSindingAasen, MitikeMollaSisay. April (2020). Juridification of maternal deaths in Ethiopia: a study of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e/10.1093/heapol/czaa043/5864436\u003c/span\u003e\u003cspan address=\"/10.1093/heapol/czaa043/5864436\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSavanaPradhan(Nepal. 2020). Medico Legal Issues in Obstetrics and Gynecology. Nep J Obstet Gynecol. 2020;15(31):8\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3126/njog. v15i2.32895\u003c/span\u003e\u003cspan address=\"10.3126/njog. v15i2.32895\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMacLennan AH, Spencer MK. Projections of Australian obstetricians ceasing practice and the reasons. Med J Aust. 2002;176:425\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVincent C, Bark P, Jones A, Olivieri L. The impact of litigation on obstetricians and gynecologists. J Obstet Gynecol. 1994;14:381\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlice Langholt. Has Your OBGYN Been Sued for Malpractice? Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.life123.com/parenting/pregnancy/prenatal\u0026ndash;care/malpractice.shtml\u003c/span\u003e\u003cspan address=\"http://www.life123.com/parenting/pregnancy/prenatal\u0026ndash;care/malpractice.shtml\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [Last accessed on 2015 Jan 21].\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoga NC. Law and society, Unhealed Wounds: Medical Malpractice in the Twentieth Century; (ed. Eric Rise). New York: LFB Scholarly Publishing PLC; 2003.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMavroforou A, Koumantakis E, Michalodimitrakis E. Physicians' liability in obstetrics and gynecology practice. Med Law. 2005;24(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJamal S, Al Jarallah NA. The pattern of medical errors and litigation against doctors in Saudi Arabia. J Family Community Med. 2013;20(2):98\u0026ndash;105. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/2230-8229.114771\u003c/span\u003e\u003cspan address=\"10.4103/2230-8229.114771\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNHS Litigation Authority. NHSLA risk management standards for Acute Trust, Primary care trust and independent sector providers of NHS care 2009/10. London: NHSLA; February 2009.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTomoko Hamasaki and Akihito Hagihara. (2015). A comparison of medical litigation filed against obstetrics and gynecology, internal medicine, and surgery departments. Hamasaki and Hagihara BMC Medical Ethics (2015) 16:72 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12910-015-0065-1\u003c/span\u003e\u003cspan address=\"10.1186/s12910-015-0065-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChandraharan E, Arulkumaran S. Medico-legal problems in obstetrics.CurrObstetGynecol 2006; 16: (4) 206\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChervenak J. Overview of professional liability. ClinPerinatol. 2007;34:227\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLocalio AR, Lawthers AG, Bengtson JM, Herbert LE, Weaver SL, Brennan TA, et al. Relationship between malpractice claims and cesarean delivery. JAMA. 1993;269:366\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eACOG Today. More ob-gyns changing practice because of liability insurance rates, fears and claims. Am Coll Obstetricians Gynecologists. 2004;48:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Malpractice, ESOG, Ob-Gyn, Ethiopia, ethics committee","lastPublishedDoi":"10.21203/rs.3.rs-7368041/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7368041/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eObstetrics is a medical specialty that is widely perceived by health professionals to be associated with a high risk of litigation. An increase in litigation against obstetrics and gynecology professionals, compared with other medical departments, is becoming an issue in medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess the magnitude of malpractice claims and the common causes or factors that lead to these malpractice claims among Ethiopian Society of Obstetricians and Gynecologists members.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional survey was conducted from October 1, 2024, to May 31, 2025, among members of the Ethiopian Society of Obstetricians and Gynecologists (ESOG). The Google form questionnaire was shared to all the members through the society. SPSS version 26 was used for analysis. The degree of association was measured by using the odds ratio with 95% CI, and significance was declared at a p value of \u0026lt; 0.05. Ethical considerations included informed consent, confidentiality, and ethical clearance from the Ethiopian Medical Association.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 462 members of the Ethiopian Society of Obstetricians and Gynecologists (ESOG) participated in the study. Most were male (86.6%), and the predominant age group was 40–50 years (35.3%). Among the 462 respondents, 54 (11.7%) reported experiencing at least one malpractice claim during their career. The most common adverse outcomes leading to malpractice litigation were perinatal death (53.7%) and maternal death (48.1%). Among those who faced malpractice claims, 79.6% lacked knowledge about insurance coverage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions and recommendations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe rate of malpractice claims is nearly 1 in 9, and there is a lack of legal and insurance protection for healthcare providers. Therefore, it is crucial to strengthen the registry for malpractice claims and encourage nationwide access to affordable malpractice insurance for Obstetrics and Gynecology professionals.\u003c/p\u003e","manuscriptTitle":"Magnitude and factors associated with malpractice claims among members of the Ethiopian Society of Obstetricians and Gynecologists: Cross sectional survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 03:47:14","doi":"10.21203/rs.3.rs-7368041/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-09-19T04:31:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T05:45:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-01T19:05:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-29T20:08:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-08-29T20:05:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e08ea42f-723e-4033-a23f-29566761421b","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-30T03:47:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 03:47:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7368041","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7368041","identity":"rs-7368041","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}