Effectiveness of the facility-based maternal near-miss case reviews in improving maternal and newborn quality of care in low-income and middle-income countries: a systematic review

Abstract

ObjectivesThe maternal near-miss case review (NMCR) has been promoted by WHO as an approach to improve quality of care (QoC) at facility level. This systematic review synthesises evidence on the effectiveness of the NMCR on QoC and maternal and perinatal health outcomes in low-income and middle-income countries (LMICs).MethodsStudies were searched for in six electronic databases (MEDLINE, Index Medicus, Web of Science, the Cochrane library, Embase, LILACS), with no language restrictions. Two authors independently screened papers and selected them for inclusion and independently extracted data. Maternal mortality was the primary outcome. Secondary outcomes included any outcome informing on any of the six dimensions of QoC: efficacy, safety, efficiency, equity, accessibility and timely care, acceptability and patient-centred care.ResultsOut of 24 822 papers retrieved, 17 studies from 11 countries were included. Maternal mortality measured before and after the implementation of the NMCR cycle significantly decreased (OR 0.77, 95% CI 0.61 to 0.98, eight studies, 55 573 043 women; I2=39%). A statistically significant reduction in the incidence of uterine rupture, postpartum haemorrhage and maternal sepsis was observed in three out of six studies. Ten studies reporting on maternal care process all showed some significant improvement when measured against predefined standards. All studies reported that the NMCR resulted in some amelioration of the facility structure (physical structure, staffing, equipment, training, organisation of care). Newborn outcomes were overall poorly reported; four studies showed no significant difference in perinatal mortality. Patient satisfaction and equity were also poorly reported.ConclusionsPolicy makers may consider implementing the maternal NMCR cycle approach among strategies aiming at improving QoC and reducing maternal mortality and morbidity in LMIC. Future studies should better document the effectiveness of the NMCR cycle particularly on outcomes reflecting patient-centred care and cost-effectiveness.

Association between maternal satisfaction and other indicators of quality of care at childbirth: a cross-sectional study based on the WHO standards

“…Interviewing mothers has been a WHO recommendation for the review of maternal near-miss cases for a long time and has shown a significant effect in reducing maternal mortality. 43 Currently, WHO, in agreement with several other agencies and bodies, recommends to routinely explore several aspects of women’s ‘experience of care’ in order to identify actions to improve the quality of maternal and newborn care at the facility level. 6 7 …”

The burden of severe maternal outcomes and indicators of quality of maternal care in Nigerian hospitals: a secondary analysis comparing two large facility‐based surveys

“…Establishment of a maternal and perinatal database across selected referral hospitals for routine collection of data during labour, childbirth, and the postpartum period (as planned by WHO in collaboration with the Nigerian Ministry of Health) would facilitate such quality improvement strategy. There is evidence to suggest that implementing near‐miss case reviews can improve the quality of maternity care and/or reduce maternal morbidity and mortality in low‐ and middle‐income country hospitals . Implementation of a near‐miss case review system should consider not only the data requirements (i.e.…”

Worldwide Original Research Production on Maternal Near-Miss: A 10-year Bibliometric Study

“…The study of women who survived a life-threatening complication enables the identification of the shortcomings and successes regarding assistance, and it also enables physicians to deepen the understanding of the disease process from the perspective of the patients, situations that are not possible in cases of maternal death. [7][8][9] Since the last decade, several studies have been using bibliometric methods to evaluate scientific productivity in several biomedical fields. 8,9 Although the measurement of the rate of MNM is promoted as an indicator of the quality of maternal health care, 6,10 in the scientific literature there is a lack of studies that estimate the global production of research on MNM.…”