Determinants of maternal near-miss among women admitted to public hospitals in North Shewa Zone, Ethiopia: A case-control study

Abstract

BackgroundA maternal near-miss (MNM) refers to a woman who presents with life-threatening complications during pregnancy, childbirth, or within 42 days of termination of pregnancy but survived by chance or due to the standard care she received. It is recognized as a valuable indicator to examine the quality of obstetrics care as it follows similar predictors with maternal death. Ethiopia is one of the sub-Saharan African countries with the highest rate of maternal mortality and morbidity. Thus, studying the cause and predictors of maternal near-miss is vital to improving the quality of obstetric care, particularly in low-income countries.ObjectiveTo identify determinants of maternal near-miss among women admitted to public hospitals in North Shewa Zone, Ethiopia, 2020.MethodsA facility-based unmatched case-control study was conducted on 264 women (88 cases and 176 controls) from February to April 2020. Data were collected using pretested interviewer-administered questionnaires and a review of medical records. Data were entered into Epi-data version 4.2.2 and exported to SPSS version 25 for analysis. Variables with a p-value <0.25 in the bivariable analysis were further analyzed using multivariable logistic regression analysis. Finally, variables with a p-value <0.05 were considered statistically significant.ResultSevere pre-eclampsia (49.5%) and postpartum hemorrhage (28.3%) were the main reasons for admission of cases. Educational level of women (AOR = 4.80, 95% CI: 1.78–12.90), education level of husbands (AOR = 5.26; 95% CI: 1.46–18.90), being referred from other health facilities (AOR = 4.73, 95% CI: 1.78–12.55), antenatal care visit (AOR = 2.75, 95% CI: 1.13–6.72), cesarean section (AOR = 3.70, 95% CI: 1.42-9.60), and medical disorder during pregnancy (AOR = 12.06, 95% CI: 2.82–51.55) were found to significantly increase the risk of maternal near-miss. Whereas, the younger age of women significantly decreased the risk of maternal near miss (AOR = 0.26, 95% CI: 0.09–0.75).ConclusionAge, educational level, antenatal care follow-ups, medical disorder during pregnancy, mode of admission, and mode of delivery were significant predictors of maternal near-miss. Socio-demographic development, use of ANC services, early detection and management of medical diseases, reducing cesarean section, and improving the referral systems are crucial to minimizing the maternal near-miss.

Incidence, Causes, and Determinants of Maternal Near-Miss among Women Attending Public Hospitals in Borena Zone of Oromia Region, Ethiopia

“…The current study showed that the leading causes of MNM were pregnancy induced hypertension and severe postpartum hemorrhage, which are comparable to the ndings of studies conducted elsewhere in Ethiopia (14,15,(21)(22)(23)(24) and other African countries (17,18). Pregnancy related infection (sepsis) was associated with the highest case fatality which is similar with the ndings of earlier studies done in other parts of the country (23,25) and other developing countries (17,18).…”

“…According to a recent systematic review and meta-analysis study, the global prevalence of maternal near miss was 1.4% (11). Among the studies that have been conducted in Africa, the weighted pooled prevalence of MNM was 31.9 per 1000 live births, with signi cant heterogeneity between studies (6).…”

Prevalence and determinants of adverse perinatal outcomes of preeclampsia with severe features at two selected public hospitals in Addis Ababa, Ethiopia

“…It found that there were nine maternal deaths, a 4.4% case fatality rate, and 151 perinatal mortality rates per 1,000 live births ( 34 ). Additionally, it was found that referral systems greatly increase the risk of maternal death in Ethiopia ( 35 , 36 ). Most of the referred cases might have potentially complicated cases involving the central nervous system, coma or loss of consciousness lasting 12 h or more; metabolic coma (consciousness loss and urine containing ketoacids and glucose); stroke, status epilepticus, involuntary convulsions, or complete paralysis.…”

Maternal near miss hospitalizations in the Borana Zone, Ethiopia: A facility-based longitudinal cross-sectional study

“…6,7 According to a recent systematic review and meta-analysis study, the global prevalence of MNM was 1.4%. 8 Among the studies that have been conducted in Africa, the weighted pooled prevalence of MNM was 31.9 with significant heterogeneity between studies. 6 Near miss events are common and are estimated to be around 12 times more frequent than maternal deaths.…”

“…6 Near miss events are common and are estimated to be around 12 times more frequent than maternal deaths. [8][9][10][11] Studies have shown that predictors of maternal near misses are postpartum hemorrhage, pregnancy induced hypertension, sepsis, ruptured uterus, and abortion. 1,4,12 Improving maternal health remains an important topic of sustainable development goals (SDG), which is to reduce the global Maternal Mortality Ratio (MMR) to less than70 per 100,000 live births by 2030 and Ethiopia also intends to achieve this target by 2030.…”