Determinants of maternal near miss among women in public hospital maternity wards in Northern Ethiopia: A facility based case-control study

Abstract

BackgroundIn Ethiopia, 20,000 women die each year from complications related to pregnancy, childbirth and post-partum. For every woman that dies, 20 more experience injury, infection, disease, or disability. “Maternal near miss” (MNM), defined by the World Health Organization (WHO) as a woman who nearly dies, but survives a complication during pregnancy, childbirth or within 42 days of a termination, is a proxy indicator of maternal mortality and quality of obstetric care. In Ethiopia, few studies have examined MNM. This study aims to identify determinants of MNM among a small population of women in Tigray, Ethiopia.MethodsUnmatched case-control study was conducted in hospitals in Tigray Region, Northern Ethiopia, from January 30-March 30, 2016. The sample included 103 cases and 205 controls recruited from among women seeking obstetric care at six (6) public hospitals. Clients with life-threatening obstetric complications, including hemorrhage, hypertensive diseases of pregnancy, dystocia, infection, and anemia or clinical signs of severe anemia (in women without hemorrhage) were taken as cases and those with normal obstetric outcomes were controls. Cases were selected based on proportion to size allocation while systematic sampling was employed for controls. Binary and multiple variable logistic regression (“odds ratio”) analyses were calculated at 95% CI.ResultsRoughly 90% of cases and controls were married and 25% experienced their first pregnancy before the age of 16 years. About two-thirds of controls and 45.6% of cases had gestational ages between 37–41 weeks. Among cases, severe obstetric hemorrhage (44.7%), hypertensive disorders (38.8%), dystocia (17.5%), sepsis (9.7%) and severe anemia (2.9%) were leading causes of MNM. Histories of chronic maternal medical problems like hypertension, diabetes were reported in 55.3% of cases and 33.2% of controls. Women with no formal education [AOR = 3.2;95%CI:1.24, 8.12], being less than 16 years of age at first pregnancy [AOR = 2.5;95%CI:1.12,5.63], induced labor[AOR = 3.0; 95%CI:1.44, 6.17], history of cesarean section[AOR = 4.6; 95% CI: 1.98, 7.61] or chronic medical disorder[AOR = 3.5;95%CI:1.78, 6.93], and women who traveled more than 60 minutes before reaching their final place of care[AOR = 2.8;95% CI: 1.19,6.35] had higher odds of experiencing MNM.ConclusionsMacro-developments like increasing road and health facility access as well as expanding education will all help reduce MNM. Work should be continued to educate women and providers about common predictors of MNM like history of C-section and chronic illness as well as teenage pregnancy. These efforts should be carried out at the facility, community, and individual levels. Targeted follow-up with women with history of chronic disease and C-section could also help reduce MNM.

Proportion of Maternal Near-Miss and Its Determinants among Northwest Ethiopian Women: A Cross-Sectional Study

“…This study showed that women who had initially diagnosed with pregnancy-induced hypertension were 5.3 times more likely to develop maternal near-miss than those without pregnancy-induced hypertension. This is consistent with the study done in Kathmandu Hospital [24]; Tigray, Ethiopia [12]; Sudan [21]; and southeast Iran [8].This might be a reflection of poor management of pregnancy-induced hypertension cases in the peripheral health centers as 50.8% of them were referral cases. On the other hand, this might be due to delay in seeking appropriate treatment because of lack of proper referral system and early detection of lifethreatening conditions like eclampsia.…”

“…The study suggested that the odds of developing maternal near-miss among women who had vaginal bleeding were 2.75 times more likely to develop life-threatening complication as compared to their counter parts. This report is supported with studies conducted in Nepal [10], southeast Iran [8], and Tigray, Ethiopia [12]. The possible explanation might be that women with excessive blood loss are more susceptible to shock with treatment regimens which often required blood transfusion.…”

“…Studying maternal near-miss allows the assessment of quality interventions, identifies the health system failures, and provides alternative strategies to reduce maternal mortality [11]. Delays in initiating timely and adequate treatment for obstetric complications were a major factor to develop maternal near-miss [12,13].…”

Predictors of maternal near miss among women admitted in Gurage zone hospitals, South Ethiopia, 2017: a case control study

“…Studies in Brazil and South Africa also illustrated that prior history of cesarean section is a risk factor for maternal near miss [ 23 , 25 – 27 ]. Similarly, a study elsewhere in Ethiopia showed prior history of cesarean section increased odds of maternal near miss in subsequent pregnancies [ 12 ]. However a study in Tanzania, indicated that previous Cesarean section is not a risk factor for severe maternal outcomes [ 28 ].…”

“…Previous researchers have shown that prior history of cesarean section, primipara, women who gave birth three and more times, age greater than 35 years, low socio economic status, lack of transport, rural residence, previous history of anemia, hindrance of family members in seeking timely care, chronic medical disorders, delay to reach or access care, delay in receiving care and non-adherence to antenatal care are significant determinants of maternal near miss [ 4 , 5 , 12 – 15 ].…”