Incidence and causes of severe maternal outcomes in Somaliland using the sub‐Saharan Africa maternal near‐miss criteria: A prospective cross‐sectional study in a national referral hospital

Abstract

Objective: To describe the incidence and causes of severe maternal outcomes and the unmet need for life-saving obstetric interventions among women admitted for delivery in a referral hospital in Somaliland. Methods:A prospective cross-sectional study was conducted from April 15, 2019 to March 31, 2020, with women admitted during pregnancy or childbirth or within 42 days after delivery. Data were collected using the World Health Organization (WHO) and sub-Saharan Africa (SSA) maternal near-miss (MNM) tools. Descriptive analysis was performed by computing frequencies, proportions, and ratios. Results:The MNM ratios were 56 (SSA criteria) and 13 (WHO criteria) per 1000 live births. The mortality index was highest among women with medical complications (63%), followed by obstetric hemorrhage (13%), pregnancy-related infection (10%), and hypertensive disorders (7.9%) according to the SSA MNM criteria.Most women giving birth received prophylactic oxytocin for postpartum hemorrhage prevention (97%), and most laparotomies (60%) for ruptured uterus were conducted after 3 h. Conclusion:There is a need to improve the quality of maternal health services through implementation of evidence-based obstetric interventions and continuous in-service training for healthcare providers. Using the SSA MNM criteria could facilitate such preventive measures in this setting as well as similar low-resource contexts.

Association between delayed cesarean section and severe maternal and adverse newborn outcomes in the Somaliland context: a cohort study in a national referral hospital

“…From the original maternal near-miss study including 6,658 women [ 14 ], 1255 women underwent a CS and were included in the analyses ( Figure 1 ). Among the total number of women included, 429 (34.2%) did not experience CS delay, 237 (18.9%) experienced CS delay ranging from one hour to less than three hours, and 594 (43.3%) experienced CS delay of three hours and over.…”

“…For the current study, we used a prospective cohort study design nested in a larger maternal near-miss (MNM) study ( n = 6658) reported elsewhere [ 14 ]. The study was reported in accordance with the Strengthening of Reporting of Observational Studies in Epidemiology (STROBE) guidelines of cohort studies [ 15 ].…”

“…Using the modified World Health Organisation Maternal Near Miss (WHO MNM) tool, we collected prospective data on all women admitted to the obstetric department for childbirth from 15 April 2019 to 30 March 2020 [ 14 ]. The data abstraction form was adapted from the WHO MNM tool to also include criteria in accordance with the more recently developed sub-Saharan Africa (SSA) near-miss criteria, which includes additional inclusion criteria for low-resource settings with the purpose of averting underreporting of severe maternal morbidity due to limited resources [ 4 , 18 ].…”

Qualitative study of the roles of midwives in the provision of sexual and reproductive healthcare services in the Somaliland health system

“…10 The leading causes of maternal deaths are postpartum haemorrhage, pre-eclampsia/eclampsia, prolonged and obstructed labour and infections combined with limited access to SRH services. [10][11][12] The recent Somaliland Health and Demographic Report (2020) showed that 67% of children are delivered at home, further contributing to high maternal and neonatal mortality and morbidity. Moreover, cultural practices such as female genital mutilation/cutting (FGM/C) are prevalent.…”

“…Somaliland has a high annual maternal mortality rate, at an estimated 396 deaths per 100 000 live births 10. The leading causes of maternal deaths are postpartum haemorrhage, pre-eclampsia/eclampsia, prolonged and obstructed labour and infections combined with limited access to SRH services 10–12. The recent Somaliland Health and Demographic Report (2020) showed that 67% of children are delivered at home, further contributing to high maternal and neonatal mortality and morbidity.…”