This study aimed to assess the magnitude, trends and determinants of intrapartum stillbirths in the public health facilities in Addis Ababa. A case-control study design was used along with quantitative data collection methods. Obstetric care data on key variables were collected from medical records of 728 cases and 1551 controls in the public health facilities during July 1, 2010 and June 30, 2015. Data were analysed using SPSS version 24 to determine associations and risk factors against intrapartum stillbirth. HMIS data from different sources were further analysed for the same period to determine trends of stillbirth in the public health facilities of Addis Ababa. Findings from this study showed a staggering high prevalence of stillbirth at an average rate of 28 per 1000 births during the period 2010-2015. This figure was comparable with the population level prevalence of prenatal death in Addis Ababa which was 30 per 1000 birth (Central Statistical Agency 2011:115). No statistically significant associations were revealed against the effects of maternal medical conditions including diabetes, hypertension, cardiac and renal diseases and key socio-demographic variables including age, parity and marital status, and intrapartum stillbirth. On the contrary, HIV and syphilis infections, foetal presentations, multiple pregnancy and the frequency of ANC visits during the index pregnancy had statistically significant associations with intrapartum stillbirth. Furthermore, low FHR, non-vertex foetal presentations and ruptured cervical membrane on admission to labour were among risk factors for intrapartum stillbirth. Similarly, women in the stillbirth group received substandard care regarding the timely assessment of foetal decent, cervical dilatation, labour induction, and episiotomy care compared to women in the livebirth group. Obstetrical complications including obstructed labour, eclampsia and preeclampsia were more common among women in the intrapartum stillbirth group indicating that the above variables were key determinant of intrapartum stillbirth. These findings suggest that poor quality of obstetric care during labour and childbirth were the underlying risk factors for intrapartum stillbirth. In conclusion, strategies to overhaul the obstetric care practices in the public health facilities through skills building, accurate use of labour monitoring tools, close supervisions, accurate classification of stillbirth, proper documentation, and ongoing research efforts. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English with abstracts and keywords in English and Setswana / Aim: The purpose of the research was to determine the magnitude and factors associated with gestational diabetes mellitus (GDM), and to explore the experiences of gynaecologists/obstetricians and midwives in the monitoring and prevention of GDM- related adverse maternal outcomes in order to propose best practice guidelines which may be implemented to overcome the problem. Methods: A concurrent mixed methods design was used. Participants for the quantitative study were selected using systematic random sampling, with purposive sampling being used for the qualitative part of the study. A total of 2000 medical records were reviewed using a checklist, in addition to which 7 gynaecologists/obstetricians and 12 midwives were interviewed using an in-depth interview guide. Descriptive and inferential statistics were used for the quantitative part, while Colaizzi’s manual qualitative data analysis method wasused for the qualitative part of the study. Findings: The magnitude of GDM was found to be 2.2%. Age and family history of diabetes mellitus were found to be factors associated with GDM (at p < 0.001). Other factors such as obesity, previous GDM, previous history of fetal macrosomia and multiple gestations were identified by respondents as factors related with GDM. In addition, the study explored the experiences of health professionals (HPs) in the monitoring and prevention of adverse maternal outcomes related to GDM, with the results showing some differences in screening and diagnostic techniques. It was also shown that lifestyle modification (physical exercise, diet management) and medication were utilised for managing women with GDM. In this regard, all the HPs agreed that creating awareness is the best intervention for preventing GDM as well as its adverse maternal outcomes. Conclusions: The magnitude of GDM is increasing, and much needs to be done to draw attention to the burden that GDM places on the health of pregnant women and the public. Since GDM is not considered a public health problem, little is being done to monitor the condition and its adverse maternal outcomes. It is hoped that the best practice guidelines developed from this research study may assist in reducing the adverse maternal outcomes of GDM in Ethiopia / Maikaelelo: Lebaka la patlisiso e ne e le go tlhotlhomisa go nna teng le mabaka a a golaganeng le bolwetsi jwa sukiri jwa baimana (GDM), le go tlhotlhomisa maitemogelo a dingaka tsa malwetsi a basadi (gynaeologists/ obstetricians) le babelegisi mo go tlhokomeleng le go thibeleng ditlamorago tse di maswe mo baimaneng tse di amanang le GDM gore go tshitshinngwe dintlhakaelo tse di gaisang tse di ka diragadiwang go fenya bothata. Mekgwa: Go dirisitswe thadiso ya mekgwa e e tlhakantsweng. Banni-le-seabe ba thutopatlisiso e e lebelelang dipalopalo ba ne ba tlhophiwa go diriswa go tlhopha sampole ka go se latele thulaganyo, mme go tlhopha sampole ka maikaelelo go ne ga diriswa mo karolong ya thutopatlisiso e e lebelelang mabaka. Go sekasekilwe palogotlhe ya direkoto tsa kalafi tse 2 000 go diriswa lenanetshekatsheko, mme mo godimo ga moo, go ne ga nna le dipotsolotso le dingaka tsa malwetsi a basadi di le supa le babelegisi ba le 12 go diriswa kaedi ya dipotsolotso tse di tseneletseng. Dipalopalo tse di tlhalosang le tse go sweditsweng ka tsona di ne tsa diriswa mo karolong ya dipalopalo ya thutopatlisiso, fa go dirisitswe mokgwa wa ga Colaizi wa tokololo ya data ya mabaka mo karolong e e lebelelang mabaka. Diphitlhelelo: Go nna teng ga GDM go ne ga fitlhelwa e le 2.2%. Dingwaga le hisetori ya bolwetsi jwa sukiri ya baimana mo lelapeng di fitlhetswe e le dintlha tse di golaganeng le GDM (ka p < 0.001). Dintlha dingwe, jaaka go nona phetelela, GDM mo nakong e e fetileng, go nna teng ga macrosomia ya masea mo nakong e e fetileng le boimana jwa masea a feta bongwe di ne tsa supiwa ke batsibogi jaaka dintlha tse di golaganeng le GDM. Go tlaleletsa foo, thuto e ne ya sekaseka maitemogelo a baporofešenale ba boitekanelo (HPs) mo tlhokomelong le thibelo ya ditlamorago tse di sa siamang mo baimaneng tse di golaganeng le GDM, mme dipholo di bontshitse dipharologano dingwe mo dithekeniking tsa go sekirina le go phekola. Go bonagetse gape gore phetolo ya mokgwa wa botshelo (katiso ya mmele, tsamaiso ya mokgwa wa go ja) le kalafi di ne tsa diriswa go laola bolwetsi jwa basadi ba ba nang le GDM. Mo lebakeng le, baporofešenale botlhe ba boitekanelo ba ne ba dumelana gore go dira temoso ke tsereganyo e e gaisang ya go thibela GDM ga mmogo le ditlamorago tsa yona tse di sa siamang mo baimaneng. Ditshwetso: Go nna teng ga GDM go a oketsega, mme go tshwanetse go dirwa go le gontsi go lemosa ka mokgweleo o bolwetse jono bo o bayang mo boitekanelong jwa baimana le setšhaba. Ka ntlha ya gore GDM ga e kaiwe jaaka bothata jwa boitekanelo jwa setšhaba, ga go dirwe go le kalo go tlhokomela bolwetsi le ditlamorago tsa jona tse di sa siamang mo baimaneng. Go solofelwa gore dintlhakaelo tsa tiriso e e gaisang tse di dirilweng mo thutopatlisisong eno di ka thusa go fokotsa ditlamorago tse di sa siamang tsa GDM mo baimaneng kwa Ethiopia. / Health Studies / D. Litt. et Phil. (Public Health)