<p>Severe maternal morbidity (near-miss) and its correlates in the world&rsquo;s newest nation: South Sudan</p>

Abstract

BackgroundThis study investigates the frequency of near-miss events and compares correlates in the world’s newest nation.MethodsA cross-sectional study was carried out to audit near-miss events and their causes. A total of 1,041 mothers were sampled. Data were gathered using World Health Organization near-miss evaluation tools according to morbidity and organ failure-based criteria. Intensive care unit admission criteria were not used (as there is no functional intensive care unit in Juba Teaching Hospital). Descriptive statistics and bivariate and multivariable logistic regression were used to analyze the data. The study adhered to the Declaration of Helsinki.ResultsNearly half (49.7%) of the clients were young pregnant women (aged 15–24 years), with a mean age of 25.07±5.65 years. During the study period, there were 994 deliveries, 94 near-misses, and 10 maternal deaths. This resulted in maternal near-miss and mortality rates of 94.1 per 1,000 and 1,007 per 100,000 live births, respectively. Severe maternal outcome and maternal near-miss rates were 10.47 per 1,000 (morbidity-based criteria) and 41.3 per 1,000 (organ failure-based criteria), respectively. The likelihood of mortality was 25% (95% CI 10%–51%) for a ruptured uterus, 9% (95% CI 4%–17%) for severe postpartum hemorrhage, and 11% (95% CI 3%–30%) for eclampsia. Anemia, hemorrhage, and dystocia were the highest contributory factors in the occurrence of maternal near-misses.ConclusionThe near-miss rate was high. Contributing factors were lack of resources, low quality of primary health care, and delays in care. All near-misses should be regarded as opportunities to improve the quality of maternity care. Health institutes should address delays in conducting interventions, referral barriers, and personnel gaps. Fully functional intensive-care units must be created in all facilities, including Juba Teaching Hospital and other hospitals. Notification policies for all near-miss cases should be in place in all health care units, with a “no shame, no blame” approach.

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.…”

“…Moreover, the last reason might be that, because of the limited facilities at the private hospitals, women with complicated pregnancies are not usually referred to these health institutions. In contrast, this study is lower as compared with the studies conducted in South Sudan 94.1% [21], Northeast Region of Brazil 31.5% [22], Southeast Iran 25.2% [8], Brazilian demographic health survey 21.1% [23], and Debre-Markos hospital, Ethiopia, 29.7% [23]. The primary possible explanation might be due to the small sample size and short study period in the current study.…”

Determinant factors of maternal near miss in selected health facilities of Berak Woreda, Oromia national regional state, Ethiopia

“…This is contrary with the finding of the study conducted in which states that mothers with higher parity and gravidity were important predictors for the occurrence of maternal near miss events. 17,21,37 This might be partly explained by the fact that women who experienced prior peaceful labor at home delivery might believe that things go similarly every time in pregnancy and might decide to give birth at home.…”

The growing use of the WHO Safe Childbirth Checklist: Lessons learned at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon

“…A multi-country study conducted in LMIC reported that closing the quality gap would produce substantial bene ts in maternal and neonatal health at current levels of access and utilization of healthcare services [8]. Therefore, reducing maternal mortality and morbidity in Cameroon hinges on identifying and improving services that are critical to the health of women and girls, such as; Antenatal Care, Emergency Obstetric and New-born Care (EmONC), skilled birth attendance and quality healthcare before, during and after childbirth [9][10][11][12][13].…”