Spatial Distribution of Maternal Mortality in Ethiopia: Further Analysis of Ethiopian Demographic and Health Survey

Abstract

Background: Maternal mortality is one of the major public health problems challenging the medical community,
especially in developing countries. In Ethiopia, despite great emphasis on reducing maternal mortality, it is still high
indicating progress in improving maternal health is inadequate. Identifying hotspot areas with a high prevalence of
maternal mortality is important to design evidence-based interventions and reduce maternal mortality. Despite this
fact, the geographical distribution of maternal mortality in Ethiopia remains unclear. Therefore, this study aimed to
explore the spatial distribution of maternal mortality in Ethiopia.
Methods: Community-based cross-sectional study design was employed in the 2016 Ethiopian Demographic and
Health Survey. A total of 12790 women were included in this analysis. The distribution of maternal mortality across
the country was observed by ArcGIS software. Getis-Ord Gi* statistics were used to identify the hot and cold spot
areas for maternal mortality.
Results: The spatial distribution of maternal mortality in Ethiopia was found to be clustered with Global Moran’s
I = 0.031 [p value < 0.0001]. Hotspot areas with high clustering of maternal mortality were identified in five
administrative zones of Tigray regional states, four zones of Afar regional state, one zone of Amhara regional state,
two zones of Oromia regional state, one zone of the Somali region, and one zone of SNNP. Cold spot areas with low
significant clustering of maternal mortality were identified in Addis Ababa, three zones of the Amhara region, five
zones of the Oromia regional state, five zones of SNNP, and two zones of the Gambella region.
Conclusion: The spatial distribution of maternal mortality in Ethiopia is non-random and varies from region to region.
The clustered hot spot areas with high clustering were identified in Tigray, Afar, Amhara, Somali, SNNP, and Oromia
regions whereas cold spot areas with low clustering of maternal mortality rates were detected in Oromia, SNNP,
Gambella, and Amhara regions. We recommend strengthening maternal health programs by targeting Tigray, Afar,
Amhara Somali, SNNP, and Oromia regions.