Predictors of Maternal Near Miss in Public Hospitals of West Shoa Zone, Central Ethiopia: A Case-Control Study

Danusa, Kababa Temesgen; Debelo, Bikila Tefera; Wakgari, Negash; Seifu, Benyam; Kenasa, Ketema; Daba, Gurmesa; Wondimu, Fikadu; Berhanu, Keneni

doi:10.3389/fmed.2022.868992

Cited by 6 publications

(6 citation statements)

References 28 publications

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“…From the pooled estimate, there is no association between rural residence and maternal near misses [AOR 0.98, 95% CI, 0.66, 1.30]. Ten studies were included to evaluate the association between ANC and MNM [15,31,36,43,44,[47][48][49][50][51]. From pooled estimates, mothers who have no ANC were 2.18 times more likely to develop MNM when compared to those who have ANC [AOR = 2.18, 95% CI: 1.33, 3.03] (Fig.…”

Section: Factors Associated With Maternal Near Missesmentioning

confidence: 99%

Prevalence and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis, 2015–2023

Negash,

Sertsu,

Mengistu

et al. 2023

BMC Women's Health

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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 Methods A systematic review and meta-analysis cover both published and unpublished studies from different databases (PubMed, CINHAL, Scopus, Science Direct, and the Cochrane Library) to search for published studies whilst searches for unpublished studies were conducted using Google Scholar and Google searches.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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Section: Factors Associated With Maternal Near Missesmentioning

confidence: 99%

Prevalence and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis, 2015–2023

Negash,

Sertsu,

Mengistu

et al. 2023

BMC Women's Health

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“…[46][47][48] A study showed that walking for more than 1 hour to a health facility was associated with about 4 times higher odds of MNMs. [47] Another study revealed that delays caused by the lack of vehicles increased the odds of MNMs by 8 times. [49] Furthermore, Hadush observed that delays in reaching a health facility contributed to about 40% of the maternal morbidities in their study.…”

Section: Defined By Each Clinical Criterionmentioning

confidence: 99%

“…[45] In many rural areas within sub-Saharan Africa, the paucity of public transportation, high transport costs, and/or poor road infrastructure exacerbate the delays in reaching these facilities during an obstetric complication. [30,37,[46][47] The unavailability of suitable transportation consequently forces some women to walk the distance during an obstetric complication. [46][47][48] A study showed that walking for more than 1 hour to a health facility was associated with about 4 times higher odds of MNMs.…”

Section: Defined By Each Clinical Criterionmentioning

confidence: 99%

“…[30,37,[46][47] The unavailability of suitable transportation consequently forces some women to walk the distance during an obstetric complication. [46][47][48] A study showed that walking for more than 1 hour to a health facility was associated with about 4 times higher odds of MNMs. [47] Another study revealed that delays caused by the lack of vehicles increased the odds of MNMs by 8 times.…”

Section: Defined By Each Clinical Criterionmentioning

confidence: 99%

“…As expected, older age at delivery increased the odds of identifying MNMs in the Comorbidities criterion. [47,[51][52][53][54] It is well-established that the risk of maternal morbidities is higher at two periods in a woman's reproductive life cycle. [26,53] The first is during adolescence (10 years -19 years) and the second is at the end of a woman's reproductive period (35 years and above.…”

Section: Defined By Each Clinical Criterionmentioning

confidence: 99%

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Evaluating the Effectiveness of the Mozambique-Canada Maternal Health (MCMH) Project Abstraction Tool in the Identification of Maternal Near-Miss (MNM) Events

Muosieyiri,

Andre,

Forsyth

et al. 2024

Preprint

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Maternal Near-Miss (MNM) is described as a woman who survives a severe obstetric event. The World Health Organization (WHO) developed an abstraction tool in 2009 for identifying MNMs, but it has come under criticism for not being suitable for use in low-resource settings. The maternal near-miss tool developed by the Mozambique-Canada Maternal Health Project, including additional clinical criteria, is an adaptation of the WHO version to suit the resource availability in Mozambique. This study examined whether these additional criteria enhanced maternal near-miss identification; if so, whether this was observed in particular groups of women. A cross-sectional study was conducted in two hospitals, the Provincial Hospital of Inhambane province, a tertiary referral care center, and a rural hospital, Vilankulo Rural Hospital, with a large rural catchment area (approximately 46,543 inhabitants), in the Inhambane province in Mozambique. Consecutive admissions in the maternity wards in these two hospitals between August 2021 and February 2022 were eligible and data from 2057 women were included. Chi-square test of independence, kappa statistics, and multiple logistic regression analyses were performed to address the study aims. The newer tool with additional clinical criteria identified more maternal near-misses (Expanded Disease criterion = 28.2%; Comorbidities criterion = 21.1%) than the original WHO tool (16.20%). Hypertension and Anemia, two criteria in the newer tool, showed strong associations with the original WHO disease criterion (p < 0.001). Hypertension demonstrated a moderate agreement with the WHO disease criterion (κ = 0.58, 95% CI: 0.53-0.63) while anemia showed a fair agreement (κ = 0.21, 95% CI: 0.16-0.26). However, HIV/AIDS, the most prevalent comorbidity, was not significantly associated with the original WHO disease criterion. Furthermore, socio-demographic indicators like distance from home to hospital, age of woman, and type of health facility (provincial or rural district) were significant predictors of identifying maternal near-misses. In conclusion, incorporating additional criteria enhances – it casts a larger net – the original WHO disease criterion’s capacity to identify maternal near-misses. Distance from home to the hospital and age emerge as strong predictors for recognizing MNMs in Inhambane province

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Cross-sectional study evaluating the effectiveness of the Mozambique–Canada maternal health project abstraction tool for maternal near miss identification in Inhambane province, Mozambique

Muosieyiri,

Forsyth,

Andre

et al. 2024

BMJ Open

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ObjectivesThe objectives of this study are to determine whether the additional clinical criteria of the Mozambique maternal near miss abstraction tool enhance the effectiveness of the original WHO abstraction tool in identifying maternal near miss cases and also evaluate the impact of sociodemographic factors on maternal near miss identification.DesignCross-sectional study.SettingTwo secondary referral hospitals in Inhambane province, Mozambique from 2021 to 2022.ParticipantsFrom August 2021 to February 2022, 2057 women presenting at two hospitals in Inhambane Province, Mozambique, were consecutively enrolled. Eligible participants included women admitted during pregnancy, labour, delivery, or up to 42 days post partum. Selection criteria focused on women experiencing obstetric complications, while those without complications or with incomplete medical records were excluded.Primary and secondary outcome measuresThe primary outcome was identifying maternal near miss cases using the original WHO Disease criterion and the additional clinical criteria from the Mozambique-Canada Maternal Health Project abstraction tool. Secondary outcomes included the association between sociodemographic factors and maternal near miss identification. All outcomes were measured as planned in the study protocol.ResultsThe new Mozambique-Canada abstraction tool identified more maternal near miss cases (28.2% for expanded disease and 21.1% for comorbidities) compared with the original WHO tool (16.2%). Hypertension and anaemia from the newer criteria were strongly associated with the original WHO Disease criterion (p<0.001), with kappa values of 0.58 (95% CI 0.53 to 0.63) and 0.21 (95% CI 0.16 to 0.26), respectively. Distance to health facilities was significantly associated, with women living over 8 km away having higher odds (OR=2.47, 95% CI 1.92 to 3.18, p<0.001). Type of hospital also influenced identification, with lower odds at Vilankulo Rural Hospital for Expanded Disease criterion (OR=0.70, 95% CI 0.57 to 0.87, p=0.001), but higher odds for comorbidities criterion (OR=3.13, 95% CI 2.40 to 4.08, p<0.001). Finally, older age was associated with higher odds of identification under the comorbidities criterion, particularly for women aged 30–39 (OR=3.06, 95% CI 2.15 to 4.36) as well as those 40 years or older (OR=4.73, 95% CI 2.43 to 9.20, p<0.001).ConclusionsThe Mozambique-Canada Maternal Health Project tool enhances maternal near miss identification over the original WHO tool by incorporating expanded clinical criteria, particularly for conditions like hypertension and anaemia. Sociodemographic factors, including healthcare access, hospital type and maternal age, significantly impact near miss detection. These findings support integrating the expanded criteria into the WHO tool for improved identification of maternal near misses in Mozambique and similar low-resource settings. Future research should examine the tool’s effectiveness across varied healthcare contexts and populations.

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Predictors of Maternal Near Miss in Public Hospitals of West Shoa Zone, Central Ethiopia: A Case-Control Study

Cited by 6 publications

References 28 publications

Prevalence and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis, 2015–2023

Prevalence and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis, 2015–2023

Evaluating the Effectiveness of the Mozambique-Canada Maternal Health (MCMH) Project Abstraction Tool in the Identification of Maternal Near-Miss (MNM) Events

Cross-sectional study evaluating the effectiveness of the Mozambique–Canada maternal health project abstraction tool for maternal near miss identification in Inhambane province, Mozambique

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