Road to maternal death: the pooled estimate of maternal near-miss, its primary causes and determinants in Africa: a systematic review and meta-analysis
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SUBMITTER: Habte A
PROVIDER: S-EPMC10874058 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundHigh rates of maternal mortality and morbidity remain significant health issues in low- and middle-income countries. Despite this, few researchers have investigated the underlying factors of severe maternal complications in sub-Saharan Africa. Therefore, the objective of this systematic review was to determine the socioeconomic, demographic, and obstetric predictors of severe maternal complications in this region.MethodFor this systematic review, we searched PubMed, Scopus and Science Direct between 2000 and 2022. Studies were eligible if they reported a relationship between impending maternal death and one or more socioeconomic, demographic or obstetric determinants. We did not contact the authors of the articles, as we had access to their full texts. The quality of qualitative and quantitative studies was assessed using the Critical Appraisal Skills quality assessment tool.ResultsAmong the 3001 identified studies, this systematic review selected 25 articles. Factors such as economic status, level of education, maternal age, marital status, rural residence, transfers to other facilities, and delays during childbirth were identified as the main determinants of severe complications occurrence in Africa. Disparities in access to maternal healthcare were observed among women from different socioeconomic groups, often due to power imbalances in decision-making processes.ConclusionSeveral factors, including education, prenatal care follow-up, pre-existing medical conditions, method of admission, and mode of delivery, have been identified as significant indicators of the likelihood of severe maternal morbidity. To reduce these cases, it is crucial to implement targeted socio-economic development programs, including improving access to education, strengthening prenatal health services, providing support to pregnant women with pre-existing medical conditions, and ensuring appropriate admission and delivery methods.
| S-EPMC11819575 | biostudies-literature
Project description:BackgroundMaternal near miss (MNM) is one of the newly adopted assessment parameters to gauge the quality of maternity care. In Ethiopia, several studies have been conducted to investigate the incidence, underlying causes, and determinants of MNM. However, the findings from those studies vary greatly and are largely inconsistent. Thus, this review aims to more robustly estimate the pooled prevalence, identify underlying causes, and single out determinants of MNM in Ethiopia.MethodsStudies were searched from international databases (PubMed/ Medline, Cochrane Library, and Embase databases) and other potential sites. All observational studies were included. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics and small study effects were checked using Egger's statistical test at a 5% significance level. Outcome measures were overall and specific underlying causes (obstetrics hemorrhage, hypertensive disorder pregnancy, pregnancy-related infection) rates of MNMs per 10,000 live births.ResultThe meta-analysis included 43 studies consisting of 77240 MNM cases. The pooled prevalence MNM per 1000 live births in Ethiopia was 54.33 (95% CI: 33.93 to 85.89). Between-study heterogeneity was high (I2 = 100%, P < 0.0001), with the highest rate observed in Amhara region (384.54 per 1000). The prevalence of obstetrics hemorrhage (14.56 per 1000) was higher than that of hypertensive disorder pregnancy (12.67 per 1000) and pregnancy-related infections (3.55 per 1000) were identified as underlying causes. Various factors, including socio demographic characteristics, previous medical and obstetrics history as well as access to and quality of care obtained, were associated with MNM.ConclusionAlmost six women encounter near miss among a hundred live births in Ethiopia. Obstetric hemorrhage and hypertensive disorder pregnancy were the most common underlying causes of MNM. Both individual and facility level determinants were found to be associated with MNM. Considering the magnitude and identified factors, tailored measures should be taken at every stage of the continuum of care.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023395259.
| S-EPMC11493713 | biostudies-literature
Project description:Objective:To analyse and improve the Namibian maternity care system by implementing maternal near-miss surveillance during 1 October 2018 and 31 March 2019, and identifying the challenges and benefits of such data collection. Methods:From the results of an initial feasibility study, we adapted the World Health Organization's criteria defining a maternal near miss to the Namibian health-care system. We visited most (27 out of 35) participating facilities before implementation and provided training on maternal near-miss identification and data collection. We visited all facilities at the end of the surveillance period to verify recorded data and to give staff the opportunity to provide feedback. Findings:During the 6-month period, we recorded 37?106 live births, 298 maternal near misses (8.0 per 1000 live births) and 23 maternal deaths (62.0 per 100?000 live births). We observed that obstetric haemorrhage and hypertensive disorders were the most common causes of maternal near misses (each 92/298; 30.9%). Of the 49 maternal near misses due to pregnancies with abortive outcomes, ectopic pregnancy was the most common cause (36/298; 12.1%). Fetal or neonatal outcomes were poor; only 50.3% (157/312) of the infants born to maternal near-miss mothers went home with their mother. Conclusion:Maternal near-miss surveillance is a useful intervention to identify within-country challenges, such as lack of access to caesarean section or hysterectomy. Knowledge of these challenges can be used by policy-makers and programme managers in the development of locally tailored targeted interventions to improve maternal outcome in their setting.
| S-EPMC7411319 | biostudies-literature
Project description:BackgroundIn Morocco, there is little information on the circumstances surrounding maternal near misses. This study aimed to determine the incidence, characteristics, and determinants of maternal near misses in Morocco.MethodA prospective case-control study was conducted at 3 referral maternity hospitals in the Marrakech region of Morocco between February and July 2012. Near-miss cases included severe hemorrhage, hypertensive disorders, and prolonged obstructed labor. Three unmatched controls were selected for each near-miss case. Three categories of risk factors (sociodemographics, reproductive history, and delays), as well as perinatal outcomes, were assessed, and bivariate and multivariate analyses of the determinants were performed. A sample of 30 near misses and 30 non-near misses was interviewed.ResultsThe incidence of near misses was 12‰ of births. Hypertensive disorders during pregnancy (45%) and severe hemorrhage (39%) were the most frequent direct causes of near miss. The main risk factors were illiteracy [OR = 2.35; 95% CI: (1.07-5.15)], lack of antenatal care [OR = 3.97; 95% CI: (1.42-11.09)], complications during pregnancy [OR = 2.81; 95% CI:(1.26-6.29)], and having experienced a first phase delay [OR = 8.71; 95% CI: (3.97-19.12)] and a first phase of third delay [OR = 4.03; 95% CI: (1.75-9.25)]. The main reasons for the first delay were lack of a family authority figure who could make a decision, lack of sufficient financial resources, lack of a vehicle, and fear of health facilities. The majority of near misses demonstrated a third delay with many referrals. The women's perceptions of the quality of their care highlighted the importance of information, good communication, and attitude.ConclusionWomen and newborns with serious obstetric complications have a greater chance of successful outcomes if they are immediately directed to a functioning referral hospital and if the providers are responsive.
| S-EPMC4303272 | biostudies-literature
Project description:BackgroundBecause 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.MethodsA 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.ResultsDuring 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.ConclusionThe 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.
| S-EPMC5460898 | biostudies-literature
Project description:ObjectiveTo explore the incidence and factors associated with maternal near-miss.DesignCross-sectional study with an embedded case-control study.SettingThree tertiary referral hospitals in southern Ghana.PopulationAll women admitted to study facilities with pregnancy-related complications or for birth.MethodsAn adapted version of the WHO Maternal Near Miss Screening Tool was used to identify maternal near-miss cases. These were compared with unmatched controls (uncomplicated deliveries) in a ratio of 1:2.Main outcome measuresIncidence of maternal near-miss, maternal near-miss to maternal mortality ratio, and cause of and factors associated with maternal near-miss.ResultsOut of 8433 live births, 288 maternal near-miss cases and 62 maternal deaths were identified. In all, 454 healthy controls were recruited for comparison. Maternal near-miss and maternal death incidence ratios were 34.2 (95% CI 30.2-38.1) and 7.4 (95% CI 5.5-9.2) per 1000 live births, respectively with a maternal near-miss to mortality ratio of 4.6:1. Cause of near-miss was pre-eclampsia/eclampsia (41.0%), haemorrhage (12.2%), maternal sepsis (11.1%) and ruptured uterus (4.2%). A major factor associated with maternal near-miss was maternal fever within the 7 days before birth (OR 5.95, 95%CI 3.754-9.424). Spontaneous onset of labour was protective against near-miss (OR 0.09 95% CI 0.057-0.141).ConclusionFor every maternal death, there were nearly five maternal near-misses. Women having a fever in the 7 days before delivery were six times more likely to experience a near-miss than women not having fever.Tweetable abstractMaternal near-miss exceeds maternal death by 5:1, with the leading cause of maternal near-miss was pre-eclampsia/eclampsia.
| S-EPMC6459711 | biostudies-literature
Project description:BackgroundApplicability 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.MethodsWe 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.ResultsFifteen 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.ConclusionThis 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.
| S-EPMC6390325 | biostudies-literature
Project description:Background:Life-threatening situations might arise unexpectedly during pregnancy. Maternal near-miss can be a proxy for maternal death and explained as women who nearly died due to obstetric-related complications. It is recognized as the predictor of level of care and maternal death. Maternal near-miss evaluates life-threatening pregnancy-related complications, and it directs the assessment of the quality of obstetric care. Objective:To determine the proportion and factors associated with maternal near-miss at maternity wards at the University of Gondar Referral Hospital, Northwest Ethiopia, 2019. Methods:A cross-sectional study design was carried out from March 1 to June 20, 2019, using WHO criteria for maternal near-miss at the University of Gondar Referral Hospital. The data are from the interviews and review of 303 systematically selected participants' medical files at maternity wards. Bivariate and multivariable logistic regression analyses were performed to analyze factors associated with maternal near-miss, including estimation of crude and adjusted odds ratios and their respective 95% confidence intervals and p value less than 0.05 through SPSS version 20. Result:The study revealed that the proportion of maternal near-miss was found to be 15.8% (95%CI = 11.9%-20.1%). In the adjusted analyses, maternal near-miss was significantly associated with low (?1000 ETB) monthly income (AOR = 399; 95%CI = 1.65, 9.65), seven or more days of hospital stay (AOR = 5.43; 95%CI = 2.49, 11.83), vaginal bleeding (AOR = 2.75, 95%CI = 1.17, 6.47), and pregnancy-induced hypertension (AOR = 5.13; 95%CI = 2.08, 12.6). Conclusion and Recommendation. The near-miss proportion was comparable to that in the region. Associated factors were low monthly income, seven or more days of hospital stay, vaginal bleeding, and pregnancy-induced hypertension. Thus, giving attention on early identification and treatment of these potential factors can be the opportunity in the reduction of maternal morbidity and mortality.
| S-EPMC7104127 | biostudies-literature
Project description:BackgroundEthiopia's progress in maternal health is commendable, but the persistence of life-threatening complications during pregnancy and childbirth highlights the need for further research and action. While individual studies on maternal near-misses (MNM) exist, a comprehensive understanding of their prevalence and underlying factors remains elusive. This systematic review and meta-analysis aimed to bridge that gap by consolidating available evidence, paving the way for targeted interventions to improve maternal health outcomes.MethodsA search for relevant studies was performed using the databases of PubMed, Scopus, the Cochrane Library, and Google Scholar, from years November 26 to 30, 2023, encompassed studies conducted in Ethiopia and published in English that reported the prevalence of maternal near miss and/or identified at least one determinant. Duplicate studies were removed using Endnote X8, resulting in a total of 13 studies included for analysis. The methodological quality of the included studies was assessed using the Joanna Briggs Institute's (JBI) quality appraisal checklist. The data synthesis and statistical analysis were performed using STATA Version 17 software. The pooled prevalence was presented using forest plots based on the random effects model.ResultThe nationwide combined prevalence of maternal near misses (MNM) in Ethiopia was an adjusted odds ratio (AOR) of 12.9 and a 95% confidence interval (CI) of 6.30 to 19.49. Several factors were identified as determinants of maternal near-misses based on the pooled estimate. These factors included the absence of formal education (AOR = 2.48, 95% CI: 1.59-3.36), pre-existing chronic conditions (AOR = 4.70, 95% CI: 2.97-6.42), lack of antenatal care (AOR = 3.09, 95% CI: 2.12, 4.05), previous cesarean section (AOR = 4.40, 95% CI: 3.51, 5.28), and a history of referral (AOR = 2.67, 95% CI: 1.36-3.98); thus, factors were found to contribute significantly.ConclusionMaternal near-misses are prevalent in Ethiopia, with determinates including chronic conditions, lack of education, referral history, inadequate antenatal care, and previous cesarean sections. Addressing this requires improving women's education access, enhancing antenatal care services for early complication management, and proactive chronic condition care during pregnancy. Promoting safe delivery practices, reducing unnecessary cesarean sections, and enhancing referral systems are crucial steps. Effective implementation necessitates collaboration among healthcare providers, policymakers, the Ethiopian Ministry of Health, and hospitals to reduce maternal near-misses in Ethiopia. The cross-sectional design hinders drawing causal conclusions, and the relevance of the findings may be limited to countries with specific socio-economic and cultural contexts, considering that the research was conducted exclusively in Ethiopia.Systematic review registrationPROSPERO CRD42023485844.
| S-EPMC11889848 | biostudies-literature
Project description:BackgroundThe lack of reliable and up-to-date statistics on maternal deaths and disabilities remains a major challenge to the implementation of Nigeria's Road Map to Accelerate the Millennium Development Goal related to Maternal Health (MDG-5). There are currently no functioning national data sources on maternal deaths and disabilities that could serve as reference points for programme managers, health advocates and policy makers. While awaiting the success of efforts targeted at overcoming the barriers facing establishment of population-based data systems, referral institutions in Nigeria can contribute their quota in the quest towards MDG-5 by providing good quality and reliable information on maternal deaths and disabilities on a continuous basis. This project represents the first opportunity to initiate a scientifically sound and reliable quantitative system of data gathering on maternal health profile in Nigeria.ObjectiveThe primary objective is to create a national data system on maternal near miss (MNM) and maternal mortality in Nigerian public tertiary institutions. This system will conduct periodically, both regionally and at country level, a review of the magnitude of MNM and maternal deaths, nature of events responsible for MNM and maternal deaths, indices for the quality of care for direct obstetric complications and the health service events surrounding these complications, in an attempt to collectively define and monitor the standard of comprehensive emergency obstetric care in the country.MethodsThis will be a nationwide cohort study of all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications using uniform criteria among women admitted in tertiary healthcare facilities in the six geopolitical zones in Nigeria. This will be accomplished by establishing a network of all public tertiary obstetric referral institutions that will prospectively collect specific information on potentially fatal maternal complications. For every woman enrolled, the health service events (care pathways) within the facility will be evaluated to identify areas of substandard care/avoidable factors through clinical audit by the local research team. A summary estimate of the frequencies of MNM and maternal deaths will be determined at intervals and indicators of quality of care (case fatality rate, both total and cause-specific and mortality index) will be evaluated at facility, regional and country levels.ManagementOverall project management will be from the Centre for Research in Reproductive Health (CRRH), Sagamu, Nigeria. There will be at least two meetings and site visits for efficient coordination of the project by regional coordinators and central coordinating staff. Data will be transferred electronically by hospital and regional coordinators and managed at the Data Management Unit of CRRH, Sagamu, Nigeria.Expected outcomesThe outcome of the study would provide useful information to the health practitioners, policy-makers and international partners on the strengths and weaknesses of the infrastructures provided for comprehensive emergency obstetric care in Nigeria. The successful implementation of this project will pave way for the long-awaited Confidential Enquiries into Maternal Deaths that would guide the formulation and or revision of obstetric policies and practices in Nigeria. Lessons learnt from the establishment of this data system can also be used to set up similar structures at lower levels of healthcare delivery in Nigeria.
| S-EPMC2702364 | biostudies-literature