Prevalence of maternal near miss and community-based risk factors in Central Uganda

Nansubuga, Elizabeth; Ayiga, Natal; Moyer, Cheryl A.

doi:10.1016/j.ijgo.2016.05.009

Cited by 18 publications

(12 citation statements)

References 17 publications

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“…Maternal age, maternal education, husband's education, household size, wealth, parity, gravidity, religion and marital status were not associated with maternal near-misses. This is different from other studies, which found age, 18 gravidity, 19 maternal education 19 and partner's education 20 to be significantly associated with maternal near-misses. Notably, one study in Brazil found that social and demographic characteristics of the mother were not directly linked to maternal near-miss status, although such factors were linked to differences in care seeking, which was then in turn linked to near-miss status.…”

Section: Discussioncontrasting

confidence: 99%

Incidence, causes and correlates of maternal near‐miss morbidity: a multi‐centre cross‐sectional study

Oppong

Bakari

Bell

et al. 2019

BJOG

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Objective To explore the incidence and factors associated with maternal near‐miss. Design Cross‐sectional study with an embedded case–control study. Setting Three tertiary referral hospitals in southern Ghana. Population All women admitted to study facilities with pregnancy‐related complications or for birth. Methods An 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 measures Incidence of maternal near‐miss, maternal near‐miss to maternal mortality ratio, and cause of and factors associated with maternal near‐miss. Results Out 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). Conclusion For 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 abstract Maternal near‐miss exceeds maternal death by 5:1, with the leading cause of maternal near‐miss was pre‐eclampsia/eclampsia.

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Section: Discussioncontrasting

confidence: 99%

Incidence, causes and correlates of maternal near‐miss morbidity: a multi‐centre cross‐sectional study

Oppong

Bakari

Bell

et al. 2019

BJOG

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“…A wide variance in the prevalence of MNM was observed. The lowest reported prevalence was 0.58% ( 33 ) and the highest was 27.87% ( 28 ). The overall pooled prevalence of MNM was 1.68% (95% CI: 1.42, 1.95) ( Figure 6 ).…”

Section: Resultsmentioning

confidence: 93%

The Prevalence and Risk Factors for Severe Maternal Morbidities: A Systematic Review and Meta-Analysis

et al. 2022

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IntroductionMaternal mortality and severe maternal morbidity remain major public health problems globally. Understanding their risk factors may result in better treatment solutions and preventive measures for maternal health. This review aims to identify the prevalence and risk factors of severe maternal morbidity (SMM) and maternal near miss (MNM).MethodsA systematic review and meta-analysis was conducted to assess the prevalence and risk factors of SMM and MNM. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A systematic search was performed in the MEDLINE (PubMed), CINAHL (EBSCOhost), and Science Direct databases for articles published between 2011 and 2020.ResultsTwenty-four of the 44 studies included were assessed as being of good quality and having a low risk of bias. The prevalence of SMM and MNM was 2.45% (95% CI: 2.03, 2.88) and 1.68% (95% CI: 1.42, 1.95), respectively. The risk factors for SMM included history of cesarean section (OR [95% CI]: 1.63 [1.43, 1.87]), young maternal age (OR [95% CI]: 0.71 [0.60, 0.83]), singleton pregnancy (OR [95% CI]: 0.42 [0.32, 0.55]), vaginal delivery (OR [95% CI]: 0.11 [0.02, 0.47]), coexisting medical conditions (OR [95% CI]: 1.51 [1.28, 1.78]), and preterm gestation (OR [95% CI]: 0.14 [0.08, 0.23]). The sole risk factor for MNM was a history of cesarean section (OR [95% CI]: 2.68 [1.41, 5.10]).ConclusionsMaternal age, coexisting medical conditions, history of abortion and cesarean delivery, gestational age, parity, and mode of delivery are associated with SMM and MNM. This helps us better understand the risk factors and their strength of association with SMM and MNM. Thus, initiatives such as educational programs, campaigns, and early detection of risk factors are recommended. Proper follow-up is important to monitor the progression of maternal health during the antenatal and postnatal periods.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226137, identifier: CRD42021226137.

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“…Maternal mortality is estimated to be 343 deaths per 100,000 live births in Uganda [ 2 ]. Morbidity due to complications in pregnancy and childbirth has been described as high in the Central region [ 28 ]. Similar to Tanzania, health system supply issues and lack of competencies and knowledge limit the effective use of measures to prevent and treat PPH [ 29 ].…”

Section: Methodsmentioning

confidence: 99%

Evaluating the effect of the Helping Mothers Survive Bleeding after Birth (HMS BAB) training in Tanzania and Uganda: study protocol for a randomised controlled trial

Hanson

Pembe

Alwy

et al. 2017

Trials

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BackgroundPostpartum haemorrhage complicates approximately 10% of all deliveries and contributes to at least a quarter of all maternal deaths worldwide. The competency-based Helping Mothers Survive Bleeding after Birth (HMS BAB) training was developed to support evidence-based management of postpartum haemorrhage. This one-day training includes low-cost MamaNatalie® birthing simulators and addresses both prevention and first-line treatment of haemorrhage. While evidence is accumulating that the training improves health provider’s knowledge, skills and confidence, evidence is missing as to whether this translates into improved practices and reduced maternal morbidity and mortality. This cluster-randomised trial aims to assess whether this training package — involving a one-day competency-based HMS BAB in-facility training provided by certified trainers followed by 8 weeks of in-service peer-based practice — has an effect on the occurrence of haemorrhage-related morbidity and mortality.Methods/designIn Tanzania and Uganda we randomise 20 and 18 districts (clusters) respectively, with half receiving the training intervention. We use unblinded matched-pair randomisation to balance district health system characteristics and the main outcome, which is in-facility severe morbidity due to haemorrhage defined by the World Health Organizationation-promoted disease and management-based near-miss criteria. Data are collected continuously in the intervention and comparison districts throughout the 6-month baseline and the 9-month intervention phase, which commences after the training intervention. Trained facility midwives or clinicians review severe maternal complications to identify near misses on a daily basis. They abstract the case information from case notes and enter it onto programmed tablets where it is uploaded.Intention-to-treat analysis will be used, taking the matched design into consideration using paired t test statistics to compare the outcomes between the intervention and comparison districts. We also assess the impact pathway from the effects of the training on the health provider’s skills, care and interventions and health system readiness.DiscussionThis trial aims to generate evidence on the effect and limitations of this well-designed training package supported by birthing simulations. While the lack of blinding of participants and data collectors provides an inevitable limitation of this trial, the additional evaluation along the pathway of implementation will provide solid evidence on the effects of this HMS BAB training package.Trial registrationPan African Clinical Trials Registry, PACTR201604001582128. Registered on 12 April 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2056-7) contains supplementary material, which is available to authorized users.

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Prevalence of maternal near miss and community-based risk factors in Central Uganda

Cited by 18 publications

References 17 publications

Incidence, causes and correlates of maternal near‐miss morbidity: a multi‐centre cross‐sectional study

Incidence, causes and correlates of maternal near‐miss morbidity: a multi‐centre cross‐sectional study

The Prevalence and Risk Factors for Severe Maternal Morbidities: A Systematic Review and Meta-Analysis

Evaluating the effect of the Helping Mothers Survive Bleeding after Birth (HMS BAB) training in Tanzania and Uganda: study protocol for a randomised controlled trial

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