WALLAGA UNIVERSITY

A THESIS SUBMITTED TO THE SCHOOL OF MEDICINE IN PARTIAL

FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE IN PUBLIC
HEALTH

ASSESMENT OF PREGNANCY OUTCOME WITH EMPHASIS ON

PERINATAL AND NEONATAL MORTALITY IN GENERAL HOSPITALL ,
ETHIOPIA

NAME ID NO
1.EBISE BIRATU ……………………………………………………………………….29565
2. BETHLEM FIKADU ………………………………………………………………….
3. ASTER FARAJA ……………………………………………………………………..

APRIL: 2024,
NEKEMTE- ETHIOPIA

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Acknowledgements
My sincere thanks go to our advisors…and Professor ……for their unreserved assistance and timely
guidance and comments until the completion of this thesis.
Our thanks should also go to Dr. …. who took his time to read my proposal and first draft and
provided me valuable advice and comment.
All staffs of Department of Community Health Wallaga University deserve our deepest appreciation
for their cooperation.
Our thanks also go to my friends for their appreciable moral support and advice.
We also thank all staffs of Bedelle health office and all supervisors and data collectors and all
mothers who participated in this study.
Special thanks and appreciation also should go to our friends who had suffered by keeping quiet while
we were in study.
Last but not least we are highly indebted to our parents who had taken the whole responsibility
managing our life during our learning process.

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 Table of Contents
Contents Pages
Acknowledgements........................................................................................................................2

List of abbreviations......................................................................................................................5

ABSTRACT....................................................................................................................................6

CHAPTER ONE............................................................................................................................9

1. Introduction............................................................................................................................9

1.1. Background of the study.....................................................................................................9

1.2. Statement of the problem.................................................................................................10

1.3. Objectives of the study......................................................................................................11

1.3.1. General objective:..........................................................................................................11

1.3.3. Specific objectives..........................................................................................................11

1.4. Research Questions...........................................................................................................11

1.5. Significance of the Study..................................................................................................11

1.6. Scope of the Study.............................................................................................................12

1.7. Delimitation of the study..................................................................................................13

1.8. Limitation of the study.....................................................................................................13

1.9. Organization of the study.................................................................................................13

CHAPTER TWO.........................................................................................................................14

2.1. LITRATURE REVIEW...................................................................................................14

2.2. Factors Associated with Perinatal and Neonatal deaths...............................................15

2.3. Low birth weight...............................................................................................................15

2.4. Maternal factors................................................................................................................16

2.4. Antenatal Care..................................................................................................................16

2.5. Infections............................................................................................................................17

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 2.6. Risk factors for neonatal tetanus in developing countries relate to:............................17

CHAPTER THREE.....................................................................................................................19

3. Introduction..........................................................................................................................19

3.1. Methodology of the study area.........................................................................................19

3.2.2. Study Population............................................................................................................20

4. Sampling procedures...........................................................................................................21

4.1 Data Collection...................................................................................................................21

4.2. Data Quality.......................................................................................................................21

4.3. Proper categorization and coding of the data................................................................21

5. Operational definitions........................................................................................................22

5.2 Late fetal deaths................................................................................................................22

5.3 Early neonatal deaths........................................................................................................22

5.4 Neonatal mortality rate.....................................................................................................22

5.5 Abortion..............................................................................................................................22

6. TIME AND BUDGET SCHUDULE........................................................................................23

6.1 Budget Break Down................................................................................................................23

Reference...................................................................................................................................24

List of Tables
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Table 1 Socio demographic characteristics of mothers by place of delivery in General HospitalL ,
Murch. 2024
Table 2 Pregnancy outcomes of mothers by delivery place in General Hospitall , Murch.2024.
Table 3 Obstetric history of mothers by place of delivery in General Hospitall ,Murch. 2024
Table 4 Selected characteristics of mothers in General Hospitall Murch..2024
Table 5 Selected characteristics of newborns in General Hospitall Murch. 2024
Table 6 Socio demographic factors associated with perinatal mortality in General Hospitall ,
Murch.2024
Table 7 Obstetric history of mothers associated with perinatal mortality in General Hospitall ,
Murch.2024
Table 8 Socio demographic factors associated with neonatal mortality General Hospitall , Murch..
2024
Table 9 Socio demographic factors associated with neonatal mortality in General Hospitall . Murch.
2024.

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List of abbreviations
PMR… … … … … … … … … … . … Perinatal Mortality Rate
NNM…..................................................Neonatal Mortality Rate
SBR………………………………..….…Stillbirth Rate
ENMR …………………………………...Early Neonatal Mortality Rate
LNMR……………………………….…..Late Neonatal Mortality Rate
ANC…………………………………….Antenatal Care
TBA…………………………………….Traditional Birth Attendant
TTBA…………………………..………Trained Traditional Birth attendant
EOC……………………………....…….Emergency Obstetric Care
CPD…………………………….....……Cephalous-Pelvic Disproportion
TTV…………………….………….…...Tetanus Toxoid Vaccination
IMR…………………….…….….…..….Infant Mortality Rate LB
OR……………………………..….…….Odds Ratio
COR………………………………..……Crude Odds Ratio

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ABSTRACT
The commonly used pregnancy outcome indicators in developing countries are maternal mortality,
abortion, perinatal, neonatal mortality, low birth weight and preterm births. About eight million
perinatal deaths are reported annually in the world of which 40-60% is neonatal mortality and
almost all are in developing countries. Many hospital based studies were conducted on those
problems, while community based are very few. Therefore this community based cross sectional
comparative study was conducted to assess the pregnancy outcome with emphasis on perinatal and
neonatal mortality by delivery place and its associated factors in Beddelle town. The study was
conducted between November 2024 and March 2024. A total of 1462 mothers who had children or
had been pregnant for the last five years were participated in the study.Pre tested standardized
questionnaires were used to obtain information on socio demographic, obstetric history and the
condition of the new born and mothers during labor and neonatal period. Analyses were made using
EP INFO 4.6 statistical package and SPSS version 10. In the study the following findings were found:
High perinatal mortality rate of 73/1000 live births with 38/1000 and 35/1000 live births being
at home and in health institutions respectively. High neonatal mortality rate of 47/1000 live births
with 28/1000 and 19/1000 live births at home and in health institutions respectively.Mothers who
had 2-4 parity had more risk to perinatal mortality than primi Para mothers. (AOR 5.15, 95%CI 1.54,
17.23) and mothers who had 5+ parity had more risk to perinatal mortality than primi Para mothers.
(AOR 4.38, 95%CI 0.65, 29.40) In this study it is found that very small and small (mother’s
perceptions birth weight) neonates have more risk to neonatal mortality than neonates who had
normal birth weight when they were born(AOR 3.61, 95%CI 1.75, 7.43) and also term babies had less
risk to perinatal and neonatal mortality than babies born preterm it is statistically significant when it
is entered into logistic regression model(AOR 0.28, 95%CI 0.11, 0.70) and (AOR 0.28, 95%CI 0.12,
0.63) respectively.Mothers whose income were <300 birr per month had more risk to neonatal
mortality than mothers whose income were >601 birr per month. (AOR 4.64, 95%CI 1.53, 14.01) and
mothers whose income were 301-600 birr per month had more risk to neonatal mortality than mothers
whose income were >601 birr per month. (AOR; 4.29, 95%CI 1.27, 14.50). Based on the above
findings of the study the following recommendations were made. Strengthening of the MCH/FP care
unit at each level and encourage mothers to use FP services and improve quality of care ,
establishing and utilization of emergency obstetric care services with special emphasis of neonatal
care and give special attention to empower of mothers and improve economic status and educational
level of women.
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CHAPTER ONE
1. Introduction
This chapter includes background of the study, statement of the problem, objectives of the study, research
questions, significance of the study, scope of the Study, delimitation of the study, limitation of the study and
finally organization of the paper.

1.1. Background of the study

Pregnancy and child birth are special event in women lives and in the lives of their families, this can
be a time of great hope and joyful anticipation; it can also be a time of fear, suffering and even
death. Pregnancy is associated with certain risk to health and survival both for the woman and for
the infant she bears. The risks are present in every society and in every setting .In developed countries
they have been overcome because every pregnant woman has access to special care during pregnancy
and childbirth, in developing countries such is not the case.
Every day at least 1600 women die from the complication of pregnancy and childbirth globally.
Women’s risk of dying from pregnancy related complications: In developing countries…1:16
In Europe: 1:1400 and
In North America: 1:3700.
A study found that in developing countries 37% of women had problems during pregnancy, 21%
during labor and 6% during the postpartum period. Approximately from 9 to 15% of deliveries require
higher-level care for serious complication in the women or her baby.
The most commonly used pregnancy outcomes for new born in developing countries include
pre/neonatal mortality, low birth weight and preterm baby. Both pre and neonatal deaths are
determined largely by delivery complications and delivery care as well as maturity of the fetus as
reflected by birth weight and gestational age.

Large proportions of infant deaths and disabilities have their origin in the perinatal period and are
primarily determined by the condition of pregnant women and the circumstances of the birth rather
than by the condition of the child itself. The underlined direct causes of these deaths relate to the
health and nutritional status of the woman during pregnancy, the quality of care during pregnancy and
delivery and the immediate care of the newborn. Maternal health care, female literacy, family
planning and social support for women are both as a right and necessity for women themselves and to
ensure the safe birth and healthy survival of the newborn.
Neonatal deaths are generally associated with elements linked to maternal care during pregnancy and
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delivery while socio-environmental factors become more important determinants of infant survival
during the post neonatal period. Despite wide recognition that in rural Africa pregnancy is a
hazardous time for both mother and child, there are few data quantifying the degree of risk. Most of
the information about maternal and pre/neonatal mortality is related to hospital-based surveys.
Although in many rural areas, few women deliver in hospital or health center, on the other hand, even
when there have been complications during the pregnancy many women deliver at home, therefore
most stillbirths and early neonatal deaths occur at home and information on the outcome of
pregnancies can be obtained only by asking these women about their past obstetric history and by
observations.

1.2. Statement of the problem

Currently more than half of all infants’ death occurs during the first week of life largely as a result of
poorly managed pregnancies and births, or because of the absence of a few simple life-saving
gestures during the first critical moments of life, neither mother nor infant will need high technology
interventions or expensive drugs or equipment. The benefits of ensuring joint care for them both
accrue not simply for families but to society as a whole. The problem of perinatal and neonatal
mortality is seriously under estimated in developing countries due to poor registration systems and
inadequate information on stillbirth in most surveys. Hospital estimates are usually higher than
community-based estimates.

Perinatal and neonatal mortality is influenced by several biologic, environmental, socio demographic
and socio economic factors. Improvements in prenatal, neonatal and obstetric care, good social
conditions, the better environment and the demographic characteristics of mothers have contributed
for the declining of perinatal mortality in the developed countries. Perinatal and neonatal mortality
can differ by rural, urban and other locations even with in large demographic Survey.

Neonatal survival rate as a measure of outcome is regularly used for medical audit purposes. In Kenya
neonatal survival rate is still useful as an audit tool since the projected mortality rates are probably
still very high. Its knowledge will help determined the broad developmental strategies to adopt for
improving the provision of medical care. Important component efforts to reduce the health risk of
mothers and children are to increase the proportion of babies delivered under the supervision of
trained birth attendant. Proper medical attention and hygienic conditions during delivery can reduce

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risk of complication and infections that may cause death or serious illness to either the mother or the
baby or both. It is impossible to change socio-economic characteristic and cultural reproductive
patterns overnight, good data collection will help to assess need and good coordinated maternity
service can provide short-term improvements. The maternity services need to embrace: Primary care,
which its emphasis on village & rural obstetric care including the teaching of traditional birth
attendants, the training of midwives, doctors and established high-risk hospital care units.

1.3. Objectives of the study

1.3.1. General objective:
 To Assess Pregnancy Outcome with emphasis on perinatal and neonatal mortality in
General Hospitall

1.3.3. Specific objectives

 To assess the perinatal mortality by delivery place.
 To assess neonatal mortality by delivery place.
 To assess factors influencing delivery outcome by delivery place.

1.4. Research Questions

 What are the factors affecting the outcome with the emphasis on perinatal and neonatal
mortality in General Hospitall ?
 What is the pooled estimate of a perinatal mortality rate in General hospital
 What was the trend of perinatal mortality over time in General hospital Was inter-pregnancy interval
less than 15 months associated with perinatal mortality as compared to its counterpart in General
Hospitall ?

1.5. Significance of the Study

The analysis of the quantitative data helps to observe the assessment of pregnancy outcome with
emphasis on perinatal and neonatal mortality in General Hospitall .Analysis of the qualitative data
helps to identify the major constraints, which causes the perinatal and neonatal mortality rate.

1.6. Scope of the Study

The study focuses on the assessment of pregnancy outcome with emphasis on perinatal and
neonatal mortality in General Hospitall . This study doesn‘t incorporate in other study area, because of
the time and financial constraints. The study concentrates only perinatal and neonatal mortality rate.

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1.7. Delimitation of the study
Furthermore, the study is delimited to one sub-city again due to time and financial constraint.
However, since administration procedures are the same in the entire city, the result that is obtained
taking case of these specific sub-cities could reflect the situation of
assessment of pregnancy outcome with emphasis on perinatal and neonatal mortality in all over
the city, under normal circumstances.

1.8. Limitation of the study

The type of questionnaire used for the study was self-administered questionnaire. The researcher
asked each respondent all the questions and filled the questionnaire by herself. The researcher also
interviewed all the respondents while filling the questionnaire, which was very tiresome and required
extra time and effort. Besides this, some respondents perceived the questionnaire as politically-
oriented, which made them uncomfortable to be open and honest on their answers concerning
perinatal and neonatal mortality rate.

1.9. Organization of the study

This study is divided into five chapters. The first chapter includes introductory parts of the study
(background of the study, statement of the problem, research objective, research questions, and
significance of the study, scope of the study and organization of the paper). The second chapter deals
with review of related literature, scholar’s perspectives and theoretical background and empirical
studies of the issue understudy. The third chapter deals with research methodology. The fourth
chapter deals with data presentation, interpretation and analysis of major findings of the study. The
fifth chapter contains conclusion and recommendations based on the finding of the study.

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CHAPTER TWO
2.1. LITRATURE REVIEW
About eight million perinatal deaths are reported annually in the world almost all 98.0% is in
developing countries, and nearly five million neonates die each year in the world of which 96% are in
developing countries.
Perinatal and neonatal deaths are the most significant contributors to infant’s mortality and reduced
life expectancy. Perinatal mortality in the developed world indicates a rate of 10/1000 live births (LB)
or less, while in developing countries perinatal mortality range from 35/1000 LB to 100/1000 LB.
Des Gupta ET. Al. in India found that perinatal mortality (in medical college hospital) is 67. 2/1000
LB and 29. 3% was early neonatal deaths.
It is estimated that neonatal deaths in developing countries can account for nearly 50- 60% of all
infants’ deaths.
In most developing countries approximately half the infant deaths occur in the first months of life
(that is the neonatal period). In some developing countries infant mortality rate ranging between 32.8
and 135.0 per 1000 live births. Neonatal death account for between 42 and 63 % of infant mortality
and neonatal mortality can differ by rural, urban and other locations even with in large demographic
survey.
In Ethiopian context studies about perinatal and neonatal mortality have been conducted since 1970s.
Naeye et al found the perinatal mortality at Tikur Anbessa Hospital 1019 post-partum examination
were performed for perinatal disease. The overall PNM rate was /1000LB. The ratio of stillbirth
(SB) to neonatal deaths was 2.7:1 indicating that maternal factors were dominant in causing the
deaths. One third of the deaths were due to amniotic fluid infections, 15% to obstructed labor, 8%
abruption placenta, & the rest more than 20% were other specific disorder. The arrival of mothers at
delivery center earlier in labor & improved obstetrical practices would probably have saved some
infants in the categories.
Frost .O in 1984 in Black Lion Hospital (BLH) conducted a study, which showed that: Stillbirth Rate
(SBR) 52.6 /1000LB, PNM 8.6/ 1000LB and MMR 7.8 /1000LB
Age, parity and socio- economic status of the mother are classical features that epidemiologists
associate with perinatal death.(10)
Frost .O in 1984 in Black Lion Hospital (BLH) conducted a study, which showed that: Stillbirth Rate

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(SBR) 52.6 /1000LB, PNM 8.6/ 1000LB and MMR 7.8 /1000LB
Age, parity and socio- economic status of the mother are classical features that epidemiologists
associate with perinatal death. (10)

Sahile Mariam Y. and Berhane Y. Studied neonatal mortality rate of 1334 singleton neonates born at
three Addis Ababa hospitals prospectively followed during the neonatal period. They found the
neonatal mortality rate to be 71.9/1000 LB. with early and late NMR of 50.9 and 20.9/1000 L.B.
respectively. The main risk factors for perinatal mortality were being low birth weigh and
prematurity.(16)
A Prospective community based study on pregnant women in rural community of south central
Ethiopia was conducted and revealed that still birth 19 per 1000 live births, Perinatal mortality
45 per 1000 live births and neonatal mortality 37 per 1000 live births. (17)
In south western Ethiopia at Jimma teaching institute hospital a study showed that perinatal
mortality rate is 138.9 per 1000 live births which is the highest in the world (12)

2.2. Factors Associated with Perinatal and Neonatal deaths.

Preterm births are defined as a birth before 37 completed weeks of pregnancy.
In developing countries precise information on gestational lengths are scarce since exact dating is
difficult because of an availability reliable menstrual data and nonattendance to or late booking in
antenatal care. It has been estimated that in the poorest countries up to 50% of all infants are born
preterm, while in affluent societies the incidence of preterm birth ranges between 4 and 16%.
Perinatal survival also depends to a large extent on delivery and new born care. Those infants born
premature have higher risk of mental defects and other neurological squealer, risk of infection and
sepsis during neonatal period.

2.3. Low birth weight

UNICEF (1999) estimates that at the global level about 17% of infants are born with birth weight less
than 2,500 grams. The prevalence of low birth weight is not uniform throughout the world: in low
income countries from about 10-30% as compared to developed countries 4-10%. Birth weight is
determined mainly by duration of gestational age and intrauterine growth rate. Low birth weight rate
is considered as one of the determinants of perinatal and neonatal mortality. Neonatal illness in
general closely related to low birth weight, low birth weight babies also tend to have higher

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mortalities. (3, 19)

2.4. Maternal factors

Maternal factors are known to influence the weight of the new born baby. Among the factors are:
parity, birth interval, nutritional status as reflected by weight pre pregnancy weight for height and
weight gain, health status of the mother indicated as the presence of anemia, antenatal infections or
complication of pregnancy and behavioral conditions like antenatal attendance and physical
conditions during pregnancy.
Maternal nutritional status is probably the most important determinant of the birth weight and the
probability of neonatal survival. Multi gravidity and parity also affects the nutritional status of the
mother. If a woman cannot recover fully from the effect of her last pregnancy and period of breast
feeding before becoming pregnant again, her nutritional status might be expected to deteriorate with
each successive pregnancy, which is called “Maternal Depression Syndrome”. This condition
increases the risk of premature birth a low birth weight babies with lower chance of survival.

2.4. Antenatal Care

Antenatal care is a broad term used to describe the medical procedures and care that are carried out
during pregnancy. The overall aim of antenatal care is to produce a healthy mother and baby at the
end of the pregnancy. Planning for a safe delivery is an integral part of antenatal care. A series of
health examinations with pre-defined content should enable health personnel to identify ailments and
other conditions in the mothers and her fetus which may threaten the pregnancy.
There is however considerable variations in the content of antenatal care worldwide and there are no
agreed criteria on what exactly constitute antenatal care. Many authors have agreed that it should
consist of motherhood education prevention of potential problems, identification of common diseases,
risk screening and referral of risk mothers. (3, 11, 20).Absence of health care deprives the pregnant
women of timely identification of risk, iron supplementation and dietary advice which are important
measures for the health of both the fetus and the mother.
Neonatal deaths are generally associated with elements linked to maternal care during pregnancy and
delivery while socio-environmental factors become more important determinants of infant survival
during the post neonatal period. It is estimated that neonatal deaths can account for nearly 50-60% of
all infants’ deaths in developing countries. Low socio economic status reflected by lack of education
low utilization of health services and poor environmental sanitation leads to poor pregnancy outcome

8
or stillbirth, low birth weight, early and late neonatal mortalities

2.5. Infections
It is one of the leading causes of perinatal and neonatal mortality in developing countries. Based on
hospital data suggest that nearly 7-54% of early neonatal deaths and 30-73% of late neonatal deaths
are associated with infections, (1.5-2 million neonatal deaths per year).
According to W.H.O 30-40% of all neonatal deaths are explained by neonatal infections. Infections
can either be transmitted from mother before birth or would begin after birth.
Rubella and Syphilis are commonly identified as the two important infections occurring before birth
in developing countries. However, in several developed and African countries infections prior birth is
one of the important determinants of premature and low birth weight babies.
The unhygienic circumstances of delivery and the associated environment are exposed to be a major
cause of after birth infections. The major causes of death due to neonatal infections are tetanus,
respiratory infections, diarrhea and sepsis.

WHO has estimated that approximately 400,000 cases of neonatal tetanus occur annually. The vast
majority of deaths are in developing countries resulting 340,000 neonatal tetanus deaths annually.

2.6. Risk factors for neonatal tetanus in developing countries relate to:
 Lack of immunization of mothers with tetanus toxoid
 Unhygienic delivery
 Unhygienic cord care during the first week of the life (11, 18)
2.7. Malaria in pregnancy
Pregnant women have an enhanced risk of malaria in regions where transmission rates are high. In
low transmission areas, the entire population is at risk, but pregnant women are especially vulnerable,
particularly during epidemics. Pregnant women may be 1.6-4.9 times more likely to be admitted for
malaria than other adults in low transmission areas. These results show that malaria is an important
cause of malarial illness, poor pregnancy outcome and deaths.
The researchers recommended that: to apply the available control measures, such as insecticide
treated bed nets, in epidemic situations.
Investigate the usefulness of providing preventative anti-malarial drug treatment during pregnancy in
low transmissions areas.
2.8. Rationale of the study

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Perinatal, neonatal and infant mortality rates are the most important vital statistics used to assess
maternal and child health program. They are indicator of the quality of antenatal care, medical
services and general health services to the mother and the children.
Follow up studies based on institutional deliveries are important to detect the magnitude of the
problem, however a significant proportion of deaths might occur outside health care facilities and
community based studies are limited. Therefore it is very important to initiate a study on perinatal and
neonatal mortalities that include home and institution deliveries.
Ethiopia like the majority of other developing countries has a problem of vital registration system.
Moreover there are no attempts to date to estimate the problems in the community where unhygienic
home deliveries are widely practiced.

At present where the health policy of Ethiopia emphasizes the government commitment to improve
the health status of the population in general, women and children in particular. This study is intended
to provide base line information for planners and decision makers.

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CHAPTER THREE
3. Introduction
This research work is a descriptive study to analyzing the assessment of pregnancy outcome with emphasi
s on perinatal and neonatal mortality in General Hospitall and the major constraints and the cause of the
perinatal and neonatal mortality in Beddelle Town. To analyze the above objective, the following research
design, questionnaire design, data collection procedure, sampling strategy, data processing and analysis were
used.

3.1. Methodology of the study area

The study was conducted in Bedele district of Bunno Bedele Zone, Oromia Regional state during
2018/19. It is bordered by the Sigmo woreda, jimma Zone on the south western, Chora woreda in the
northwest, Arjo woreda in the northern, and by the Gechi i in the east. The woreda is located in the
south western part of Ethiopia. It has a total area of 2,210.16 km2 with 41 rural and 2 unban kebele
total 43 kebeles. The woreda has a total population of 152,675 people out of which 75,698 and 71,977
are male and female respectively and 14270 household heads out of which 12856 male and 1414
female house hold head. Furthermore, 94.8% of the population lives in rural area and 5.2% lives in
urban area. The population density of the study area is 534.3 persons per kilometer square. Mixed
farming (crop production and livestock rearing) is the predominant sources of livelihood for the
majority of the population in the area. Geographically, the woreda falls between 36o 0` 0`` up to 28o
80` 0``N latitude and 20°79`E longitude. The woreda receives an average annual rainfall ranging from
about 887 up to 1,194mm, altitude 1500 up to 2100 and temperature 18 up to 30 Centigrade. The
landscape includes valley, high forests and plain divided by valleys. The woreda has 45% arable land
or cultivable land (57% was under annual crops), 4.7% pasture land, 35%, and 12% is considered
swampy and degraded or otherwise unusable land respectively. Maize is an important food crop and
Coffee is as important cash crop for this woreda; over 3000 hectares are planted with this crop CSA
(2007).
Bedelle is found in south western part of Ethiopia, 424 Km away from the capital city (Addis Ababa
Potential health Service Coverage of Beddelle is 95%. There is one Hospital, Health centers, 6 health
stations & 12 health posts. There is one hospital, 5 lower, 7 mediums & one higher private owned
clinic in the town. The 2 health centers, Clinics & 12 health posts are found in the peasant
associations. The 2 hospitals, 5 health centers & 6 clinics render delivery services. (Health Office)
The population growth rate is 2.5% & total fertility rate (TFR) 4.5 child/women. IMR is 94/1000 LB
11
and U5 MR is 136/1000LB. The EPI coverage is 40.4%. TT2 + coverage for pregnant and non-
pregnant women are 52.8% and 11.8% respectively. ANC coverage is 45.5% while attended
deliveries by trained birth attendants is 22.5%. Institutional delivery coverage is 31%. FP coverage is
64.1% (9, 21, and 22)
3.2. Study design- Community based cross-sectional comparative study
3.2.1. Source of population
All women of child bearing age group living in Beddelle town.

3.2.2. Study Population

The study was conducted on mother who was pregnant and gave birth in the past five years. The
four urban kebeles were included in the study. The time of the study was conducted from December
2024 to March 2024. The total sample size was 1414.
3.3. Sources of Data
In order to collect reliable data, both primary and secondary sources of data were the major focus of the
researcher. To achieve the objectives of this study, the primary data was collected through questionnaires and
interviews. Secondary data relevant for this research work were collected from different national documents
from strategic document, guidelines and other published documents prepared by different governmental and
non-governmental organizations. Information extracted from this process provided an insight of government
supportive services for perinatal and neonatal and served as the basis in designing the study and data collection
tools.
3.4. Inclusion criteria:
All women who were pregnant and gave birth during the last five year were included.
3.4.1. Exclusion criteria:
Mothers, who were critically ill, could not talk or listen, and those who came out of the study area.
3.4.2. Study variables:
Dependent variables
 Perinatal and neonatal mortality rates.
Independent variables:
 Socio-demographic and socio economic variables (age of the mother, marital status, religion,
and number of pregnancies, number of children, ethnicity, gestational age, educational status,
occupation, monthly income and place of delivery).

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4. Sampling procedures
Beddelle has two higher that consist of two kebeles each. From each higher one kebele was randomly
selected using lottery method. Census method was used to collect data from randomly selected two
kebeles.
A total of 1427 households were visited. From each household one mother who had child less than 5
years old or mother who had been pregnant for the past 5 years were interviewed. If there were two
mothers in a household one was selected using lottery method. A total of 1414 mothers participated in
the study. When respondents were not found at home for some reasons, at least three attempts were
made to interview each respondent before skipping.

4.1 Data Collection

Data were collected using pre tested structured questionnaire. The questionnaires were prepared in
English and translated into Amharic and back translated to English. Fifteen 12th grade completed data
collectors who speak Amharic, Oromiffa, and Somaligna were recruited and three nurse supervisors
were selected. The data collectors and supervisors were trained using the training guideline on how to
interview the respondents. Moreover the Amharic version data collection tools were pre-tested before
the actual data collections in one of the kebeles outs ide of the selected kebeles and necessary
adjustments were made.

4.2. Data Quality

Data quality was assured through:
 Careful design of questionnaire and translation,
 Pre-testing of the questionnaires
 Proper training of the interviewers,
 Closed supervision of the data collection by principal investigator.

4.3. Proper categorization and coding of the data

4.3.1. Supervision
During the actual data collection each supervisor were supervising five data collectors. The
supervisors were checking the activities of each data collectors by moving with them in each kebele
by revisiting 5 percent of households. Every night supervisors were checking the filled questionnaires
for completeness, clarity and proper identifications of the respondents. Then the principal investigator
randomly checked at least 10 percent of the supervisors work every day. Incomplete and unclear
questionnaires were returned to the interviewers the next morning to get them completed. When

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data collection for a particular kebele was completed, supervisors made a thorough check up before
leaving that kebeles.

5. Operational definitions
5.1. Perinatal mortality-
It is fetal death starting from 28 weeks of gestational age and the death of new born in the first week
of life, which comprises late fetal and early neonatal death.

5.2 Late fetal deaths

Are those deaths occurring before or during delivery of fetus corresponding gestational age of 28
weeks.

5.3 Early neonatal deaths

Are those deaths occurring in the first week of life (0-6 days). Therefore perinatal mortality rate is
usually expressed as the rate of late fetal and early neonatal deaths.

5.4 Neonatal mortality rate

The mortality of live born newborns that die before reaching 4 weeks of age or a month expressed as
a rate per 1000 live birth.

5.5 Abortion
The termination of the process of gestation after the time when the zygote attaches itself to the uterine
wall or 14 days after conception, but before the fetus is possibly capable of surviving on its own or 28
weeks from conception.

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6. TIME AND BUDGET SCHUDULE
Work Plan
Description activities December January February March April
Title approval 

Proposal preparation and 

defense

Review of literature 
Questionnaire preparation 
Data collection 
Data entry, editing & coding 

Data analysis 
Report writing 
First draft thesis submission 
Final thesis defense 

6.1 Budget Break Down

No Stationary Unit Quantity Unit price Total price
1 Pen and pencil - 5 30 150
2 Note books and Bag - 10 30 300
4 Thesis printing Bind 2 200 800
5 Compact disk read only(CD-R) Number - - -
6 Flash disk 32GB 1 500 500
7 Mobile card Number 6 600 600
8 Data collection from different sources 164 3pages 4birr 3500
9 Transportation & food - - - 400
10 Miscellaneous expense - - - 2100
Total Cost 8350

15
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