Maternal near‐misses at a provincial hospital in Papua New Guinea: A prospective observational study

Bolnga, John; Morris, Marilyn C.; Totona, Catherine; Laman, Moses

doi:10.1111/ajo.12650

Cited by 15 publications

(28 citation statements)

References 25 publications

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“…There are several other middle-income countries which used the MNM approach. However, they applied the WHO criteria or locally established criteria without validating them, and most of these studies only included referral or tertiary hospitals [16][17][18][19][20][21][22]. For example, a large national study from Brazil included 27 referral hospitals and used the WHO criteria [18].…”

Section: Discussionmentioning

confidence: 99%

Measuring maternal near-miss in a middle-income country: assessing the use of WHO and sub-Saharan Africa maternal near-miss criteria in Namibia

Heemelaar

Kabongo

Ithindi

et al. 2019

Global Health Action

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Background : Namibia, a middle-income country in sub-Saharan Africa (SSA), plans to use the Maternal Near Miss (MNM) approach. Adaptations of the World Health Organization (WHO) MNM defining criteria (‘WHO MNM criteria’) were previously proposed for low-income settings in sub-Saharan Africa (‘SSA MNM criteria’), but whether these adaptations are required in middle-income settings is unknown. Objective : To establish MNM criteria suitable for use in Namibia, a middle-income country in SSA. Methods : Cross-sectional study from 1 March 2018 to 31 May 2018 in four Namibian hospitals. Pregnant women or within 42 days of termination of pregnancy or birth, fulfilling at least one WHO or SSA MNM criterion were included. Records of women identified by either only WHO criteria or only SSA criteria were assessed in detail. Results : 194 Women fulfilled any MNM criterion. WHO criteria identified 61 MNM, the SSA criteria 184 MNM. Of women who only fulfilled any of the unique SSA MNM criteria, 18 fulfilled the criterion ‘eclampsia’, one ‘uterine rupture’ and five ‘laparotomy’. These women were assessed to be MNM. Thresholds for blood transfusion to define MNM due to haemorrhage were two units in the SSA and five in WHO set. Two or three units were given to 95 women for mild/moderate haemorrhage or chronic anaemia who did not fulfil any WHO criterion and were not considered MNM. Fourteen women who were assessed to be MNM from severe haemorrhage received four units. Conclusions : WHO MNM criteria may underestimate and SSA MNM criteria overestimate the prevalence of MNM in a middle-income country such as Namibia, where MNM criteria ‘in between’ may be more appropriate. Namibia opts to apply a modification of the WHO criteria, including eclampsia, uterine rupture, laparotomy and a lower threshold of four units of blood to define MNM. We recommend that other middle-income countries validate our criteria for their setting.

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Section: Discussionmentioning

confidence: 99%

Measuring maternal near-miss in a middle-income country: assessing the use of WHO and sub-Saharan Africa maternal near-miss criteria in Namibia

Heemelaar

Kabongo

Ithindi

et al. 2019

Global Health Action

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“…25,27 The only community-based study had an even higher MMR estimate, ranging between 600-900 per 100,000 live births in rural settings. 24 Three of the four studies were based on case notes [24][25][26][27] Neonatal health Neonatal mortality rate (NMR) 1 26 Stillbirth rate 8 [24][25][26][28][29][30][31][32] Reproduction Reproductive health Contraception prevalence rate (CPR) 3 [33][34][35] Obstetric and gynaecological admissions owing to abortions 2 36,37 Pregnancy Maternal health Adolescent birth rate 0 n/a STI prevalence in pregnancy 6 25,[38][39][40][41][42] HIV prevalence in pregnancy 7 25,28,32,35,39,41,43 Malaria prevalence in pregnancy 7 27,29,31,32,[44][45][46] Anaemia prevalence in pregnancy 6 25,29,31,32,35,…”

Section: Mortality Indicatorsmentioning

confidence: 99%

“…5 Most stillbirth indicator estimates (5 of 8 studies) originate from hospital settings such as the Goroka General Hospital (Goroka province), Port Moresby General Hospital (National Capital District) and the Modilon Hospital (Madang province) with a range of 8-30 per 1000 live births. 25,26,28,30,43 Only one study provides a rural estimate for the catchment area of health centres with an estimate of 8 per 1000 live births. 29 Three included studies, which took place at health care centres, did not specify whether the region was considered rural, peri-rural, urban or periurban and again showed a range of 8-26 per 1000 live births.…”

Section: Mortality Indicatorsmentioning

confidence: 99%

“…31,32,43 Overall, five of the eight studies estimated the stillbirth rate between 20 and 30 per 1000 live births. 25,26,30,31,43 .…”

Section: Mortality Indicatorsmentioning

confidence: 99%

“…The rate of caesarean section was mostly consistent across the five studies at less than 10%, except for one study from the Modilon Hospital in Madang which reported a rate of 27% between 2014 and 2016. 30 The remaining studies were from Port Moresby General Hospital. 28,40,49,50 Two of these studies were conducted over several decades giving an estimate of 3.9% (1977-2010) 40 and 4.4% (1977-2015) 50 respectively.…”

Section: Indicators With Some Variabilitymentioning

confidence: 99%

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Maternal and newborn health indicators in Papua New Guinea – 2008–2018

Robbers

Vogel

Mola

et al. 2019

Sexual and Reproductive Health Matters

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Papua New Guinea (PNG) is the most populous country in the Pacific with more than 9 million people. Difficult terrain, poor roads and limited infrastructure mean providing effective health careespecially in rural areas, where most people liveis challenging. Women and newborns in PNG experience high rates of preventable morbidity and mortality; however, reliable data are often limited or unavailable. The aim of this paper is to provide an overview of research on key maternal and neonatal health (MNH) indicators conducted approximately over the past 11 years in PNG comparing research findings to global MNH estimates of the indicators. There was considerable variation in mortality indicators (maternal mortality ratio, neonatal mortality rate and stillbirth) reported across studies in PNG. Mortality was generally higher in rural areas. Rates of sexually transmitted infections (STIs) in pregnancy were consistently high, while anaemia in pregnancy, preterm birth and low birth weight varied widely between studies and settings. Breastfeeding seems to have been under-researched. There was a lack of data available on other indicators such as the adolescent birth rate, postnatal care provided to women and newborns, intermittent preventative treatment to prevent malaria in pregnancy and treatment to prevent mother-to-child transmission of HIV. Studies demonstrate the high burden of preventable maternal and newborn morbidity and mortality across PNG. Efforts to improve MNH outcomes need to be escalated.

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Maternal near misses (MNM) and their determinants among women who sought obstetric care from fort portal regional referral hospital, Western Uganda

Omona

Babirye

2022

Cogent Public Health

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Maternal near‐misses at a provincial hospital in Papua New Guinea: A prospective observational study

Cited by 15 publications

References 25 publications

Measuring maternal near-miss in a middle-income country: assessing the use of WHO and sub-Saharan Africa maternal near-miss criteria in Namibia

Measuring maternal near-miss in a middle-income country: assessing the use of WHO and sub-Saharan Africa maternal near-miss criteria in Namibia

Maternal and newborn health indicators in Papua New Guinea – 2008–2018

Maternal near misses (MNM) and their determinants among women who sought obstetric care from fort portal regional referral hospital, Western Uganda

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