Dataset Information

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

ABSTRACT:

Objective

To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals.

Design

Nationwide cross-sectional study.

Setting

Forty-two tertiary hospitals.

Population

Women admitted for pregnancy, childbirth and puerperal complications.

Methods

All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period.

Main outcome measures

Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO).

Results

Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre-eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21-215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non-availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care.

Conclusions

Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care.

Tweetable abstract

Of 998 maternal deaths and 1451 near-misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

SUBMITTER: Oladapo OT

PROVIDER: S-EPMC5016783 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

Oladapo O T OT Adetoro O O OO Ekele B A BA Chama C C Etuk S J SJ Aboyeji A P AP Onah H E HE Abasiattai A M AM Adamu A N AN Adegbola O O Adeniran A S AS Aimakhu C O CO Akinsanya O O Aliyu L D LD Ande A B AB Ashimi A A Bwala M M Fabamwo A A Geidam A D AD Ikechebelu J I JI Imaralu J O JO Kuti O O Nwachukwu D D Omo-Aghoja L L Tunau K K Tukur J J Umeora Ouj O Umezulike A C AC Dada O A OA Tunçalp Ӧ Ӧ Vogel J P JP Gülmezoglu A M AM

BJOG : an international journal of obstetrics and gynaecology 20150514 6

<h4>Objective</h4>To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals.<h4>Design</h4>Nationwide cross-sectional study.<h4>Setting</h4>Forty-two tertiary hospitals.<h4>Population</h4>Women admitted for pregnancy, childbirth and puerperal complications.<h4>Methods</h4>All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WH ...[more]

PMID: 25974281

Similar Datasets

Project description:BackgroundNeonatal near miss is a neonate who nearly died but survived from a severe complication occurred during pregnancy, birth or within 0-28 days of extra-uterine life. However, there is no available data that quantifies the magnitude of neonatal near miss (NNM) in Ethiopia where there is high prevalence of neonatal mortality. Therefore, this study is designed to provide information about the magnitude and associated factors of neonatal near miss among women who give a live birth at Hawassa City Governmental hospitals, 2019.MethodsA facility based cross-sectional study design was conducted on 604 mothers who gave live neonates at Adare General Hospital and Hawassa University Comprehensive and Specialized Hospital from May 9, 2019 to June 7, 2019. Face to face interviewer administered structured questionnaire with a supplementation of maternal and neonatal medical records with checklists were used to collect the data. Data were coded and entered in to Epi data version 3.1 and then exported to the Statistical Package for Social Science IBM version 25 for analysis. Descriptive statistics was run and the data were presented using frequency tables and figure. The bi-variable and multivariable logistic regression was used to identify the possible factors of neonatal near miss. Finally, Adjusted Odds Ratio and 95% Confidence Intervals were used to declare statsticall significance.ResultAmong all 604 selected live births an overall proportion of NNM cases, 202 (33.4%) (95% CI: 29.7-37.1%) was obtained at Hawassa City Government Hospitals. Respiratory distress 158 (94%) and infection or sepsis 138 (84%) were found to be the leading causes of NNM cases in our study. Governmental and non-governmental employed mother (AOR = 3.05, 95% CI: 1.46-6.44) and Cesarean Section delivery (AOR = 1.89, (95% CI: 1.25-2.83)) were positively significantly associated with neonatal near miss. Whereas, pregnancy induced Hypertension (AOR = 0.43, 95%CI: 0.27-0.69) was negatively associated with neonatal near miss.ConclusionThis study revealed relatively high prevalence of NNM in the study areas. Employed women, pregnancy induced hypertension and cesarean section mode of delivery were found to be independent factors affecting the prevalence of NNM cases. Therefore, HUCSH and Adare general Hospitals should focus on proving quality antenatal care and prevention of occupational related problems among pregnant women.

Project description:There is little available evidence that quantifies the determinats of NNM in Ethiopia despite an increasing magnitude of neonatal mortality. Therefore, this study was designed to provide concrte evidence about the determinats of NNMS among neonates admitted to Guji and Borena Zones Public Hospitals, Southern Ethiopia, 2021. A facility based unmatched case control study design was conducted on 402 (134 cases and 268 controls) selected neonates admitted to Bule Hora, Adola and Yabelo General Hospitals from February 1-March 31, 2021. Cases were consecutively selected. Whereas for each case, two controls were selected by systematic random sampling technique. The data collection included a pretested and structured face-to-face interviewer administered questionnaire with a supplementation of maternal and neonatal medical records with checklists. Then the data were coded and entered in to Epi data version 3.1 and then exported to the Statistical Package for Social Science IBM version 25 for analysis. The descriptive statistics run and the results of the data were presented using frequencies, and tables. Bivariable and multi variable logistic regression was used for the analsysis of the data. Finally, Adjusted Odds Ratio together with 95% Confidence Intervals and p value <0.05 was used to declare the significance of all statistic. A total of 134 cases (neonatal near misses) and 268 controls (normal neonate) were participated in this study to make a response rate of 100% for both cases, and controls. In this study rural residence (AOR = 0.51, 95% CI: 0.27, 0.96), previous history of neonatal death (AOR = 4.85, 95%CI: 2.24,10.49), birth interval ≤ 2 years (AOR = 1.83, 95% CI: 1.04, 3.11) and history of abortion (both induced and miscarriage) (AOR = 1.97, 95%CI: 1.17, 3.31) were found to be statistically significant at a p-value of <0.05. History of prior abortion history of prior neonatal death and short birth interval (≤ 2 years) were identified to be the determinats of NNMs. High quality antenatal and intrapartum continuum of care should be provided for women and neonates. Additionally, contraceptive utilization should be encouraged for a women to space the births of their children.

Dataset Information

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusions

Tweetable abstract

Publications

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets