Surviving mothers and lost babies – burden of stillbirths and neonatal deaths among women with maternal near miss in eastern Ethiopia: a prospective cohort study

Tura, Abera Kenay; Scherjon, Sicco A.; Roosmalen, Jos van; Zwart, Joost J.; Stekelenburg, Jelle; Akker, Thomas van den

doi:10.7189/jogh.10.010413

Cited by 20 publications

(23 citation statements)

References 31 publications

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“…In support of the current study, there existed an association between MNM and higher rates of adverse perinatal outcome born to these mothers [45,57,65,66]. Tura et al claim that adverse perinatal outcomes among MNM women is self-evident given the fact that MNM are identi ed using severe clinical criteria along with organ disfunction, which was also supported by their ndings [28].…”

Section: Discussionsupporting

confidence: 82%

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Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study

Rajbanshi

Hussain

2020

Preprint

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Background: Unlike the infant mortality rate, the rate of neonatal mortality has not declined and remains a major health challenge in the low- and middle-income countries. There is an urgent need to focus on newborn care, especially during the first 24 hours after birth and the early neonatal period. Neonatal near miss (NNM) is an emerging concept similar to that of maternal near miss. NNM events occur three to eight times more often than the neonatal deaths. The objective of this study was to establish the prevalence of NNM and identify its associated factors. Methods: A hospital-based cross-sectional study was conducted at Koshi Hospital, Morang district, Nepal. Neonates and their mothers of unspecified maternal age and number of gestational weeks were enrolled. The key inclusion criterion was the pragmatic and management markers of NNM, and admission of newborn infants to the neonatal intensive care unit (NICU) in Koshi Hospital. Non-Nepali citizens were excluded. Consecutive sampling was used until the required sample size of 1,000 newborn infants was reached. Simple and multiple logistic regression analysis was performed using SPSS® version 24.0.Results: One thousand respondents were recruited. The prevalence of NNM was 79 per 1,000 live births. Severe maternal morbidity (adjusted odds ratio (AOR): 4.51, 95% confidence interval (CI): 2.07–9.84), maternal secondary (AOR: 0.46, 95% CI: 0.24–0.88) and tertiary education (AOR: 0.18, 95% CI: 0.05–0.56), multiparity (AOR: 0.52, 95% CI: 0.39–0.86), and caesarean section (AOR: 0.48, 95% CI: 0.19–0.99) were associated with NNM. Conclusions: The prevalence of NNM in Nepal was 7.9%. Mothers’ obstetric factors, maternal complications and education were associated with NNM. Referral hospitals should have safer access to caesarean section and be prepared to offer NICU intervention to save mothers and their newborns.

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Section: Discussionsupporting

confidence: 82%

“…Studies from southern and northern Ethiopia reported that multiparity was a risk factor for NNM [26,27]. A recent prospective cohort study in Ethiopia reported that grand multiparity was a risk factor for perinatal mortality among women with MNM [28].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study

Rajbanshi

Hussain

2020

Preprint

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“…In support of the current study, an association between MNM and higher rates of adverse perinatal outcome was found (47,54,61,62). Tura et al claim that adverse perinatal outcomes among SAMM women is self-evident given the fact that SAMM are identi ed using severe clinical criteria along with organ disfunction (30).…”

Section: Discussionsupporting

confidence: 79%

“…A recent prospective cohort study in Ethiopia reported that grand multiparity was a risk factor for perinatal mortality among women with MNM (30).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study

Rajbanshi

Hussain

2021

Preprint

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Background: Unlike the infant mortality rate, the rate of neonatal mortality has not significantly declined and remains a major health challenge in the low- and middle-income countries. There is an urgent need to focus on newborn care, especially during the first 24 hours after birth and the early neonatal period. Neonatal near miss (NNM) is an emerging concept similar to that of maternal near miss. NNM events occur three to eight times more often than neonatal deaths. The objective of this study was to establish the prevalence of NNM and identify its associated factors. Methods: A hospital-based cross-sectional study was conducted in Koshi Hospital, Morang district, Nepal. Neonates and their mothers of unspecified maternal age and number of gestational weeks were enrolled. The key inclusion criterion was the pragmatic and management markers of NNM, and admission of newborn infants to the neonatal intensive care unit (NICU) in Koshi Hospital. Non-Nepali citizens were excluded. Consecutive sampling was used until the required sample size of 1,000 newborn infants was reached. Simple and multiple logistic regression was performed using SPSS® version 24.0.Results: One thousand respondents were recruited. Prevalence of NNM was 79 per 1,000 live births. Severe maternal morbidity (adjusted odds ratio (aOR) 4.52; 95% confidence interval (CI): 2.07–9.84), no education (aOR 2.16; 95% CI 1.12–4.14), multiparity (aOR 0.52; 95% CI 0.32–0.86), and caesarean section (aOR 0.44: 95% CI 0.19–0.99) were associated with NNM. Conclusions: Prevalence of NNM in Nepal was 7.9%. Mothers’ obstetric factors, maternal complications and education were associated with NNM. Women in referral hospitals should have safer access to caesarean section and be prepared for NICU intervention to save mothers and their newborns.

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“…Although it is clear that complications leading to MNM also contribute to adverse perinatal outcomes, the magnitude and causes of perinatal deaths among women with MNM are mainly unknown in low- and middle-income countries. The stillbirth rate among women with WHO-MNM in Suriname (193/1000 births) is higher than reported in Brazil (140/1000 births) [ 37 ] or other Latin American countries (128/1000 births) [ 30 ], and lower than in low-resource settings (eg, Ethiopia 284/1000 births [ 38 ]). The higher stillbirth rate among women with WHO-criteria (than Namibian- or SSA-criteria) further confirms that the WHO-tool comprises of the most clinically severe criteria.…”

Section: Discussionmentioning

confidence: 90%

Applicability of the WHO maternal near-miss tool: A nationwide surveillance study in Suriname

Verschueren¹,

Kodan²,

Paidin³

et al. 2020

Journal of Global Health

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Background Maternal near-miss (MNM) is an important maternal health quality-of-care indicator. To facilitate comparison between countries, the World Health Organization (WHO) developed the “MNM-tool”. However, several low- and middle-income countries have proposed adaptations to prevent underreporting, ie, Namibian and Sub-Sahara African (SSA)-criteria. This study aims to assess MNM and associated factors in middle-income country Suriname by applying the three different MNM tools. Methods A nationwide prospective population-based cohort study was conducted using the Suriname Obstetric Surveillance System (SurOSS). We included women with MNM-criteria defined by WHO-, Namibian- and SSA-tools during one year (March 2017-February 2018) and used hospital births (86% of total) as a reference group. Results There were 9114 hospital live births in Suriname in the one-year study period. SurOSS identified 71 women with WHO-MNM (8/1000 live births, mortality-index 12%), 118 with Namibian-MNM (13/1000 live births, mortality-index 8%), and 242 with SSA-MNM (27/1000 live births, mortality-index 4%). Namibian- and SSA-tools identified all women with WHO-criteria. Blood transfusion thresholds and eclampsia explained the majority of differences in MNM prevalence. Eclampsia was not considered a WHO-MNM in 80% (n = 35/44) of cases. Nevertheless, mortality-index for MNM with hypertensive disorders was 17% and the most frequent underlying cause of maternal deaths (n = 4/10, 40%) and MNM (n = 24/71, 34%). Women of advanced age and maroon ethnicity had twice the odds of WHO-MNM (respectively adjusted odds ratio (aOR) = 2.6, 95% confidence interval (CI) = 1.4-4.8 and aOR = 2.0, 95% CI = 1.2-3.6). The stillbirths rate among women with WHO-MNM was 193/1000births, with six times higher odds than women without MNM (aOR = 6.8, 95%CI = 3.0-15.8). While the prevalence and mortality-index differ between the three MNM tools, the underlying causes of and factors associated with MNM were comparable. Conclusions The MNM ratio in Suriname is comparable to other countries in the region. The WHO-tool underestimates the prevalence of MNM (high mortality-index), while the adapted tools may overestimate MNM and compromise global comparability. Contextualized MNM-criteria per obstetric transition stage may improve comparability and reduce underreporting. While MNM studies facilitate international comparison, audit will remain necessary to identify shortfalls in quality-of-care and improve maternal outcomes.

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Surviving mothers and lost babies – burden of stillbirths and neonatal deaths among women with maternal near miss in eastern Ethiopia: a prospective cohort study

Cited by 20 publications

References 31 publications

Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study

Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study

Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study

Applicability of the WHO maternal near-miss tool: A nationwide surveillance study in Suriname

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