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Habte A, Bizuayehu HM, Lemma L, Sisay Y. Road to maternal death: the pooled estimate of maternal near-miss, its primary causes and determinants in Africa: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:144. [PMID: 38368373 PMCID: PMC10874058 DOI: 10.1186/s12884-024-06325-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Maternal near-miss (MNM) is defined by the World Health Organization (WHO) working group as a woman who nearly died but survived a life-threatening condition during pregnancy, childbirth, or within 42 days of termination of pregnancy due to getting quality of care or by chance. Despite the importance of the near-miss concept in enhancing quality of care and maternal health, evidence regarding the prevalence of MNM, its primary causes and its determinants in Africa is sparse; hence, this study aimed to address these gaps. METHODS A systematic review and meta-analysis of studies published up to October 31, 2023, was conducted. Electronic databases (PubMed/Medline, Scopus, Web of Science, and Directory of Open Access Journals), Google, and Google Scholar were used to search for relevant studies. Studies from any African country that reported the magnitude and/or determinants of MNM using WHO criteria were included. The data were extracted using a Microsoft Excel 2013 spreadsheet and analysed by STATA version 16. Pooled estimates were performed using a random-effects model with the DerSimonian Laired method. The I2 test was used to analyze the heterogeneity of the included studies. RESULTS Sixty-five studies with 968,555 participants were included. The weighted pooled prevalence of MNM in Africa was 73.64/1000 live births (95% CI: 69.17, 78.11). A high prevalence was found in the Eastern and Western African regions: 114.81/1000 live births (95% CI: 104.94, 123.59) and 78.34/1000 live births (95% CI: 67.23, 89.46), respectively. Severe postpartum hemorrhage and severe hypertension were the leading causes of MNM, accounting for 36.15% (95% CI: 31.32, 40.99) and 27.2% (95% CI: 23.95, 31.09), respectively. Being a rural resident, having a low monthly income, long distance to a health facility, not attending formal education, not receiving ANC, experiencing delays in health service, having a previous history of caesarean section, and having pre-existing medical conditions were found to increase the risk of MNM. CONCLUSION The pooled prevalence of MNM was high in Africa, especially in the eastern and western regions. There were significant variations in the prevalence of MNM across regions and study periods. Strengthening universal access to education and maternal health services, working together to tackle all three delays through community education and awareness campaigns, improving access to transportation and road infrastructure, and improving the quality of care provided at service delivery points are key to reducing MNM, ultimately improving and ensuring maternal health equity.
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Affiliation(s)
- Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
| | | | - Lire Lemma
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Yordanos Sisay
- Department of Epidemiology, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Silva FX, Katz L, Cecatti JG. Prognostic scores for prediction of maternal near miss and maternal death after admission to an intensive care unit: A narrative review. Health Care Women Int 2023; 44:1558-1572. [PMID: 36256459 DOI: 10.1080/07399332.2022.2134391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
Near miss morbidity and maternal death (defined as severe maternal outcomes - SMO) are the most important adverse outcomes in obstetric settings to assess delays and characteristics of health care management. Intensive care units (ICUs) represent an opportunity of adequate care for women who, in several cases, experienced earlier clinical delays in their maternal health care management. Some prognostic scores widely used in ICU have been useful in characterizing patients in terms of severity of illness in clinical studies, for evaluation of ICU performance, in quality improvement initiatives and for benchmark purposes. Prediction of SMO during the admission to the ICU could greatly improve obstetric care management. We reviewed the feasibility of the existing ICU clinical and obstetric prediction scores in predicting maternal near miss and maternal death.
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Affiliation(s)
- Flávio Xavier Silva
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, Brazil
- Centro de Atenção à Mulher (CAM), Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil
| | - Leila Katz
- Centro de Atenção à Mulher (CAM), Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil
| | - José Guilherme Cecatti
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, Brazil
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Negash A, Sertsu A, Mengistu DA, Tamire A, Birhanu Weldesenbet A, Dechasa M, Nigussie K, Bete T, Yadeta E, Balcha T, Debele GR, Dechasa DB, Fekredin H, Geremew H, Dereje J, Tolesa F, Lami M. Prevalence and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis, 2015-2023. BMC Womens Health 2023; 23:380. [PMID: 37468876 PMCID: PMC10357694 DOI: 10.1186/s12905-023-02523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/01/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND One of the most challenging problems in developing countries including Ethiopia is improving maternal health. About 303,000 mothers die globally, and one in every 180 is at risk from maternal causes. Developing regions account for 99% of maternal deaths. Maternal near miss (MNM) resulted in long-term consequences. A systematic review and meta-analysis was performed to assess the prevalence and predictors of maternal near miss in Ethiopia from January 2015 to March 2023. METHODS A systematic review and meta-analysis cover both published and unpublished studies from different databases (PubMed, CINHAL, Scopus, Science Direct, and the Cochrane Library) to search for published studies whilst searches for unpublished studies were conducted using Google Scholar and Google searches. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Duplicated studies were removed using Endnote X8. The paper quality was also assessed based on the JBI checklist. Finally, 21 studies were included in the study. Data synthesis and statistical analysis were conducted using STATA Version 17 software. Forest plots were used to present the pooled prevalence using the random effect model. Heterogeneity and publication bias was evaluated using Cochran's Q test, (Q) and I squared test (I2). Subgroup analysis based on study region and year of publication was performed. RESULT From a total of 705 obtained studies, twenty-one studies involving 701,997 pregnant or postpartum mothers were included in the final analysis. The national pooled prevalence of MNM in Ethiopia was 140/1000 [95% CI: 80, 190]. Lack of formal education [AOR = 2.10, 95% CI: 1.09, 3.10], Lack of antenatal care [AOR = 2.18, 95% CI: 1.33, 3.03], history of cesarean section [AOR = 4.07, 95% CI: 2.91, 5.24], anemia [AOR = 4.86, 95% CI: 3.24, 6.47], and having chronic medical disorder [AOR = 2.41, 95% CI: 1.53, 3.29] were among the predictors of maternal near misses from the pooled estimate. CONCLUSION The national prevalence of maternal near miss was still substantial. Antenatal care is found to be protective against maternal near miss. Emphasizing antenatal care to prevent anemia and modifying other chronic medical conditions is recommended as prevention strategies. Avoiding primary cesarean section is recommended unless a clear indication is present. Finally, the country should place more emphasis on strategies for reducing MNM and its consequences, with the hope of improving women's health.
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Affiliation(s)
- Abraham Negash
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Addisu Sertsu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dechasa Adare Mengistu
- School of Environmental Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Aklilu Tamire
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adisu Birhanu Weldesenbet
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mesay Dechasa
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Nigussie
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Bete
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Elias Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Taganu Balcha
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Deribe Bekele Dechasa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hamdi Fekredin
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Habtamu Geremew
- College of Health Sciences, Oda Bultum University, Chiro, Ethiopia
| | - Jerman Dereje
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fikadu Tolesa
- College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Magarsa Lami
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Verma A, Choudhary R, Chaudhary R, Kashyap M. Maternal Near-Miss and Maternal Mortality in a Tertiary Care Center of Western Uttar Pradesh: A Retrospective Study. Cureus 2023; 15:e42697. [PMID: 37654928 PMCID: PMC10465351 DOI: 10.7759/cureus.42697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Maternal mortality is an important indicator to assess the quality of services provided by the health care system. However, maternal near-misses as well as maternal mortality are also indicators of how well the health care system serves pregnant women. To improve our healthcare system in terms of investigative capacity, infrastructure, and personnel, a near-miss registry can provide important information on gaps in pregnancy facilities. This will help us to identify the requirements for referral facility improvements and the need for various health awareness programs. We, therefore, designed this study to analyze the various near-miss events in mothers and compare them with maternal mortality. METHODS Present study was conducted in the Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (L.L.R.M.) Medical College associated with Sardar Vallabh Bhai Patel (S.V.B.P.) Hospital Meerut, Uttar Pradesh (UP), India for a period of one year and data were collected retrospectively from January 2022 to January 2023. All patients with life-threatening conditions such as excessive bleeding during pregnancy, hypertensive disorders of pregnancy (HDP), and septicemia that occurred during pregnancy or childbirth or within 42 days of termination of pregnancy and required ICU admissions, were included in the study. The total number of deliveries during the study period was 4,360 with 4,333 live births (LB). The total number of eligible cases was 79, out of which 52 were identified as maternal near misses and 27 were maternal mortality. Various maternal mortality and near-miss indices were analysed and statistical analysis was done using the SPSS version 21 (IBM Corp., Armonk, NY, USA). RESULTS Our hospital's maternal mortality ratio (MMR) was 623/1lakh (0.623%), which is higher than the probability due to the deficiency of appropriate medical services in the nearby areas of western UP. The number of maternal near misses per 1000 LB (maternal near-miss ratio [MNMR]) was 12/1000 LB and the severe maternal outcome rate (SMOR) was 18/1000 LB (1.82%). In our study, hemorrhage and hypertensive disorder in pregnancy were the leading cause of morbidity and mortality followed by sepsis and severe anemia. Among organ dysfunction cardiac illness followed by respiratory dysfunction was the leading cause of morbidity and mortality. CONCLUSION It is clear that there is a high burden of maternal near-miss in developing countries. There should be the establishment of well-equipped referral units at the periphery with trained manpower. The establishment of obstetrical high-dependence units (HDUs), rapid availability of blood and blood products, training of staff, and availability of multidisciplinary teams can minimize maternal mortality and morbidity.
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Affiliation(s)
- Aruna Verma
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
| | - Renu Choudhary
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
| | - Rachna Chaudhary
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
| | - Monika Kashyap
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
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Bagambe PG, Nyirazinyoye L, Floyd Cechetto D, Luginaah I. Perceptions of male partners on maternal near-miss events experienced by their female partners in Rwanda. PLoS One 2023; 18:e0286702. [PMID: 37294814 PMCID: PMC10256223 DOI: 10.1371/journal.pone.0286702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/22/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Maternal near-miss refers to women who survive death from life-threatening obstetric complications and has various social, financial, physical, and psychological impacts on families. OBJECTIVE To explore male partners' perceptions of maternal near-miss experienced by their female partners and the associated psychosocial impacts on their families in Rwanda. METHODS This was a qualitative study involving 27 semi-structured in-depth interviews with male partners whose spouses experienced a maternal near-miss event. Data were analyzed using a thematic coding to generate themes from participants' responses. RESULTS Six key themes that emerged were: male partner's support during wife's pregnancy and during maternal near-miss hospitalization, getting the initial information about the spouse's near-miss event, psychosocial impacts of spouse's near-miss, socio-economic impact of spouse's near-miss, post- maternal near-miss family dynamics, and perceived strategies to minimize the impacts of near-miss. Male partners reported emotional, social, and economic impacts as a result of their traumatic experiences. CONCLUSIONS The impact of maternal near-miss among families in Rwanda remains an area that needs healthcare attention. The residual emotional, financial, and social consequences not only affect females, but also their male partners and their relatives. Male partners should be involved and be well-informed about their partners' conditions and the expected long-term effects of near-miss. Also, medical and psychological follow-up for both spouses is necessary for the enhancement of the health and well-being of affected households.
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Affiliation(s)
- Patrick Gatsinzi Bagambe
- Department of Obstetrics and Gynecology, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | | | - David Floyd Cechetto
- Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, London, Ontario, Canada
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Firoz T, Trigo Romero CL, Leung C, Souza JP, Tunçalp Ö. Global and regional estimates of maternal near miss: a systematic review, meta-analysis and experiences with application. BMJ Glob Health 2022; 7:bmjgh-2021-007077. [PMID: 35387768 PMCID: PMC8987675 DOI: 10.1136/bmjgh-2021-007077] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Maternal near miss (MNM) is a useful means to examine quality of obstetric care. Since the introduction of the WHO MNM criteria in 2011, it has been tested and validated, and is being used globally. We sought to systematically review all available studies using the WHO MNM criteria to develop global and regional estimates of MNM frequency and examine its application across settings. Methods We conducted a systematic review by implementing a comprehensive literature search from 2011 to 2018 in six databases with no language restrictions. The predefined data collection tool included sections on study characteristics, frequency of near-miss cases and study quality. Meta-analysis was performed by regional groupings. Reported adaptations, modifications and remarks about application were extracted. Results 7292 articles were screened by title and abstract, and 264 articles were retrieved for full text review for the meta-analysis. An additional 230 articles were screened for experiences with application of the WHO MNM criteria. Sixty studies with near-miss data from 56 countries were included in the meta-analysis. The pooled global near-miss estimate was 1.4% (95% CI 0.4% to 2.5%) with regional variation in MNM frequency. Of the 20 studies that made adaptations to the criteria, 19 were from low-resource settings where lab-based criteria were adapted due to resource limitations. Conclusions The WHO MNM criteria have enabled the comparison of global and sub-national estimates of MNM frequency. There has been good uptake in low-resource countries but contextual adaptations are necessary.
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Affiliation(s)
- Tabassum Firoz
- Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Carla Lionela Trigo Romero
- Department of Social Medicine, University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil
| | - Clarus Leung
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - João Paulo Souza
- Department of Social Medicine, University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Andrade MS, Bonifácio LP, Sanchez JAC, Oliveira-Ciabati L, Zaratini FS, Franzon ACA, Pileggi VN, Braga GC, Fernandes M, Vieira CS, Souza JP, Vieira EM. Fatores associados à morbidade materna grave em Ribeirão Preto, São Paulo, Brasil: estudo de corte transversal. CAD SAUDE PUBLICA 2022; 38:e00021821. [DOI: 10.1590/0102-311x00021821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
Este estudo investigou os fatores associados à morbidade materna grave entre mulheres atendidas em maternidades públicas do Município de Ribeirão Preto, São Paulo, Brasil. Trata-se de um estudo quantitativo, analítico, transversal. Participaram 1.098 puérperas com parto em uma das quatro maternidades públicas do município. A coleta de dados ocorreu entre 3 de agosto de 2015 e 2 de fevereiro de 2016, a partir de entrevistas face a face, obtenção de informações dos prontuários e dos cartões da gestante. Para a análise de dados, considerou-se como variável dependente a ocorrência de morbidade materna grave, ou seja, quando a mulher era classificada como near miss materno ou condição potencialmente ameaçadora à vida a partir dos critérios de elegibilidade da Organização Mundial de Saúde. Calculou-se a razão do near miss materno, odds ratio (OR), intervalo de 95% de confiança (IC95%) e regressão logística múltipla. A razão do near miss materno foi de 3,6 casos por mil nascidos vivos. As complicações ocorreram principalmente na gravidez (53,8%) e os distúrbios hipertensivos foram os mais frequentes (49,4%). A análise de regressão múltipla mostrou associação entre morbidade materna grave e gestação de risco (OR = 4,5; IC95%: 2,7-7,7) e com trabalho de parto induzido (OR = 2,1; IC95%: 1,2-3,9). A ocorrência de morbidade materna grave, principalmente na gestação, com destaque para as síndromes hipertensivas, aponta para a necessidade de melhor rastreamento e manejo da elevação dos níveis pressóricos no pré-natal. A associação entre morbidade materna grave e gestação de risco também remonta ao pré-natal, para a demanda de uma maior atenção às mulheres classificadas como risco gestacional. A qualidade da assistência é ponto chave para o enfretamento da morbimortalidade materna no país.
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Drechsel KC, Adu-Bonsaffoh K, Olde Loohuis KM, Srofenyoh EK, Boateng D, Browne JL. Maternal near-miss and mortality associated with hypertensive disorders of pregnancy remote from term: A multicenter observational study in Ghana. AJOG GLOBAL REPORTS 2022; 2:100045. [PMID: 36275498 PMCID: PMC9564034 DOI: 10.1016/j.xagr.2021.100045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Maternal death rates remain high in many low- and middle-income countries. Hypertensive disorders of pregnancy account for 18% of maternal mortality in Ghana. The maternal near-miss approach was designed to evaluate severe (acute) complications in pregnancy, which is useful to detect potential areas for clinical care improvement. OBJECTIVE This study aimed (1) to determine the incidence of severe maternal complications, maternal near-miss cases, and mortality cases associated with hypertensive disorders of pregnancy remote from term and (2) to assess the health system's performance indicators for the management of hypertensive disorders of pregnancy remote from term in middle-income country referral hospitals. STUDY DESIGN This study was nested in the ongoing Severe Preeclampsia adverse Outcome Triage study, a multicenter observational cohort study, and included women recruited from December 1, 2017, to May 31, 2020, from 5 referral hospitals in Ghana. Women aged >16 years, admitted to the hospital with hypertensive disorders of pregnancy, with gestational age between 26 and 34 weeks were eligible. Near miss was defined according to the World Health Organization and sub-Saharan African near-miss criteria. Descriptive statistics of pregnancy and maternal and perinatal outcomes up to 6 weeks after delivery of women with severe maternal outcomes were presented for maternal deaths and maternal near-miss casigurees and compared with that of women without severe maternal outcomes. The health system's maternal and perinatal performance indicators were calculated. RESULTS Overall, 447 women with hypertensive disorders of pregnancy were included in the analyses with a mean maternal age of 32 (±5.8) years and mean gestational age at recruitment of 30.5 (±2.4) weeks. Of these patients, 46 (10%) had gestational hypertension, 338 (76%) had preeclampsia, and 63 (14%) had eclampsia. There were 148 near-miss cases (33.1%) and 12 maternal deaths (2.7%). Severe maternal outcomes constituted complications from severe preeclampsia (80/160 [50%]) and eclampsia (63/160 [39.4%]). Concerning organ dysfunction, hematologic and respiratory dysfunctions constituted 59/160 [38.6%] and 23/160 [14.8%] respectively. Nearly all women had a cesarean delivery (347/447 [84%] and 140/160 [93%] in the severe maternal outcome group) and delivered prematurely (83%, with 178/379 [93%] at <32 weeks of gestation). Stillbirth and neonatal deaths occurred in 63 of 455 women (14%) and 81 of 392 women (19%), respectively, constituting a stillbirth ratio of 161 per 1000 live births and neonatal mortality rate of 207 per 1000 live births as there were 392 live births in this cohort. Overall, the intensive care unit admission rate was 12.7% (n=52/409); moreover, 45 of 52 women (86.5%) admitted to the intensive care unit had severe maternal outcomes. The maternal death ratio was 3100 per 100,000 live births, the maternal near-miss–to–mortality ratio was 12.3, and the mortality index was 8%. CONCLUSION Maternal near miss and maternal and perinatal mortalities were common in women with hypertensive disorders of pregnancy remote from term in referral hospitals in Ghana. Providing appropriate patient-centered and multidisciplinary quality care for these women is crucial in improving pregnancy outcomes. Context-tailored interventions should be considered in the clinical management of complications associated with hypertensive disorders of pregnancy in resource-limited settings. Further research on interventions to improve timely referral and reduce in-hospital delays in care provision is recommended to facilitate emergency care services for women with hypertensive emergencies.
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Affiliation(s)
- Katja C.E. Drechsel
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (Drs Drechsel, Adu-Bonsaffoh, Olde Loohuis, Boateng, and Browne)
| | - Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (Drs Drechsel, Adu-Bonsaffoh, Olde Loohuis, Boateng, and Browne)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana (Dr Adu-Bonsaffoh)
- Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana (Dr Adu-Bonsaffoh)
- Corresponding author: Kwame Adu-Bonsaffoh, MD.
| | - Klaartje M. Olde Loohuis
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (Drs Drechsel, Adu-Bonsaffoh, Olde Loohuis, Boateng, and Browne)
| | - Emmanuel K. Srofenyoh
- Department of Obstetrics and Gynecology, Greater Accra Regional Hospital, Ghana Health Service, Accra, Ghana (Dr Srofenyoh)
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (Drs Drechsel, Adu-Bonsaffoh, Olde Loohuis, Boateng, and Browne)
| | - Joyce L. Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (Drs Drechsel, Adu-Bonsaffoh, Olde Loohuis, Boateng, and Browne)
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Teka H, Yemane A, Berhe Zelelow Y, Tadesse H, Hagos H. Maternal near-miss and mortality in a teaching hospital in Tigray region, Northern Ethiopia. WOMEN'S HEALTH 2022; 18:17455057221078739. [PMID: 35196926 PMCID: PMC8883400 DOI: 10.1177/17455057221078739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: This study seeks to examine the prevalence of maternal morbidities and deaths in Ayder Comprehensive Specialized Hospital from 1 July 2018 to 30 June 2019. Methods: This was a cross-sectional study. Total purposive sampling method was employed to collect data prospectively using modified World Health Organization criteria for baseline assessment of maternal near-miss and mortality. Pregnant women or those who are within 42 days postpartum/any form of pregnancy termination that satisfy the inclusion criteria were enrolled. Results: A total of 691 mothers were recorded as having severe maternal complications. Out of these, 170 women developed severe maternal outcome, ending with 146 maternal near-miss cases and 24 maternal deaths. The maternal near-miss ratio and maternal mortality ratio were 28.5 per 1000 live births and 469.1 per 100,000 live births, respectively. The overall mortality index was 14%. The top underlying causes of severe maternal complications were the infamous triads of preeclampsia (n = 303, 43.8%), obstetric hemorrhage (n = 166, 24.0%) and sepsis (n = 130, 18.8%). About 62.5% of mothers who died were not admitted to intensive care unit. Conclusion: This study found that the infamous triads of preeclampsia, obstetric hemorrhage and sepsis persist as the commonest causes of severe maternal complications in the study area. A significant number of women with severe maternal outcome were not admitted to intensive care unit. It also highlights that the severe maternal complications, severe maternal outcome, maternal near-miss ratio and mortality index in the study area are disproportionately higher than the global average. These staggering numbers call for a system re-thinking at multiple junctures.
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Affiliation(s)
- Hale Teka
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Awol Yemane
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Yibrah Berhe Zelelow
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Habtom Tadesse
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Ethiopia
| | - Hadgay Hagos
- Department of Epidemiology, School of Public Health, Mekelle University, Mekelle, Ethiopia
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Musarandega R, Nyakura M, Machekano R, Pattinson R, Munjanja SP. Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020. J Glob Health 2021; 11:04048. [PMID: 34737857 PMCID: PMC8542378 DOI: 10.7189/jogh.11.04048] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Maternal deaths remain high in Sub-Saharan Africa (SSA) and their causes of maternal death must be analysed frequently in this region to guide interventions. Methods We conducted a systematic review of studies published from 2015 to 2020 that reported the causes of maternal deaths in 57 SSA countries. The objective was to identify the leading causes of maternal deaths using the international classification of disease - 10th revision, for maternal mortality (ICD-MM). We searched PubMed, WorldCat Discovery Libraries Worldwide (including Medline, Web of Science, LISTA and CNHAL databases), and Google Scholar databases and citations, using the search words "maternal mortality", "maternal death", "pregnancy-related death", "reproductive age mortality" and "causes" as MeSH terms or keywords. The last date of search from all databases was 21 May 2021. We included original research articles published in English and excluded articles that mentioned SSA country names without study results for those countries, studies that reported death from a single cause or assigned causes of death using computer models or incompletely broke down the causes of death. We exported, de-duplicated and screened the searches electronically in EndNote version 20. We selected the final articles by reading the titles, abstracts and full texts. Two authors searched the articles and assessed the risk of bias using a tool adapted from Montoya and others. Data from the articles were extracted onto an Excel worksheet and the deaths classified into ICD-MM groups. Proportions were calculated with 95% confidence intervals and compared for deaths attributed to each cause and ICD-MM group. We compared the results with WHO and Global Burden of Disease (GDB) estimates. Results We identified 38 studies that reported 11 427 maternal and four incidental deaths. Twenty-one of the third-eight studies were retrospective record reviews. The leading causes of death (proportions and 95% confidence intervals (CI)) were obstetric hemorrhage: 28.8% (95% CI = 26.5%-31.2%), hypertensive disorders in pregnancy: 22.1% (95% CI = 19.9%-24.2%), non-obstetric complications: 18.8% (95% CI = 16.4%-21.2%) and pregnancy-related infections: 11.5% (95% CI = 9.8%-13.2%). The studies reported few deaths of unknown/undetermined and incidental causes. Conclusions Limitations of this review were the failure to access more data from government reports, but the study results compared well with WHO and GDB estimates. Obstetric hemorrhage, hypertensive disorders in pregnancy, non-obstetric complications, and pregnancy-related infections are the leading causes of maternal deaths in SSA. However, deaths from incidental causes are likely under-reported in this region. SSA countries must continue to invest in health information systems that collect and publishes comprehensive, quality, maternal death causes data. A publicly accessible repository of data sets and government reports for causes of maternal death will be helpful in future reviews. This review received no specific funding and was not registered.
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Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, University of Pretoria, South Africa.,Department of Obstetrics and Gynaecology, Victoria Falls Hospital, Zimbabwe
| | - Michael Nyakura
- Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rhoderick Machekano
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, South Africa
| | - Robert Pattinson
- Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Causes of Maternal Mortality in Rwanda, 2017-2019. Obstet Gynecol 2021; 138:552-556. [PMID: 34623066 DOI: 10.1097/aog.0000000000004534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the causes of maternal mortality at a referral hospital in Rwanda. METHODS A secondary data analysis of 217 women with recorded maternal mortality from 2017 to 2019 was conducted among 11,308 total maternal admissions. Demographics, diagnosis, management, referring hospital source, and outcomes were recorded. RESULTS The mean (±SD) age of maternal death was 30.7±7.2 years (range 16-57 years). The overall maternal mortality rate was 1.99%, with yearly rates of 2.45%, 2.53%, and 1.84% in 2017, 2018, and 2019, respectively. A significant seasonal variation was noted. Sepsis was the most common cause of maternal death (50%), followed by hemorrhage (19%) and hypertensive disorders (15%). Causes of maternal deaths included preeclampsia (13%) and abortion (8%). Furthermore, 82% of all the deaths were referrals from smaller community hospitals. CONCLUSION Maternal death due to sepsis remain a major cause of maternal deaths in Rwanda. Infection prevention and the early diagnosis and management of sepsis must be a priority in reducing maternal mortality.
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Niyonzima FN, Dusabimana A, Mutijima JB. Pregnancy Induced Hypertension and Uric Acid Levels among Pregnant Women Attending Ruhengeri Referral Hospital, in Rwanda. East Afr Health Res J 2021; 5:44-49. [PMID: 34308244 PMCID: PMC8291203 DOI: 10.24248/eahrj.v5i1.650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 05/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Pregnancy Induced Hypertension (PIH) is a common burden during pregnancy usually associoted with adverse maternal and paternal outcomes. The uric acid serum level was identified as an important biochemical marker which can predict preeclampsia, a type of PIH. This study was conducted to evaluate the effects of serum uric acid levels in association with blood pressure among pregnant women attending Ruhengeri Referral Hospital. Methodology: A cross-sectional study was designed and 80 pregnant women in different gestation trimesters participated in the study. Data was collected from September to October 2018. Digital sphygmomanometer was used to test blood pressures for participants. Blood samples were collected in red top tubes and centrifuged to obtain serum for uric acid levels. Using Humastar 80, uric acid levels were measured for each participant. Data was analysed using Statistical Package for Social Sciences (SPSS) version 23.0. Bivariate correlation was used to analyse the relationship between uric acid levels and participants’ blood pressure. Results: The median age was 27 in interquartile 23-31 ranging from 19 to 39 years. 58.75% of participants were in their 1st trimester, followed by 21.25% in the 2nd trimester and 20% in the 3rd trimester. The prevalence of hypertension was 11.3% (7.5% for stage 1 and 3.8% for stage 2). Hyperuricemia was found in 15% of the participants. The mean of uric acid level was 7.12 ±1.86 mg/dl in the hypertensive group and 4.49 ±1.22 mg/dl in the non-hypertensive group. The study revealed a strong positive correlation between uric acid levels and systolic/diastolic blood pressure. Conclusion: High prevalence of hypertension among pregnant women was revealed. The association of hypertension and hyperuricemia was recorded with a strong correlation between blood pressures and serum uric acid levels. Examination of Uric acid levels among pregnant women should be routinely performed for early identification and management of hypertension.
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Affiliation(s)
- Francois Niyongabo Niyonzima
- Department of Biomedical Laboratory Sciences (BLS), Faculty of Applied Fundamental Sciences (AFS), INES - Institute of Applied Sciences, Rwanda
| | - Ally Dusabimana
- Department of Biomedical Laboratory Sciences (BLS), Faculty of Applied Fundamental Sciences (AFS), INES - Institute of Applied Sciences, Rwanda
| | - Jean Berchmas Mutijima
- Department of Biomedical Laboratory Sciences (BLS), Faculty of Applied Fundamental Sciences (AFS), INES - Institute of Applied Sciences, Rwanda
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Rudakemwa A, Cassidy AL, Twagirumugabe T. High mortality rate of obstetric critically ill women in Rwanda and its predictability. BMC Pregnancy Childbirth 2021; 21:401. [PMID: 34034687 PMCID: PMC8144868 DOI: 10.1186/s12884-021-03882-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/17/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Reasons for admission to intensive care units (ICUs) for obstetric patients vary from one setting to another. Outcomes from ICU and prediction models are not well explored in Rwanda owing to lack of appropriate scores. This study aimed to assess reasons for admission and accuracy of prediction models for mortality of obstetric patients admitted to ICUs of two public tertiary hospitals in Rwanda. METHODS We prospectively collected data from all obstetric patients admitted to the ICUs of the two public tertiary hospitals in Rwanda from March 2017 to February 2018 to identify reasons for admission, demographic and clinical characteristics, outcome including death and its predictability by both the Modified Early Obstetric Warning Score (MEOWS) and quick Sequential Organ Failure Assessment (qSOFA). We analysed the accuracy of mortality prediction models by MEOWS or qSOFA by using logistic regression adjusting for factors associated with mortality. Area under the Receiver Operating characteristic (AUROC) curves is used to show the predicting capacity for each individual tool. RESULTS Obstetric patients (n = 94) represented 12.8 % of all 747 ICU admissions which is 1.8 % of all 4.999 admitted women for pregnancy or labor. Sepsis (n = 30; 31.9 %) and obstetric haemorrhage (n = 24; 25.5 %) were the two commonest reasons for ICU admission. Overall ICU mortality for obstetric patients was 54.3 % (n = 51) with average length of stay of 6.6 ± 7.525 days. MEOWS score was an independent predictor of mortality (adjusted (a)OR 1.25; 95 % CI 1.07-1.46) and so was qSOFA score (aOR 2.81; 95 % CI 1.25-6.30) with an adjusted AUROC of 0.773 (95 % CI 0.67-0.88) and 0.764 (95 % CI 0.65-0.87), indicating fair accuracy for ICU mortality prediction in these settings of both MEOWS and qSOFA scores. CONCLUSIONS Sepsis and obstetric haemorrhage were the commonest reasons for obstetric admissions to ICU in Rwanda. MEOWS and qSOFA scores could accurately predict ICU mortality of obstetric patients in resource-limited settings, but larger studies are needed before a recommendation for their use in routine practice in similar settings.
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Affiliation(s)
- Alcade Rudakemwa
- Ruhengeri Referral Hospital , North Province, Ruhengeri, Rwanda.
| | - Amyl Lucille Cassidy
- Department of Anesthesiology, Wake Forest University School of Medicine, North Carolina, Winston-Salem, USA
| | - Théogène Twagirumugabe
- College of Medicine and Health Sciences, University of Rwanda, University Teaching Hospital of Butare, Butare, Rwanda
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Kebede TT, Godana W, Utaile MM, Sebsibe YB. Effects of antenatal care service utilization on maternal near miss in Gamo Gofa zone, southern Ethiopia: retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:209. [PMID: 33726708 PMCID: PMC7962281 DOI: 10.1186/s12884-021-03683-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background Antenatal care (ANC) provides an opportunity to prevent, identify and intervene maternal health problems. Maternal near miss (MNM), as an indicator of maternal health, is increasingly gaining global attention to measure these problems. However, little has been done to measure the effect of ANC on MNM in Ethiopia. Therefore, this study is aimed at determining the effect of ANC on MNM and its associated predictors at Gamo Gofa zone, southern Ethiopia. Methods Employing a retrospective cohort study design, 3 years data of 1440 pregnant mothers (480 ANC attendant and 960 non-attendant) were collected from all hospitals in the zone. Taking ANC visit as an exposure variable; we used a pretested checklist to extract relevant information from the study participants’ medical records. Characteristics of study participants, their ANC attendance status, MNM rates and associated predictors were determined. Results Twenty-five (5.2%) ANC attendant and seventy-one (7.4%) non-attendant mothers experienced MNM, (X2 = 2,46, df = 2, p = 0.12). The incidence rates were 59.6 (95% CI: 40.6–88.2) and 86.1 (95%CI: 67.3–107.2)/1000 person-years for the ANC attendant and non-attendant mothers, respectively. Mothers who were living in rural areas had higher hazard ratio of experiencing MNM than those who were living in urban areas, with an adjusted hazard ratio (AHR) of 1.68 (95% CI, 1.01, 2.78). Conclusion ANC attendance tended to reduce MNM. However, late initiation and loss to follow-up were higher in the current study. Therefore, on time initiation and consistent utilization of ANC are required.
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Affiliation(s)
- Tayue Tateke Kebede
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Wanzahun Godana
- Department of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Mesfin Mamo Utaile
- Department of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Yemisirach Berhanu Sebsibe
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Maternal near miss in Ethiopia: Protective role of antenatal care and disparity in socioeconomic inequities: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Mekonnen A, Fikadu G, Seyoum K, Ganfure G, Degno S, Lencha B. Factors associated with maternal near-miss at public hospitals of South-East Ethiopia: An institutional-based cross-sectional study. WOMEN'S HEALTH 2021; 17:17455065211060617. [PMID: 34798796 PMCID: PMC8606979 DOI: 10.1177/17455065211060617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction: Maternal near-miss precedes maternal mortality, and women are still alive indicating that the numbers of near-misses occur more often than maternal mortality. This study aims to assess the prevalence of maternal near-miss and associated factors at public hospitals of Bale zone, Southeast Ethiopia. Methods: Facility-based cross-sectional study design was carried out from 1 October 2018 to 28 February 2019, among 300 women admitted to maternity wards. A structured questionnaire and checklist were used to collect data. Epi-info for data entry and statistical package for social science for analysis were used. The descriptive findings were summarized using tables and text. Adjusted odds ratio with 95% confidence interval and p-value < 0.05 were used to examine the association between the independent and dependent variables. Result: The prevalence of maternal near-miss in our study area was 28.7%. Age < 20 years, age at first marriage < 20 years, husbands with primary education, and being from rural areas are factors significantly associated with the prevalence of maternal near-miss. The zonal health department in collaboration with the education department and justice office has to mitigate early marriage by educating the community about the impacts of early marriage on health.
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Affiliation(s)
- Ashenafi Mekonnen
- Department of Midwifery, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Genet Fikadu
- Department of Midwifery, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Gemechu Ganfure
- Department of Midwifery, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Sisay Degno
- Department of Public Health, School of Health Science, Madda Walabu University, Shashemene, Ethiopia
| | - Bikila Lencha
- Department of Public Health, School of Health Science, Madda Walabu University, Shashemene, Ethiopia
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Kodan LR, Verschueren KJC, Prüst ZD, Zuithoff NPA, Rijken MJ, Browne JL, Klipstein-Grobusch K, Bloemenkamp KWM, Grunberg AW. Postpartum hemorrhage in Suriname: A national descriptive study of hospital births and an audit of case management. PLoS One 2020; 15:e0244087. [PMID: 33338049 PMCID: PMC7748130 DOI: 10.1371/journal.pone.0244087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is the leading cause of direct maternal mortality globally and in Suriname. We aimed to study the prevalence, risk indicators, causes, and management of PPH to identify opportunities for PPH reduction. Methods A nationwide retrospective descriptive study of all hospital deliveries in Suriname in 2017 was performed. Logistic regression analysis was applied to identify risk indicators for PPH (≥ 500ml blood loss). Management of severe PPH (blood loss ≥1,000ml or ≥500ml with hypotension or at least three transfusions) was evaluated via a criteria-based audit using the national guideline. Results In 2017, the prevalence of PPH and severe PPH in Suriname was 9.2% (n = 808/8,747) and 2.5% (n = 220/8,747), respectively. PPH varied from 5.8% to 15.8% across the hospitals. Risk indicators associated with severe PPH included being of African descent (Maroon aOR 2.1[95%CI 1.3–3.3], Creole aOR 1.8[95%CI 1.1–3.0]), multiple pregnancy (aOR 3.4[95%CI 1.7–7.1]), delivery in Hospital D (aOR 2.4[95%CI 1.7–3.4]), cesarean section (aOR 3.9[95%CI 2.9–5.3]), stillbirth (aOR 6.4 [95%CI 3.4–12.2]), preterm birth (aOR 2.1[95%CI 1.3–3.2]), and macrosomia (aOR 2.8 [95%CI 1.5–5.0]). Uterine atony (56.7%, n = 102/180[missing 40]) and retained placenta (19.4%, n = 35/180[missing 40]), were the main causes of severe PPH. A criteria-based audit revealed that women with severe PPH received prophylactic oxytocin in 61.3% (n = 95/155[missing 65]), oxytocin treatment in 68.8% (n = 106/154[missing 66]), and tranexamic acid in 4.9% (n = 5/103[missing 117]). Conclusions PPH prevalence and risk indicators in Suriname were similar to international and regional reports. Inconsistent blood loss measurement, varied maternal and perinatal characteristics, and variable guideline adherence contributed to interhospital prevalence variation. PPH reduction in Suriname can be achieved through prevention by practicing active management of the third stage of labor in every birth and considering risk factors, early recognition by objective and consistent blood loss measurement, and prompt treatment by adequate administration of oxytocin and tranexamic acid according to national guidelines.
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Affiliation(s)
- Lachmi R. Kodan
- Department of Obstetrics and Gynecology, Academic Hospital Paramaribo, Paramaribo, Suriname, South Africa
- Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- * E-mail:
| | - Kim J. C. Verschueren
- Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Zita D. Prüst
- Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P. A. Zuithoff
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marcus J. Rijken
- Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joyce L. Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kitty W. M. Bloemenkamp
- Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Antoon W. Grunberg
- Board of Doctoral Graduations and Honorary Doctorate Awards, Anton de Kom University, Paramaribo, Suriname, South Africa
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Alves LC, Costa JR, Monteiro JCDS, Gomes-Sponholz FA. Women's sexual health six months after a severe maternal morbidity event. Rev Lat Am Enfermagem 2020; 28:e3293. [PMID: 32578751 PMCID: PMC7304979 DOI: 10.1590/1518-8345.3500.3293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to investigate female sexual function in women six months postpartum and to compare sexual function among women who had and who did not have severe maternal morbidity (SMM). METHOD a cross-sectional study conducted with 110 women in the postpartum period, with and without SMM. Two instruments were used, one for the characterization of sociodemographic and obstetric variables and the Female Sexual Function Index (FSFI) for sexual function. Univariate, bivariate and regression model analyses were performed. RESULTS FSFI scores showed 44.5% of female sexual dysfunction, of which 48.7% were among women who had SMM and 42.0% among those who had not. There were significant differences between age (P=0.013) and duration of pregnancy (P<0.001) between women with or without SMM. Among the cases of SMM, hypertensive disorders were the most frequent (83%). An association was obtained between some domains of the FSFI and the following variables: orgasm and self-reported skin color, satisfaction and length of relationship, and pain and SMM. CONCLUSION white women have greater difficulty in reaching orgasm when compared to non-white women and women with more than 120 months of relationship feel more dissatisfied with sexual health than women with less time in a relationship. Women who have had some type of SMM have more dyspareunia when compared to women who have not had SMM.
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Affiliation(s)
- Lisiane Camargo Alves
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Jessica Ribeiro Costa
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Juliana Cristina Dos Santos Monteiro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Flávia Azevedo Gomes-Sponholz
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
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Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. LANCET GLOBAL HEALTH 2020; 7:e513-e522. [PMID: 30879511 DOI: 10.1016/s2214-109x(19)30036-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/13/2018] [Accepted: 01/11/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING Medical Research Council of South Africa.
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García-Tizón Larroca S, Amor Valera F, Ayuso Herrera E, Cueto Hernandez I, Cuñarro Lopez Y, De Leon-Luis J. Human Development Index of the maternal country of origin and its relationship with maternal near miss: A systematic review of the literature. BMC Pregnancy Childbirth 2020; 20:224. [PMID: 32299375 PMCID: PMC7164222 DOI: 10.1186/s12884-020-02901-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/27/2020] [Indexed: 01/09/2023] Open
Abstract
Background The reduction in maternal mortality worldwide has increased the interest in studying more frequent severe events such as maternal near miss. The Human Development Index is a sociodemographic country-specific variable that includes key human development indicators such as living a long and healthy life, acquiring knowledge, and enjoying a decent standard of living, allowing differentiation between countries. In a globalised environment, it is necessary to study whether the Human Development Index of each patient's country of origin can be associated with the maternal near-miss rate and thus classify the risk of maternal morbidity and mortality. Methods A systematic review of the literature published between 2008 and 2019 was conducted, including all articles that reported data about maternal near miss in their sample of pregnant women, in addition to describing the study countries of their sample population. The Human Development Index of the study country, the maternal near-miss rate, the maternal mortality rate, and other maternal-perinatal variables related to morbidity and mortality were used. Results After the systematic review, eighty two articles from over thirty countries were included, for a total of 3,699,697 live births, 37,191 near miss cases, and 4029 mortality cases. A statistically significant (p <0.05) inversely proportional relationship was observed between the Human Development Index of the study country and the maternal near-miss and mortality rates. The most common cause of maternal near miss was haemorrhage, with an overall rate of 38.5%, followed by hypertensive disorders of pregnancy (34.2%), sepsis (7.5%), and other undefined causes (20.9%). Conclusions The Human Development Index of the maternal country of origin is a sociodemographic variable allowing differentiation and classification of the risk of maternal mortality and near miss in pregnant women. The most common cause of maternal near miss published in the literature was haemorrhage. Trial registration PROSPERO ID: CRD 42019133464
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Affiliation(s)
- Santiago García-Tizón Larroca
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.
| | - Francisco Amor Valera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Esther Ayuso Herrera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Ignacio Cueto Hernandez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Yolanda Cuñarro Lopez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Juan De Leon-Luis
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.,Department of Public and Maternal-Infant Health, Complutense University, Madrid, Spain
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21
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Shaboodien G, Spracklen TF, Kamuli S, Ndibangwi P, Van Niekerk C, Ntusi NAB. Genetics of inherited cardiomyopathies in Africa. Cardiovasc Diagn Ther 2020; 10:262-278. [PMID: 32420109 DOI: 10.21037/cdt.2019.10.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCDs) is rising disproportionately in comparison to the rest of the world, affecting urban, semi-urban and rural dwellers alike. NCDs are predicted to surpass infections like human immunodeficiency virus, tuberculosis and malaria as the leading cause of mortality in SSA over the next decade. Heart failure (HF) is the dominant form of cardiovascular disease (CVD), and a leading cause of NCD in SSA. The main causes of HF in SSA are hypertension, cardiomyopathies, rheumatic heart disease, pericardial disease, and to a lesser extent, coronary heart disease. Of these, the cardiomyopathies deserve greater attention because of the relatively poor understanding of mechanisms of disease, poor outcomes and the disproportionate impact they have on young, economically active individuals. Morphofunctionally, cardiomyopathies are classified as dilated, hypertrophic, restrictive and arrhythmogenic; regardless of classification, at least half of these are inherited forms of CVD. In this review, we summarise all studies that have investigated the incidence of cardiomyopathy across Africa, with a focus on the inherited cardiomyopathies. We also review data on the molecular genetic underpinnings of cardiomyopathy in Africa, where there is a striking lack of studies reporting on the genetics of cardiomyopathy. We highlight the impact that genetic testing, through candidate gene screening, association studies and next generation sequencing technologies such as whole exome sequencing and targeted resequencing has had on the understanding of cardiomyopathy in Africa. Finally, we emphasise the need for future studies to fill large gaps in our knowledge in relation to the genetics of inherited cardiomyopathies in Africa.
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Affiliation(s)
- Gasnat Shaboodien
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Timothy F Spracklen
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stephen Kamuli
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Polycarp Ndibangwi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carla Van Niekerk
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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22
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Incidence of maternal near miss among women in labour admitted to hospitals in Ethiopia. Midwifery 2019; 82:102597. [PMID: 31862558 DOI: 10.1016/j.midw.2019.102597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/18/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess the incidence of maternal near miss and contributing factors among hospitals in Ethiopia. The study also assessed the ability of hospitals to provide signal functions of emergency obstetric care and its regional distribution. DESIGN A national dataset accessed from the Ethiopian Public Health Institute were analysed to assess the incidence of maternal near miss and mortality index among women admitted to hospitals with obstetric complications. SETTING Maternal health indicators including obstetric complications, maternal deaths and births conducted at all hospitals available in Ethiopia were included. MEASUREMENTS The maternal near miss incidence ratio, which is the number of near miss cases per 1,000 live births, and the mortality index were presented descriptively. Chi-squared test at p value ≤ 0.05 was used to assess the presence of significant regional differences of the provision of signal functions of emergency obstetric care. RESULTS In 2015, 78,195 women were admitted to hospitals with both the direct (68,002) and indirect (10,193) causes of maternal mortality. Of women who experienced the direct causes, 435 died which means there were 67,567 maternal near miss cases. In the same year, 323,824 live births were reported in hospitals, making the crude maternal near miss incidence ratio of 20.8% (9.1-38.8%) and mortality index of 0.64% (435/68,002) for the direct causes of maternal mortality. A significant regional variation was observed with regard to incidence of maternal near miss, mortality index and the provision of signal functions of emergency obstetric care. Administration of parenteral antibiotics was the most frequently practiced signal function of emergency obstetric care while blood transfusion was the least provided signal function. CONCLUSIONS In Ethiopian hospitals, the incidence of maternal near miss was unacceptably high. A significant regional variation was detected with regard to maternal near miss incidence ratio, mortality index and the provision of signal functions of emergency obstetric care. The Ethiopian government needs to work on equitable resource distribution and quality improvement initiatives in order to close the detected regional variations. IMPLICATIONS FOR PRACTICE The Ethiopian government needs to practice evidence-based maternal health strategies, including capacity building of the regional hospitals in order to improve the distribution of resources and quality of maternal health.
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23
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Abdollahpour S, Heidarian Miri H, Khadivzadeh T. The global prevalence of maternal near miss: a systematic review and meta-analysis. Health Promot Perspect 2019; 9:255-262. [PMID: 31777704 PMCID: PMC6875559 DOI: 10.15171/hpp.2019.35] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Improving the maternal health is one of the world's most challenging problems. Despite significant movements over the past decades, maternal health has been still considered as a central goal for sustainable development. Maternal near miss (MNM) cases experience long-term physical and psychological effects. To present a clear portrait of the current situation, we performed a systematic review and meta-analysis with the purpose to assess the worldwide prevalence of MNM. Methods: We conducted a systematic review on PubMed, Scopus and Web of Science electronic databases to find published papers in English, before March 2019 and regardless of the type of study. We, then, assessed the prevalence of MNM according to the World Health Organization(WHO) criteria. Finally, 49 papers were included in the study. Random effects meta-analysis was used to pool the available prevalence. The quality of studies was also evaluated. Results: The weighted pooled worldwide prevalence of MNM, was 18.67/1000 (95% CI: 16.28-21.06). Heterogeneity was explored using subgroup analyses based on the continent and the country. We used meta-regression of MNM on MD which resulted in adjusted R-squared as78.88%. Conclusion: The prevalence of MNM was considerable. Low- and middle-income countries should develop systematic approaches to improve quality of care in the facilities and to reducethe risk of MNM events, with the hope to women's health.
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Affiliation(s)
- Sedigheh Abdollahpour
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Heidarian Miri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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24
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Herklots T, van Acht L, Khamis RS, Meguid T, Franx A, Jacod B. Validity of WHO's near-miss approach in a high maternal mortality setting. PLoS One 2019; 14:e0217135. [PMID: 31095635 PMCID: PMC6522045 DOI: 10.1371/journal.pone.0217135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 05/06/2019] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the validity of WHO’s near-miss approach in a low-resource, high maternal mortality setting. Design Prospective cohort study. Setting Mnazi Mmoja Hospital, the main referral hospital of Zanzibar, Tanzania, from 1 April 2017 until 31 December 2018. Population All women, pregnant or until 42 days after the end of pregnancy, admitted at Mnazi Mmoja Hospital, the tertiary referral hospital in Zanzibar. Methods Cases of maternal morbidity and mortality were evaluated according to WHO’s near-miss approach. The approach’s performance was determined by calculating its accuracy through sensitivity, specificity and positive and negative likelihood ratios. The approach’s validity was assessed with Pearson’s correlation coefficient between the number of organ dysfunction markers and risk of mortality. Main outcomes measures Correlation between number of organ dysfunction markers and risk of mortality, sensitivity and specificity. Results 26,842 women were included. There were 335 with a severe maternal outcome: 256 maternal near-miss cases and 79 maternal deaths. No signs of organ dysfunction were documented in only 4 of the 79 cases of maternal death. The number of organ dysfunction markers was highly correlated to the risk of mortality with Pearson’s correlation coefficient of 0.89. Conclusions WHO’s near-miss approach adequately identifies women at high risk of maternal mortality in Zanzibar’s referral hospital. There is a strong correlation between the number of markers of organ dysfunction and mortality risk.
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Affiliation(s)
- Tanneke Herklots
- Division of Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Lieke van Acht
- Division of Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rashid Saleh Khamis
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Stone Town, Zanzibar, United Republic of Tanzania
| | - Tarek Meguid
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Stone Town, Zanzibar, United Republic of Tanzania
- School of Health & Medical Sciences, State University of Zanzibar (SUZA), Zanzibar, United Republic of Tanzania
| | - Arie Franx
- Division of Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Benoit Jacod
- Department Obstetrics & Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
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25
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Tura AK, Trang TL, van den Akker T, van Roosmalen J, Scherjon S, Zwart J, Stekelenburg J. Applicability of the WHO maternal near miss tool in sub-Saharan Africa: a systematic review. BMC Pregnancy Childbirth 2019; 19:79. [PMID: 30808325 PMCID: PMC6390325 DOI: 10.1186/s12884-019-2225-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/19/2019] [Indexed: 01/31/2023] Open
Abstract
Background Applicability of the World Health Organization (WHO) maternal near miss criteria in low-income settings is not systematically addressed in the literature. The objective of this review was to determine the applicability of the WHO maternal near miss tool in sub-Saharan Africa. Methods We searched PubMed, Embase, Popline, CINAHL, AJOL, and Google scholar using key words for maternal near miss and sub-Saharan Africa. Studies which applied the WHO maternal near miss criteria, containing clear definitions, and published between January 1st, 2009 and December 31st, 2017 were included. Two authors independently extracted data. Quantitative analysis and narrative synthesis were conducted, and medians with interquartile range (IQR) were calculated for summarizing the findings. Methodological quality of the studies was assessed using the Estabrook’s quality assessment and validity tool. Results Fifteen studies from nine countries comprising 227,077 participants were included. Median maternal near miss ratio was 24.2 (IQR: 12.4–35.8) per 1000 live births ranging from 4.4 in a population-based study in South Africa to 198 in a rural private hospital in Nigeria. Eight studies reported challenges in implementing the WHO maternal near miss tool, especially related to the threshold for blood transfusion, and availability of several laboratory-based criteria. In three studies, local adaptations were made. Conclusion This review showed that the WHO maternal near miss tool is not uniformly applied in sub-Saharan Africa. Therefore, a common adaptation for the region is required to increase its applicability. Electronic supplementary material The online version of this article (10.1186/s12884-019-2225-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia. .,Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB, P.O.B, 30 001, Groningen, The Netherlands.
| | - To Lam Trang
- Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sicco Scherjon
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB, P.O.B, 30 001, Groningen, The Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynecology, Deventer Ziekenhuis, Deventer, The Netherlands
| | - Jelle Stekelenburg
- Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, The Netherlands.,Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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26
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Santos IDDL, Medeiros FF, Ferrari RAP, Serafim D, Maciel SM, Cardelli AAM. Maternal near-miss in labor and delivery in the light of technologies in health. Rev Esc Enferm USP 2019; 52:e03409. [PMID: 30624534 DOI: 10.1590/s1980-220x2017049603409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/17/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To know maternal near-miss situations during labor and delivery according to technologies in health. METHOD A quantitative study conducted with puerperal women in a public institution in which the maternity department is a reference for high risk care. Data collection was performed from October 2016 to August 2017, and data were processed in SPSS 20.0. Technologies in health were used for discussing the results. RESULTS Participation of 319 puerperal women. Primiparous women (p=0.027), previous diagnosis of hypertension (p=0.0001), preeclampsia (p=0.0001) and urinary tract infection (p=0.002) were items with statistical significance for the maternal near-miss outcome in labor and delivery. The hard technology associated with the outcome was transportation for hospitalization (p=0.035). Among the light-hard technologies, the following were associated: characteristics of amniotic fluid (p=0.05), vital signs check (p=0.0001), and initiation of the partograph for cesarean section (p=0.026). Among the light technologies, user satisfaction was relevant (p=0.007). CONCLUSION Health technologies can be used for structuring the assistance in order to prevent maternal near-miss.
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Affiliation(s)
| | - Fabiana Fontana Medeiros
- Universidade Estadual de Londrina, Programa de Pós-Graduação em Enfermagem, Londrina, PR, Brazil
| | | | - Deise Serafim
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Departamento de Enfermagem, Londrina, PR, Brazil
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27
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Severe maternal outcomes in eastern Ethiopia: Application of the adapted maternal near miss tool. PLoS One 2018; 13:e0207350. [PMID: 30427926 PMCID: PMC6235311 DOI: 10.1371/journal.pone.0207350] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 10/30/2018] [Indexed: 11/19/2022] Open
Abstract
Background With the reduction of maternal mortality, maternal near miss (MNM) has been used as a complementary indicator of maternal health. The objective of this study was to assess the frequency of MNM in eastern Ethiopia using an adapted sub-Saharan Africa MNM tool and compare its applicability with the original WHO MNM tool. Methods We applied the sub-Saharan Africa and WHO MNM criteria to 1054 women admitted with potentially life-threatening conditions (including 28 deaths) in Hiwot Fana Specialized University Hospital and Jugel Hospital between January 2016 and April 2017. Discharge records were examined to identify deaths or women who developed MNM according to the sub-Saharan or WHO criteria. We calculated and compared MNM and severe maternal outcome ratios. Mortality index (ratio of maternal deaths to SMO) was calculated as indicator of quality of care. Results The sub-Saharan Africa criteria identified 594 cases of MNM and all the 28 deaths while the WHO criteria identified 128 cases of MNM and 26 deaths. There were 7404 livebirths during the same period. This gives MNM ratios of 80 versus 17 per 1000 live births for the adapted and original WHO criteria. Mortality index was 4.5% and 16.9% in the adapted and WHO criteria respectively. The major difference between the two criteria can be attributed to eclampsia, sepsis and differences in the threshold for transfusion of blood. Conclusion The sub-Saharan Africa criteria identified all the MNM cases identified by the WHO criteria and all the maternal deaths. Applying the WHO criteria alone will cause under reporting of MNM cases (including maternal deaths) in this low-resource setting. The mortality index of 4.5% among women who fulfilled the adapted MNM criteria justifies labeling these women as having ‘life-threatening conditions’.
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28
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Cancedda C, Cotton P, Shema J, Rulisa S, Riviello R, Adams LV, Farmer PE, Kagwiza JN, Kyamanywa P, Mukamana D, Mumena C, Tumusiime DK, Mukashyaka L, Ndenga E, Twagirumugabe T, Mukara KB, Dusabejambo V, Walker TD, Nkusi E, Bazzett-Matabele L, Butera A, Rugwizangoga B, Kabayiza JC, Kanyandekwe S, Kalisa L, Ntirenganya F, Dixson J, Rogo T, McCall N, Corden M, Wong R, Mukeshimana M, Gatarayiha A, Ntagungira EK, Yaman A, Musabeyezu J, Sliney A, Nuthulaganti T, Kernan M, Okwi P, Rhatigan J, Barrow J, Wilson K, Levine AC, Reece R, Koster M, Moresky RT, O’Flaherty JE, Palumbo PE, Ginwalla R, Binanay CA, Thielman N, Relf M, Wright R, Hill M, Chyun D, Klar RT, McCreary LL, Hughes TL, Moen M, Meeks V, Barrows B, Durieux ME, McClain CD, Bunts A, Calland FJ, Hedt-Gauthier B, Milner D, Raviola G, Smith SE, Tuteja M, Magriples U, Rastegar A, Arnold L, Magaziner I, Binagwaho A. Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda. Int J Health Policy Manag 2018; 7:1024-1039. [PMID: 30624876 PMCID: PMC6326644 DOI: 10.15171/ijhpm.2018.61] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/19/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. METHODS The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. RESULTS In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. CONCLUSION The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.
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Affiliation(s)
- Corrado Cancedda
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phil Cotton
- Office of the Vice-Chancellor, University of Rwanda, Kigali, Rwanda
| | - Joseph Shema
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Stephen Rulisa
- Office of the Dean, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Lisa V. Adams
- Center for Health Equity, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Paul E. Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeanne N. Kagwiza
- Office of the Principal, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University - Western Campus, Ishaka, Uganda
| | - Donatilla Mukamana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Chrispinus Mumena
- Office of the Dean and Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David K. Tumusiime
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lydie Mukashyaka
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Esperance Ndenga
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Theogene Twagirumugabe
- Department of Anesthesiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Kaitesi B. Mukara
- Department of Ear, Nose, and Throat, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Vincent Dusabejambo
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Timothy D. Walker
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Department of General Medicine, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Emmy Nkusi
- Department of Neurosurgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lisa Bazzett-Matabele
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Alex Butera
- Department of Orthopedic Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Belson Rugwizangoga
- Department of Pathology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Claude Kabayiza
- Department of Pediatrics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Simon Kanyandekwe
- Department of Mental Health, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Louise Kalisa
- Department of Radiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Faustin Ntirenganya
- Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Tanya Rogo
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Pediatrics, BronxCare Health System, Bronx, NY, USA
| | - Natalie McCall
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Mark Corden
- Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rex Wong
- Global Health Leadership Institute, Yale School of Public Health, New Haven, CT, USA
| | - Madeleine Mukeshimana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Agnes Gatarayiha
- Office of the Dean and Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Preventive and Community Dentistry, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Egide Kayonga Ntagungira
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Attila Yaman
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Anne Sliney
- Clinton Health Access Initiative, Boston, MA, USA
| | | | | | - Peter Okwi
- Clinton Health Access Initiative, Kigali, Rwanda
| | - Joseph Rhatigan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jane Barrow
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Kim Wilson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rebecca Reece
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael Koster
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rachel T. Moresky
- sidHARTe Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Jennifer E. O’Flaherty
- Department of Anesthesiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Paul E. Palumbo
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Rashna Ginwalla
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Nathan Thielman
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Michael Relf
- Duke Global Health Institute, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Rodney Wright
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, New York City, NY, USA
- Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center, New York City, NY, USA
| | - Mary Hill
- Division of Nursing, Howard University College of Nursing and Allied Health Sciences, Washington, DC, USA
| | - Deborah Chyun
- University of Connecticut School of Nursing, Storrs, CT, USA
| | - Robin T. Klar
- New York University Rory Meyers College of Nursing, New York City, NY, USA
| | - Linda L. McCreary
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Tonda L. Hughes
- Columbia University School of Nursing, New York City, NY, USA
| | - Marik Moen
- Department of Family & Community Health, University of Maryland School of Nursing, Baltimore, MD, USA
- Global Education and Mentorship, Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Valli Meeks
- Department of Oncology & Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Beth Barrows
- Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA
- Partnerships, Professional Education, and Practice, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Marcel E. Durieux
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Craig D. McClain
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Amy Bunts
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Forrest J. Calland
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Danny Milner
- Center for Global Health, American Society for Clinical Pathology, Chicago, IL, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Stacy E. Smith
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Meenu Tuteja
- Global Health and Research Programs, Biomedical Research Institute, Brigham and Women’s Hospital, Boston MA, USA
| | - Urania Magriples
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Asghar Rastegar
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Linda Arnold
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Agnes Binagwaho
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
- Office of the Vice-Chancellor, University of Global Health Equity, Kigali, Rwanda
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Kasahun AW, Wako WG. Predictors of maternal near miss among women admitted in Gurage zone hospitals, South Ethiopia, 2017: a case control study. BMC Pregnancy Childbirth 2018; 18:260. [PMID: 29940889 PMCID: PMC6019215 DOI: 10.1186/s12884-018-1903-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/18/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Maternal mortality and morbidity remain unacceptably high in developing countries. Behind every maternal death, many other women suffered from acute and chronic obstetric complications. Women who survive severe acute maternal morbidities/near miss have many characteristics in common with maternal death events particularly on risk factors. Ethiopia is among countries with high maternal mortality and morbidities in sub-Saharan Africa. However there is scarce evidence on risk factors of severe acute maternal morbidities in Ethiopia. Therefore this study aimed to identify predictors of maternal near miss among women admitted in Gurage zone hospitals, south Ethiopia, 2017. METHODS Hospital based case control study was conducted to assess predictors of maternal near miss among women admitted in five hospitals of Gurage zone, South Ethiopia. Data of 229 (77 cases and 152 controls) women were included in the analysis. Cases were women admitted due to severe acute maternal morbidity while controls were women admitted for normal labor or women admitted due to mild to moderate obstetric complications. Cases were identified by validated-disease specific criteria. Then, two controls were selected for each verified case using lottery method among eligible women. Data were collected using interviewer administered questionnaire and reviewing patients' records. Data were entered using Epi Info 7 and analyzed by SPSS 21. Multivariable logistic regression analysis was done to identify independent predictors of maternal near miss. RESULT Majority of cases were admitted due to dystocia (57.1%) and obstetric hemorrhage (26%). The median first delay (delay to seek health care) among cases and controls was six and 4 h respectively. Prior history of cesarean section {AOR 7.68, 95%CI, 3.11-18.96}, first delay {AOR 2.79, 95%CI, 1.42-5.50}, and being referred from other health facilities {AOR 7.47, 95% CI, 2.27-24.51} were independent predictors of maternal near miss. CONCLUSIONS Prior history of cesarean section, being referred from other health facilities and first delay were factors associated with maternal near miss. Timely health care seeking behavior of women is uncommon in the study area. Therefore primary health care programs need to enhance the existing efforts to improve timely health care seeking behavior of women.
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Affiliation(s)
- Abebaw Wasie Kasahun
- Department of Public Health, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Wako Golicha Wako
- Department of Public Health, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
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Preventability of maternal near miss and mortality in Rwanda: A case series from the University Teaching Hospital of Kigali (CHUK). PLoS One 2018; 13:e0195711. [PMID: 29944664 PMCID: PMC6019403 DOI: 10.1371/journal.pone.0195711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/28/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Assess the primary causes and preventability of maternal near misses (MNM) and mortalities (MM) at the largest tertiary referral hospital in Rwanda, Kigali University Teaching Hospital (CHUK). Methods We reviewed records for all women admitted to CHUK with pregnancy-related complications between January 1st, 2015 and December 31st, 2015. All maternal deaths and near misses, based on WHO near miss criteria were reviewed (Appendix A). A committee of physicians actively involved in the care of pregnant women in the obstetric-gynecology department reviewed all maternal near misses/ pregnancy-related deaths to determine the preventability of these outcomes. Preventability was assessed using the Three Delays Model.[1] Descriptive statistics were used to show qualitative and quantitative outcomes of the maternal near miss and mortality. Results We identified 121 maternal near miss (MNM) and maternal deaths. The most common causes of maternal near miss and maternal death were sepsis/severe systemic infection (33.9%), postpartum hemorrhage (28.1%), and complications from eclampsia (18.2%)/severe preeclampsia (5.8%)/. In our obstetric population, MNM and deaths occurred in 87.6% and 12.4% respectively. Facility level delays (diagnostic and therapeutic) through human error or mismanagement (provider issues) were the most common preventable factors accounting for 65.3% of preventable maternal near miss and 10.7% maternal deaths, respectively. Lack of supplies, blood, medicines, ICU space, and equipment (system issues) were responsible for 5.8% of preventable maternal near misses and 2.5% of preventable maternal deaths. Delays in seeking care contributed to 22.3% of cases and delays in arrival from home to care facilities resulted in 9.1% of near misses and mortalities. Cesarean delivery was the most common procedure associated with sepsis/death in our population. Previous cesarean delivery (24%) and obstructed/prolonged labor (13.2%) contributed to maternal near miss and mortalities. Conclusion The most common preventable causes of MNM and deaths were medical errors, shortage of medical supplies, and lack of patient education/understanding of obstetric emergencies. Reduction in medical errors, improved supply/equipment availability and patient education in early recognition of pregnancy-related danger signs will reduce the majority of delays associated with MNM and mortality in our population.
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Geller SE, Koch AR, Garland CE, MacDonald EJ, Storey F, Lawton B. A global view of severe maternal morbidity: moving beyond maternal mortality. Reprod Health 2018; 15:98. [PMID: 29945657 PMCID: PMC6019990 DOI: 10.1186/s12978-018-0527-2] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality continues to be of great public health importance, however for each woman who dies as the direct or indirect result of pregnancy, many more women experience life-threatening complications. The global burden of severe maternal morbidity (SMM) is not known, but the World Bank estimates that it is increasing over time. Consistent with rates of maternal mortality, SMM rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs). SEVERE MATERNAL MORBIDITY IN HIGH-INCOME COUNTRIES Since the WHO recommended that HICs with low maternal mortality ratios begin to examine SMM to identify systems failures and intervention priorities, researchers in many HICs have turned their attention to SMM. Where surveillance has been conducted, the most common etiologies of SMM have been major obstetric hemorrhage and hypertensive disorders. Of the countries that have conducted SMM reviews, the most common preventable factors were provider-related, specifically failure to identify "high risk" status, delays in diagnosis, and delays in treatment. SEVERE MATERNAL MORBIDITY IN LOW AND MIDDLE INCOME COUNTRIES The highest burden of SMM is in Sub-Saharan Africa, where estimates of SMM are as high as 198 per 1000 live births. Hemorrhage and hypertensive disorders are the leading conditions contributing to SMM across all regions. Case reviews are rare, but have revealed patterns of substandard maternal health care and suboptimal use of evidence-based strategies to prevent and treat morbidity. EFFECTS OF SMM ON DELIVERY OUTCOMES AND INFANTS Severe maternal morbidity not only puts the woman's life at risk, her fetus/neonate may suffer consequences of morbidity and mortality as well. Adverse delivery outcomes occur at a higher frequency among women with SMM. Reducing preventable severe maternal morbidity not only reduces the potential for maternal mortality but also improves the health and well-being of the newborn. CONCLUSION Increasing global maternal morbidity is a failure to achieve broad public health goals of improved women's and infants' health. It is incumbent upon all countries to implement surveillance initiatives to understand the burden of severe morbidity and to implement review processes for assessing potential preventability.
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Affiliation(s)
- Stacie E. Geller
- Departments of Obstetrics & Gynecology and Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL USA
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | - Abigail R. Koch
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | - Caitlin E. Garland
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | - E. Jane MacDonald
- Centre for Women’s Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Francesca Storey
- Centre for Women’s Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Beverley Lawton
- Centre for Women’s Health Research, Victoria University of Wellington, Wellington, New Zealand
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Shaw D, Christilaw J, Munjanja SP. Safe Surgery Globally by 2030: The Essential Role of Anesthesia, The View From Obstetrics. Anesth Analg 2018; 126:1109-1111. [PMID: 29547415 DOI: 10.1213/ane.0000000000002561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Dorothy Shaw
- From the Departments of Obstetrics and Gynaecology.,Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
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Tura AK, Stekelenburg J, Scherjon SA, Zwart J, van den Akker T, van Roosmalen J, Gordijn SJ. Adaptation of the WHO maternal near miss tool for use in sub-Saharan Africa: an International Delphi study. BMC Pregnancy Childbirth 2017; 17:445. [PMID: 29284433 PMCID: PMC5747119 DOI: 10.1186/s12884-017-1640-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/19/2017] [Indexed: 11/21/2022] Open
Abstract
Background Assessments of maternal near miss (MNM) are increasingly used in addition to those of maternal mortality measures. The World Health Organization (WHO) has introduced an MNM tool in 2009, but this tool was previously found to be of limited applicability in several low–resource settings. The aim of this study was to identify adaptations to enhance applicability of the WHO MNM tool in sub–Saharan Africa. Methods Using a Delphi consensus methodology, existing MNM tools were rated for applicability in sub-Saharan Africa over a series of three rounds. Maternal health experts from sub-Saharan Africa or with considerable knowledge of the context first rated importance of WHO MNM parameters using Likert scales, and were asked to suggest additional parameters. This was followed by two confirmation rounds. Parameters accepted by at least 70% of the panel members were accepted for use in the region. Results Of 58 experts who participated from study onset, 47 (81%) completed all three rounds. Out of the 25 WHO MNM parameters, all 11 clinical, four out of eight laboratory, and four out of six management–based parameters were accepted, while six parameters (PaO2/FiO2 < 200 mmHg, bilirubin >100 μmol/l or >6.0 mg/dl, pH <7.1, lactate >5 μmol/l, dialysis for acute renal failure and use of continuous vasoactive drugs) were deemed to not be applicable. An additional eight parameters (uterine rupture, sepsis/severe systemic infection, eclampsia, laparotomy other than caesarean section, pulmonary edema, severe malaria, severe complications of abortions and severe pre-eclampsia with ICU admission) were suggested for inclusion into an adapted sub-Saharan African MNM tool. Conclusions All WHO clinical criteria were accepted for use in the region. Only few of the laboratory- and management based were rated applicable. This study brought forward important suggestions for adaptations in the WHO MNM criteria to enhance its applicability in sub-Saharan Africa and possibly other low–resource settings.
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Affiliation(s)
- Abera K Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. .,Department of Obstetrics and Gynaecology (CB20), University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9700 RB, Groningen, Netherlands.
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.,Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - Sicco A Scherjon
- Department of Obstetrics and Gynaecology (CB20), University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9700 RB, Groningen, Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynaecology, Deventer Ziekenhuis, Deventer, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.,Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics and Gynaecology (CB20), University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9700 RB, Groningen, Netherlands
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Sayinzoga F, Bijlmakers L, van der Velden K, van Dillen J. Severe maternal outcomes and quality of care at district hospitals in Rwanda- a multicentre prospective case-control study. BMC Pregnancy Childbirth 2017; 17:394. [PMID: 29178885 PMCID: PMC5702108 DOI: 10.1186/s12884-017-1581-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 11/16/2017] [Indexed: 11/18/2022] Open
Abstract
Background Despite a significant decrease in maternal mortality in the last decade, Rwanda needs further progress in order to achieve Sustainable Development Goals (SDG)3 which addresses among others maternal mortality. Analysis of severe maternal outcomes (SMO) was performed to identify their characteristics, causes and contributory factors, using standard indicators for quality of care. Methods A prospective case-control study was conducted for which data were collected between November 2015 and April 2016 in four rural district hospitals. The occurrence of SMO with near miss incidence ratios was established, followed by an analysis of the characteristics, clinical outcomes, causes and contributory factors. Results The SMO incidence ratio was 38.4 per 1000 live births (95% CI 33.4–43.4) and the maternal near-miss incidence ratio was 36 per 1000 live births (95% CI 31.1–40.9). The leading causes of SMO were postpartum haemorrhage (23.4%), uterine rupture (22.9%), abortion related complications (16.8%), malaria (13.6%) and hypertensive disorders (8.9%). The case fatality rate was high for women with hypertensive disorders (10.5%; CI 3.3–24.3) and severe postpartum haemorrhage (8%; CI 0.5–15.5). Stillbirth (OR = 181.7; CI 43.5–757.9) and length of stay at the hospital (OR = 7.9; CI 4.5–13.8) were strongly associated with severe outcomes. Conclusions Despite the use of life saving interventions, SMO are frequent. Mortality index was found to be low at the level of district hospitals. SMO were associated with long stay at the hospital and stillbirth. There is a need for improvement of quality of care, referral practices and certain types of infrastructure, especially blood banks, which would ensure truly comprehensive emergency obstetric care and reduce the occurrence of SMO. Electronic supplementary material The online version of this article (10.1186/s12884-017-1581-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felix Sayinzoga
- Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, PO Box 84, Kigali, Rwanda.
| | - Leon Bijlmakers
- Department of Health Evidence, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Koos van der Velden
- Department of Primary and Community Care, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care. PLoS One 2017; 12:e0181470. [PMID: 28832665 PMCID: PMC5568340 DOI: 10.1371/journal.pone.0181470] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/30/2017] [Indexed: 11/19/2022] Open
Abstract
Objective to analyse the impact of in-hospital care on severe maternal morbidity using WHO’s near-miss approach in the low-resource, high mortality setting of Zanzibar’s referral hospital. Setting Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. Methods We identified all cases of morbidity and mortality in women admitted within 42 days after the end of pregnancy at Mnazi Mmoja Hospital in the period from April to October 2016. The severity of complications was classified using WHO’s near-miss approach definitions: potentially life-threatening condition (PLTC), maternal near-miss (MNM) or maternal death (MD). Quality of in-hospital care was assessed using the mortality index (MI) defined as ratio between mortality and severe maternal outcome (SMO) where SMO = MD + MNM, cause-specific case facility rates and comparison with predicted mortality based on the Maternal Severity Index model. Main outcomes 5551 women were included. 569 (10.3%) had a potentially life-threatening condition and 65 (1.2%) a severe maternal outcome (SMO): 37 maternal near-miss cases and 28 maternal deaths. The mortality index was high at 0.43 and similar for women who developed a SMO within 12 hours of admission and women who developed a SMO after 12 hours. A standardized mortality ratio of 6.03 was found; six times higher than that expected in moderate maternal mortality settings given the same severity of cases. Obstetric haemorrhage was found to be the main cause of SMO. Ruptured uterus and admission to ICU had the highest case-fatality rates. Maternal death cases seemed to have received essential interventions less often. Conclusions WHO’s near-miss approach can be used in this setting. The high mortality index observed shows that in-hospital care is not preventing progression of disease adequately once a severe complication occurs. Almost one in two women experiencing life-threatening complications will die. This is six times higher than in moderate mortality settings.
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Semasaka Sengoma JP, Krantz G, Nzayirambaho M, Munyanshongore C, Edvardsson K, Mogren I. Prevalence of pregnancy-related complications and course of labour of surviving women who gave birth in selected health facilities in Rwanda: a health facility-based, cross-sectional study. BMJ Open 2017; 7:e015015. [PMID: 28694344 PMCID: PMC5734260 DOI: 10.1136/bmjopen-2016-015015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study estimated health facility-based prevalence for pre-eclampsia/eclampsia, postpartum haemorrhage and caesarean section (CS) due to prolonged labour/dystocia. The background characteristics of Rwandan pregnant women, the course of labour and the level of healthcare were investigated in relation to pregnancy and delivery outcomes. METHODS This is health facility-based study and data were collected in 2014-2015 through structured interviews and medical records (n=817) in Kigali and Northern Province, Rwanda. Frequencies and prevalence were used to describe participants' background factors, labour and delivery-related characteristics. Bivariable and multivariable logistic regression models were performed for different background factors and pregnancy/delivery outcomes. RESULTS Pre-eclampsia/eclampsia, postpartum haemorrhage and CS due to prolonged labour/dystocia represented 1%, 2.7% and 5.4% of all participants, respectively. In total, 56.4% of the participants were transferred from facilities with low levels to those with higher levels of healthcare, and the majority were transferred from health centres to district hospitals, with CS as the main reason for transfer. Participants who arrived at the health facility with cervical dilation grade of ≤3 cm spent more hours in maternity ward than those who arrived with cervical dilatation grade of ≥4 cm. Risk factors for CS due to prolonged labour or dystocia were poor households, nulliparity and residence far from health facility. CONCLUSIONS The estimated health facility-based prevalence of pregnancy-related complications was relatively low in this sample from Rwanda. CS was the main reason for the transfer of pregnant women from health centres to district hospitals. Upgrading the capacity of health centres in the management of pregnant women in Rwanda may improve maternal and fetal health.
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Affiliation(s)
- Jean Paul Semasaka Sengoma
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
- University of Rwanda College of Medicine and Health Sciences School of Public Health, Kigali, Rwanda
| | - Gunilla Krantz
- Department of Public Health and Community Medicine and Public Health, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Manasse Nzayirambaho
- University of Rwanda College of Medicine and Health Sciences School of Public Health, Kigali, Rwanda
| | - Cyprien Munyanshongore
- University of Rwanda College of Medicine and Health Sciences School of Public Health, Kigali, Rwanda
| | - Kristina Edvardsson
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
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Liyew EF, Yalew AW, Afework MF, Essén B. Incidence and causes of maternal near-miss in selected hospitals of Addis Ababa, Ethiopia. PLoS One 2017; 12:e0179013. [PMID: 28586355 PMCID: PMC5460898 DOI: 10.1371/journal.pone.0179013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 05/23/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Because maternal mortality is a rare event, it is important to study maternal near-miss as a complement to evaluate and improve the quality of obstetric care. Thus, the study was conducted with the aim of assessing the incidence and causes of maternal near-miss. METHODS A facility-based cross-sectional study was conducted in five selected public hospitals of Addis Ababa, Ethiopia from May 1, 2015 to April 30, 2016. All maternal near-miss cases admitted to the selected hospitals during the study period were prospectively recruited. World Health Organization criteria were used to identify maternal near-miss cases. The number of maternal near-miss cases over one year per 1000 live births occurring during the same year was calculated to determine the incidence of maternal near-miss. Underlying and contributing causes of maternal near-miss were documented from each participant's record. RESULTS During the one-year period, there were a total of 238 maternal near-miss cases and 29,697 live births in all participating hospitals, which provides a maternal near-miss incidence ratio of 8.01 per 1000 live births. The underlying causes of the majority of maternal near-miss cases were hypertensive disorders and obstetric hemorrhage. Anemia was the major contributing cause reported for maternal near-miss. Most of the maternal near-miss cases occurred before the women's arrival at the participating hospitals. CONCLUSION The study demonstrated a lower maternal near-miss incidence ratio compared to previous country-level studies. The majority of the near-miss cases occurred before the women's arrival at the participating hospitals, which underscores the importance of improving pre-hospital barriers. Efforts made toward improvement in the management of life-threatening obstetric complications could reduce the occurrence of maternal near-miss problems that occur during hospitalization.
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Affiliation(s)
- Ewnetu Firdawek Liyew
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Alemayehu Worku Yalew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mesganaw Fantahun Afework
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birgitta Essén
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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Bolnga JW, Morris M, Totona C, Laman M. Maternal near-misses at a provincial hospital in Papua New Guinea: A prospective observational study. Aust N Z J Obstet Gynaecol 2017; 57:624-629. [PMID: 28580650 DOI: 10.1111/ajo.12650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/05/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Maternal near-miss indices are World Health Organisation (WHO) recognised indicators that may improve our understanding of factors associated with maternal morbidity and mortality. In Papua New Guinea (PNG) where maternal mortality is among the highest in the world, only one study has documented near-miss indices in a tertiary-level hospital, but none from provincial hospitals where the majority of under-privileged women access healthcare services. AIMS To determine the near-miss ratio, maternal mortality index (MMI), and associated maternal indices for Modilon Hospital in Madang Province of PNG. METHODS All women attending Modilon Hospital who met the WHO maternal near-miss definition and/or a WHO-modified (PNG-specific) near-miss definition, were prospectively enrolled. RESULTS There were 6019 live births during the audit period; 163 women presented with life-threatening conditions (153 near-misses and 10 maternal deaths). The maternal near-miss ratio was 25.4/1000 live births and the maternal mortality ratio (MMR) was 166/100 000 live births, with a maternal death to near-miss ratio of 1:15.3. The severe maternal outcome ratio was 27.1/1000 live births and the total mortality index was 6.8%. Higher proportions of near-miss women were aged ≥30 years, nulliparous, illiterate, from rural communities, lacked formal employment, referred from peripheral health facilities, unbooked, had history of still births and were anaemic. CONCLUSION Sociodemographic factors such as women's rights, education level and status in society, in addition to appropriate health reforms with greater financial and political support are urgently needed to ensure underprivileged women in rural PNG have access to family planning, supervised deliveries and skilled emergency obstetric care.
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Affiliation(s)
| | | | | | - Moses Laman
- Department of Paediatrics, Modilon Hospital, Madang, Papua New Guinea.,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
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Ntuli ST, Mogale M, Hyera FLM, Naidoo S. An investigation of maternal mortality at a tertiary hospital of the Limpopo province of South Africa. S Afr J Infect Dis 2017. [DOI: 10.1080/23120053.2017.1293902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Sam Thembelihle Ntuli
- Research Development Administration, University of Limpopo, Sovenga, South Africa
- Department of Public Health Medicine, University of Limpopo, Polokwane, South Africa
| | - Mabina Mogale
- Department of Public Health: Epidemiology and Biostatistics, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Francis LM Hyera
- Department of Public Health Medicine, University of Limpopo, Polokwane, South Africa
| | - Shan Naidoo
- Department of Community Health, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Mgawadere F, Kana T, van den Broek N. Measuring maternal mortality: a systematic review of methods used to obtain estimates of the maternal mortality ratio (MMR) in low- and middle-income countries. Br Med Bull 2017; 121:121-134. [PMID: 28104630 PMCID: PMC5873731 DOI: 10.1093/bmb/ldw056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 11/22/2016] [Accepted: 01/05/2017] [Indexed: 12/04/2022]
Abstract
Background The new global target for maternal mortality ratio (MMR) is a ratio below 70 maternal deaths per 100 000 live births by 2030. We undertook a systematic review of methods used to measure MMR in low- and middle-income countries. Sources of data Systematic review of the literature; 59 studies included. Areas of agreement Civil registration (5 studies), census (5) and surveys (16), Reproductive Age Mortality Studies (RAMOS) (4) and the sisterhood methods (11) have been used to measure MMR in a variety of settings. Areas of controversy Middle-income countries have used civil registration data for estimating MMR but it has been a challenge to obtain reliable data from low-income countries with many only using health facility data (18 studies). Growing points and areas for further research Based on the strengths and feasibility of application, RAMOS may provide reliable and contemporaneous estimates of MMR while civil registration systems are being introduced. It will be important to build capacity for this and ensure implementation research to understand what works where and how.
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Affiliation(s)
- Florence Mgawadere
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Terry Kana
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Kalisa R, Rulisa S, van den Akker T, van Roosmalen J. Maternal Near Miss and quality of care in a rural Rwandan hospital. BMC Pregnancy Childbirth 2016; 16:324. [PMID: 27769193 PMCID: PMC5075154 DOI: 10.1186/s12884-016-1119-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 10/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The WHO Maternal Near Miss (MNM) approach was developed to evaluate and improve quality of obstetric care worldwide. This study aimed to study the incidence of MNM and quality of care at a district hospital in rural Rwanda by applying this approach. METHODS A facility based, prospective cohort study conducted at a district hospital in rural Rwanda between June 2013 and December 2014. Subjects were followed from time of admission to discharge or death. RESULTS In 3979 deliveries, 3827 singletons and 152 twins pairs were born. Among the 4131 neonates, there were 3994 live births and 137 stillbirths. Ninety-nine women suffered severe maternal outcome (SMO): 86 maternal near misses and 13 deaths. This adds up to a maternal near miss ratio of 21.5 per 1000 live births (95 % CI 17.3-26.5), a maternal mortality ratio of 325 per 100 000 live births (95 % CI 181-543) and a mortality index of 13.1 % (95 % CI 7.3-21.9). Hemorrhage (n = 49, 57 %) and hypertensive disorders (n = 27, 31.4 %) were the commonest MNM conditions. Eclampsia (n = 4/13; 30.7 %) was the leading cause of maternal mortality, while sepsis/peritonitis following cesarean section (n = 2/6; 33.3 %) had the highest mortality index. Seventy-seven out of 99 SMO cases (77.9 %) were referred from other facilities with critical conditions and 28 out of 99 SMO cases (28.3 %) were admitted into the Intensive Care Unit. Several indicators such as administration of oxytocin, magnesium sulfate and antibiotics were found to be suboptimal. CONCLUSIONS MNM is common at district level in Rwanda. The MNM approach enabled us to identify shortfalls in clinical practice and the referral system.
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Affiliation(s)
- Richard Kalisa
- Department of Obstetrics and Gynecology, Ruhengeri Hospital, Musanze, Rwanda. .,Athena Institute, VU University, Amsterdam, The Netherlands.
| | - Stephen Rulisa
- Department of Obstetrics and Gynecology, University of Rwanda, Kigali, Rwanda
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, The Netherlands.,Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
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Ntirushwa D, Rulisa S, Muhorakeye F, Bazzett-Matabele L, Rurangwa T, Small M. Gastric Rupture in Pregnancy: Case Series from a Tertiary Institution in Rwanda and Review of the Literature. AJP Rep 2016; 6:e436-e441. [PMID: 28078172 PMCID: PMC5222991 DOI: 10.1055/s-0036-1597619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Gastric rupture is a rare, life-threatening condition during pregnancy. Case study We present three cases of gastric perforation during pregnancy and the puerperium. The first patient presented with gastric perforation 4 days following an uncomplicated cesarean delivery for obstetric indications. She initially complained of epigastric pain; however, those symptoms resolved. She later demonstrated worsening abdominal distension, intra-abdominal free fluid, and signs of peritonitis. At laparotomy, an ascariasis-associated gastric rupture was diagnosed. She died from sepsis 4 days following the laparotomy. The second patient presented 19 days following a normal vaginal delivery. She presented with hemodynamic instability and underwent emergent laparotomy due to suspected septic shock peritonitis. Gastric rupture was diagnosed intraoperatively. She improved clinically and was discharged home. The third patient underwent emergency cesarean delivery due to non-reassuring fetal status in the setting of preeclampsia. She was initially diagnosed with ascites and pulmonary edema as a result of preeclampsia. Later in her course, she developed features in favor of acute abdomen and signs of sepsis. At the time of emergent laparotomy, a gastric rupture was identified and repaired. She died 2 days later from sepsis. Conclusion We report the management and outcome of three cases of pregnancy-related gastric rupture. To our knowledge, these three cases represent the largest series of pregnancy-related gastric ruptures from a single institution.
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Affiliation(s)
- David Ntirushwa
- Department of Obstetrics and Gynecology, University of Rwanda, Rwanda; Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Stephen Rulisa
- Department of Obstetrics and Gynecology, University of Rwanda, Rwanda
| | | | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, University of Rwanda, Rwanda; Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Obstetrics and Gynecology, Yale University, New Heaven, Connecticut
| | | | - Maria Small
- Department of Obstetrics and Gynecology, University of Rwanda, Rwanda; Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; Department of Obstetrics and Gynecology, Yale University, New Heaven, Connecticut
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Påfs J, Musafili A, Binder-Finnema P, Klingberg-Allvin M, Rulisa S, Essén B. Beyond the numbers of maternal near-miss in Rwanda - a qualitative study on women's perspectives on access and experiences of care in early and late stage of pregnancy. BMC Pregnancy Childbirth 2016; 16:257. [PMID: 27590589 PMCID: PMC5010768 DOI: 10.1186/s12884-016-1051-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/20/2016] [Indexed: 11/19/2022] Open
Abstract
Background Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. We explored care-seeking and experiences of maternity care among women who suffered a near-miss event during either the early or late stage of pregnancy, and identified potential health system limitations or barriers to maternal survival in this setting. Methods A framework of Naturalistic Inquiry guided the study design and analysis, and the ‘three delays’ model facilitated data sorting. Participants included 47 women, who were interviewed at three hospitals in Kigali, and 14 of these were revisited in their homes, from March 2013 to April 2014. Results The women confronted various care-seeking barriers depending on whether the pregnancy was wanted, the gestational age, insurance coverage, and marital status. Poor communication between the women and healthcare providers seemed to result in inadequate or inappropriate treatment, leading some to seek either traditional medicine or care repeatedly at biomedical facilities. Conclusion Improved service provision routines, information, and amendments to the insurance system are suggested to enhance prompt care-seeking. Additionally, we strongly recommend a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy.
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Affiliation(s)
- Jessica Påfs
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Akademiska Sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden.
| | - Aimable Musafili
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Akademiska Sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden.,Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, University of Rwanda, P.O. Box 217, Butare, Huye, Rwanda
| | - Pauline Binder-Finnema
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Akademiska Sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Marie Klingberg-Allvin
- School of Education, Health and Social Studies, Dalarna University, SE-791 88, Falun, Sweden
| | - Stephen Rulisa
- Department of Obstetrics & Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Rwanda, P.O.Box 3286, Kigali, Rwanda.,Department of Clinical Research, University Teaching Hospital of Kigali, BP 655, Kigali, Rwanda
| | - Birgitta Essén
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Akademiska Sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden
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Rwabizi D, Rulisa S, Findlater A, Small M. Maternal near miss and mortality due to postpartum infection: a cross-sectional analysis from Rwanda. BMC Pregnancy Childbirth 2016; 16:177. [PMID: 27439909 PMCID: PMC4955257 DOI: 10.1186/s12884-016-0951-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 07/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study is to evaluate 'near miss' and mortality in women with postpartum infections. METHODS We performed a retrospective review of all patients referred to the University Teaching Hospital of Kigali (CHUK) between January 2012 and December 2013. We identified 117 patients with postpartum infections. Demographic data, length of admission, location of referral, initial surgery and subsequent treatment modalities including antibiotic administration and secondary surgery were recorded. The primary outcome of interest was a composite of maternal mortality and "near miss" defined as more than one laparotomy with/without hysterectomy and prolonged hospitalization. RESULTS Diagnoses at CHUK were: pelvic peritonitis (56 %), deep surgical site infection including fasciitis (17 %), and endometritis (15 %). The primary procedures performed prior to transfer were: cesarean section (81 %), septic abortion management (12 %), and vaginal delivery (7 %). Antibiotics were initiated prior to transfer in 66 % of women. Surgery was required in 73 % of patients. Hysterectomies were performed in 22 % of patients. Maternal death occurred in 5 % of the patient population. The primary outcome of severe maternal morbidity and mortality occurred in 90 patients (77 %). CONCLUSION Peritonitis-primarily as a result of cesarean deliveries-is associated with significant morbidity and mortality in our population.
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Affiliation(s)
- Denis Rwabizi
- Department of Obstetrics and Gynecology, University of Rwanda, BP 655, Kigali, Rwanda.,Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Stephen Rulisa
- Department of Obstetrics and Gynecology, University of Rwanda, BP 655, Kigali, Rwanda. .,Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali, Kigali, Rwanda.
| | | | - Maria Small
- Department of Obstetrics and Gynecology, University of Rwanda, BP 655, Kigali, Rwanda.,Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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