Assessment of Maternal Near Miss at Debre Markos Referral Hospital, Northwest Ethiopia: Five Years Experience

Molla Gedefaw^1*, Habtamu Gebrehana², Ayu Gizachew³, Fentahun Taddess⁴

¹GAMBY College of Medical Sciences, Bahir Dar, Ethiopia.
²Debre Markos Referral Hospital, Ethiopia.
³Department of Reproductive Health, Debre Markos University, Debre Markos, Ethiopia.
⁴Debre Markos Town Administration, Ethiopia.

DOI: 10.4236/ojepi.2014.44026                

Abstract

Maternal mortality in Ethiopia is one of the highest in the world. Data on maternal near miss cases and events among mothers who received care at health institutions is lacking. The main aim of this study was, therefore, to assess trend and correlates of maternal near miss case at a referral hospital. Case notes of clients who received care in obstetric and gynecologic ward of Debre Markos Referral Hospital from 1st January 2008 to 30th December 2012 were reviewed. Case notes were selected using systematic random sampling technique. Tailored format was data collection tool. SPSS version 16 was used to analyze the data. Logistic regression was fitted to determine possible association, and strength of associations was measured using odds ratio at 95% confidence interval. A total of 1355 case notes were reviewed. Of them, 403 (29.7%) were near miss cases. The data showed that maternal near miss ratio over the study period was decreasing (X2 = 7.4, p = 0.007). Distance from the hospital, history of difficult labor, and antenatal care (ANC) utilization were found to be major determinates of maternal near miss cases. The most common types of near miss events were obstructed labor and hemorrhage. Majority of maternal near miss cases brought referral letter to hospital. Although maternal near miss ratio is still high, it appears to decrease over the last five years period. This may reflect success of the government’s Endeavour to decrease maternal mortality. However, this effort needs to continue in a sustainable manner to avoid preventable causes of maternal mortality in Ethiopia.

Keywords

Maternal Near Miss, Maternal Near Miss Events, Maternal Death

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	WHO (2011) Evaluating the Quality of Care for Severe Pregnancy Complications: The WHO Near Miss Approach for Maternal Health. World Health Organization
[2]	Chou, D., Inoue, M., Mathers, C., Oestergaard, M., Say, L., Mills, S., et al. (2010) Trends in Maternal Mortality: 1990 to 2008. Estimates Developed by WHO, UNICEF, UNFPA and The World Bank.
[3]	UN (2010) We Can End Poverty 2015 Millennium Developmental Goal. The Millennium Development Goals Report.
[4]	World Health Organization (2004) Beyond the Numbers: Reviewing Maternal Deaths and Complications to Make Pregnancy Safer. Geneva.
[5]	Maternal Death Surveillance and Response (MDSR) Technical Guideline (2012) Ministry of Health of Ethiopia Addis Ababa, Ethiopia.
[6]	Trends in Maternal Health in Ethiopia (2012) In-Depth Analysis of the EDHS 2000-2011. UNFPA, Addis Ababa, Ethiopia.
[7]	Oladapo, O.T., Sule-Odu, A.O., Olatunji, A.O. and Daniel, O.J. (2005) Near-Miss Obstetric Events and Maternal Deaths in Sagamu, Nigeria: A Retrospective Study. Reproductive Health, 2, 9. http://dx.doi.org/10.1186/1742-4755-2-9
[8]	Wianwiset, W. (2012) Maternal Near Miss (Severe Morbidity) at Sisaket Hospital. Thai Journal of Obstetrics and Gynecology, 20, 69-76.
[9]	Ali, A., Khojali, A., Okud, A., Adam, G.K. and Adam, I. (2011) Maternal Near-Miss in a Rural Hospital in Sudan. BMC Pregnancy and Child Birth, 11, 48. http://dx.doi.org/10.1186/1471-2393-11-48
[10]	Amaral, E., Souza, J.P., Surita, F., Campbell, O., Guilherme, J., et al. (2011) A Population-Based Surveillance Study on Severe Acute Maternal Morbidity (Near-Miss) and Adverse Perinata Outcomes in Campinas, Brazil. BMC Pregnancy and Childbirth, 11, 9. http://dx.doi.org/10.1186/1471-2393-11-9
[11]	Kaye, D.K., Kakire, O. and Osinde, M.O. (2011) Systematic Review of the Magnitude and Case Fatality Ratio for Severe Maternal Morbidity in Sub-Saharan Africa between 1995 and 2010. BMC Pregnancy and Childbirth, 11, 65. http://dx.doi.org/10.1186/1471-2393-11-65
[12]	Drau, P.H., Musa, J., Achara, P. and Pam, I.C. (2008) Near Miss Maternal Mortality in Jos University Teaching Hospital (Juth), Jos, Plateau State Nigeria. Department of Obstetrics and Gynecology, Jos University Teaching Hospital, Jos, Plateau State. Ibom Medical Journal, 3, 1.
[13]	Mustafa, R. and Hashmi, H. (2009) Near-Miss Obstetrical Events and Maternal Deaths. Journal of the College of Physicians and Surgeons Pakistan, 19,781-785.
[14]	Say, L., Pattinon, R.C. and Gulmezoglu, A.M. (2004) WHO Systematic Review of Maternal Morbidity and Mortality: The Prevalence of Severe Acute Maternal Morbidity (Near Miss). Reproductive Health, 1, 3. http://dx.doi.org/10.1186/1742-4755-1-3
[15]	Almerie, Y., Almerie, M.Q., Matar, H.E., Shahrour, Y., Chamat, A.A. and Abdulsalam, A. (2010) Obstetric Near-Miss and Maternal Mortality in Maternity University Hospital, Damascus, Syria: A Retrospective Study. BMC Pregnancy and Childbirth, 10, 65. http://dx.doi.org/10.1186/1471-2393-10-65
[16]	Sikeder, S.S., Labrique, A.B., Ullah, B., Ali, H., Rashid, M., Mehra, S., et al. (2011) Accounts of Severe Acute Obstetric Complications in Rural Bangladesh. BMC Pregnancy and Childbirth, 11, 76. http://dx.doi.org/10.1186/1471-2393-11-76
[17]	Jabir, M., Abul-Hassan, S., Abdul-Salam, l., AL-Hilli, W., Abul-Hassan, S., et al. (2013) Maternal Near Miss and Quality of Maternal Health Care in Baghdad, Iraq. BMC Pregnancy and Childbirth, 13, 11. http://dx.doi.org/10.1186/1471-2393-13-11
[18]	Abdella, A. (2010) Maternal Mortality Trend in Ethiopia. Ethiopian Journal of Health Development, 24, 115-122.
[19]	Gaym, A. (2000) A Review of Maternal Mortality at Jimma Hospital, South East Ethiopia. Ethiopian Journal of Health Development, 14, 215-223.
[20]	Kabakyenga, J.K., Ostergren, P.O., Turyakira, E., Mukasa, P.M. and Pettersson, K.O. (2011) Individual and Health Facility Factors and the Risk for Obstructed Labor and Its Adverse Outcomes in South-Western Uganda. BMC Pregnancy and Childbirth, 11, 73. http://dx.doi.org/10.1186/1471-2393-11-73
[21]	Imam, A.M., Dhaher, E., et al. (2012) Maternal near Miss in Four Governmental Hospitals in the West Bank, Occupied Palestinian Territory, in 2010: A Retrospective, Facility-Based Survey. The Lancet, 380, S37-S38.