Incidence, determinants and perinatal outcomes of near miss maternal morbidity in Ile-Ife Nigeria: a prospective case control study

BMC Pregnancy and Childbirth

Adesegun O Fatusi²  Adedeji A Onayade²  Ikeola A Adeoye¹ 

[1] Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria;Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria

关键词: Nigeria;    Perinatal outcomes;    Pregnancy complications;    Maternal health;    Near miss maternal morbidity;   

Others  :  1138077
DOI  :  10.1186/1471-2393-13-93

 received in 2012-08-16, accepted in 2013-03-27,  发布年份 2013

【 摘 要 】

Background

Maternal mortality ratio in Nigeria is one of the highest in the world. Near misses occur in larger numbers than maternal deaths hence they allow for a more comprehensive analysis of risk factors and determinants as well as outcomes of life-threatening complications in pregnancy. The study determined the incidence, characteristics, determinants and perinatal outcomes of near misses in a tertiary hospital in South-west Nigeria.

Methods

A prospective case control study was conducted at the maternity units of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between July 2006 and July 2007. Near miss cases were defined based on validated disease-specific criteria which included severe haemorrhage, hypertensive disorders in pregnancy, prolonged obstructed labour, infection and severe anemia. Four unmatched controls of pregnant women were selected for every near miss case. Three categories of risk factors (background, proximate, clinical) which derived from a conceptual framework were examined. The perinatal outcomes were also assessed. Bi-variate logistic regressions were used for multivariate analysis of determinants and perinatal outcomes of near miss.

Results

The incidence of near miss was 12%. Severe haemorrhage (41.3%), hypertensive disorders in pregnancy (37.3%), prolonged obstructed labour (23%), septicaemia (18.6%) and severe anaemia (14.6%) were the direct causes of near miss. The significant risk factors with their odds ratio and 95% confidence intervals were: chronic hypertension [OR=6.85; 95% CI: (1.96 – 23.93)] having experienced a phase one delay [OR=2.07; 95% CI (1.03 – 4.17)], Emergency caesarian section [OR=3.72; 95% CI: (0.93 – 14.9)], assisted vaginal delivery [OR=2.55; 95% CI: (1.34 – 4.83)]. The protective factors included antenatal care attendance at tertiary facility [OR=0.19; 95% CI: (0.09 – 0.37)], knowledge of pregnancy complications [OR=0.47; 95% CI (0.24 – 0.94)]. Stillbirth [OR=5.4; 95% CI (2.17 – 13.4)] was the most significant adverse perinatal outcomes associated with near miss event.

Conclusions

The analysis of near misses has evolved as a useful tool in the investigation of maternal health especially in life-threatening situations. The significant risk factors identified in this study are amenable to appropriate public health and medical interventions. Adverse perinatal outcomes are clearly attributable to near miss events. Therefore the findings should contribute to Nigeria’s effort to achieving MDG 4 and 5.

【 授权许可】

   
2013 Adeoye et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]WHO/UNFPA/UNICEF/World Bank: Maternal mortality 2005. Estimates developed by WHO, UNICEF, UNFPA, and the World Bank. Geneva: The World Health Organization; 2007.
• [2]AbouZahr C, Wardlaw T: Maternal mortality at the End of a decade: signs of progress? Bull World Health Organ 2001, 79(6):561-568.
• [3]WHO/UNFPA/UNICEF/World Bank: Reduction of maternal mortality: A joint WHO/UNFPA/UNICEF/World Bank statement. Geneva: The World Health Organization; 1999.
• [4]Ronsmans C, Filippi V: Reviewing severe maternal morbidity: learning from survivors from life-threatening complications. In Beyond the Numbers: Reviewing Maternal Deaths and Complication to Make Pregnancy Safer. (Chapter 7). Geneva: World Health Organization; 2004:103-124.
• [5]Mantel GD, Buchmann E, Rees H, Pattinson RC: Severe acute maternal morbidity: a pilot study of a definition for a near miss. Br J Obstet Gynaecol 1998, 105:985-990.
• [6]Tunçalp O, Hindin MJ, Souza JP, Chou D, Say L: The prevalence of maternal near miss: a systematic review. Br J Obstet Gynaecol 2012, 119:653-661.
• [7]Say L, Souza JP, Pattinson RC, WHO working group on Maternal Mortality and Morbidity classifications: Maternal near miss – towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol 2009, 23:287-296.
• [8]Pattison RC, Buchmann E, Mantel G, Schoon M, Rees H: Can enquires into severe acute maternal morbidity act as surrogate for maternal death enquires? BJOG 2003, 110:889-893.
• [9]Souza J, Cecatti JG, Hardy EF, Serruya SJ, Amaral E: Appropriate criteria for identification of near miss maternal morbidity in tertiary care facilities: a cross sectional study. BMC Pregnancy Childbirth 2007, 7:20. BioMed Central Full Text
• [10]Waterstone M, Bewley S, Wolfe C: Incidence and predictors of severe obstetric morbidity: case control study. Br Med J 2001, 322:1084-1094.
• [11]Paruk F, Moodley J: Severe obstetric morbidity. Curr Opin Obstet Gynecol 2001, 13:563-568.
• [12]Goffman D, Madden RC, Harrison EA, Merkatz IR, Chazotte C: Predictors of maternal mortality and near-miss maternal morbidity. J Perinatol 2007, 27:597-601.
• [13]Haywood LB, Small M, Taylor YJ, Chireau M, Howard DL: Near miss maternal mortality in a multiethnic population. Ann Epidemiol 2011, 21:73-77.
• [14]Pattinson RC, Hall M: Near misses: a useful adjunct to maternal death enquires. Br Med Bull 2003, 67:231-243.
• [15]Bewley S, Wolfe C, Waterstone M: Severe morbidity in the UK. In Maternal Morbidity and Mortality. Edited by MacLean AB, Neilson JP. London: RCOG Press; 2002:132-146.
• [16]Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, Moawad AH: Maternal and perinatal outcome associated with a trial of labour after prior caesarian delivery. N Eng J Med 2004, 351:2581-2589.
• [17]Bang RA, Bang AT, Reddy MH, Deshmukh MD, Baitule SB, Filippi V: Maternal morbidity during labour and the puerperium in rural home and the need for medical attention: a prospective observational study in gadchiroli. India BJOG 2004, 3:231-238.
• [18]Filippi V, Ganaba R, Storeng K, Sombie I, Ouedraogo T, Marshall T, Ouattara F, Akoum M, Collin S, Meda : Consequences of near miss obstetric complications in Burkina Faso: Initial insight into further questions. 2000.
• [19]United Nations Children Fund (UNICEF): Levels and Trends in Child Mortality Report 2011 generated by UN Inter-agency group on Childhood mortality estimation. http://www.childinfo.org/files/Child_Mortality_Report_2011.pdf webcite. Accessed 20 May 2012. p.9-12.
• [20]Shi Wu W, Huang L, Liston R, Heaman M, Baskett T, Rusen ID, Joseph KS, Kramer MS: Severe maternal morbidity in Canada, 1991 – 2001. CMAJ 2005, 173(7):759-764.
• [21]Mantel GD, Buchmann E, Rees H, Pattinson RC: Severe acute maternal morbidity: a pilot study of a definition for a near miss. J Obstet Gynaecol 1998, 105:985-990.
• [22]Baskett TF, Sternadel J: Maternity intensive care and near-miss mortality in obstetrics. Br J Obstet Gynaecol 1998, 105:981-984.
• [23]Ali AA, Khojali A, Okud A, Adam GK, Adam I: Maternal near-miss in a rural hospital in Sudan. BMC Pregnancy Childbirth 2011, 11:48. http://www.biomedcentral.com/content/pdf/1471-2393-11-48.pdf webcite BioMed Central Full Text
• [24]Almerie Y, Almerie MQ, Matar HE, Yasser S, Chamat AA, Abdulsalam A: Obstetric near-miss in maternity university hospital, Damascus, Syria: a retrospective study. BMC Pregnancy Childbirth 2010, 10:65. http://www.biomedcentral.com/content/pdf/1471-2393-10-65.pdf webcite BioMed Central Full Text
• [25]Reynolds HW, Bouvier-Colle MH, Bennett T: Adolescent’s use of Health care services and the risk for maternal morbidity in West Africa: the MOMA study. 2010, 24. http://www.archive-iussp.org/Brazil2001/s80/S86_03_Reynolds.pdf webcite. Accessed 23 December
• [26]National Bureau of Statistics: Federal Republic of Nigeria Official Gazette. Legal notice on publication of 2006 census final result. Vol 6, No 2,. 2009. http://placng.org/Legal%20Notice%20on%20Publication%20of%202006%20Census%20Final%20Results.pdf webcite. Accessed 3 December 2010.
• [27]Filippi V, Ronsmans C, Gohou V, Goufodji S, Lardi M, Amina S, Saizonou J, de Brouwere V: Maternity wards or emergency obstetric rooms? Incidence of near miss events in African hospitals. Acta Obstetrica et Gynaecolgica Scandinavica 2005, 84:11-16.
• [28]Oladapo OT, Sule-Odu AO, Olatunji AO, Daniel OJ: “Near- Miss” obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study. Reprod Heal 2005, 2:9. http://www.reproductive-health-journal.com/content/pdf/1742-4755-2-9.pdf webcite BioMed Central Full Text
• [29]Hennekens CH, Buring JE: Epidemiology in Medicine. 1987.
• [30]Federal Ministry of Health, Nigeria (FMOH): Integrated Maternal, Newborn and Child Health strategy. Abuja: FMOH; 2007.
• [31]National Population Commission (NPC) [Nigeria] and ICF Macro: Nigeria Demographic and Health Survey, 2010. Abuja and Calvertion, ICF Macro
• [32]Federal Ministry of Health, Nigeria (FMOH): Technical Report, National HIV/AIDS and Reproductive Health Survey 2007. Abuja: FMOH; 2007.
• [33]Seely EW, Maxwell C: Chronic Hypertension in pregnancy. Circulation 2007, 115:e188-e190. http://circ.ahajournals.org/content/115/7/e188.full.pdf webcite+html accessed
• [34]WHO: Global status report on noncommunicable diseases 2010. Geneva: The World Health Organization; 2010.
• [35]Killewo J, Anwar I, Bashir I, Yunnus M: Perceived delay in healthcare-seeking behaviour for episodes of serious illness and implications for safe motherhood interventions in rural Bangladesh. J Health Popul Nutr 2006, 24(4):403-412.
• [36]Babalola S, Fatusi A: Determinants of the use of maternal health services in Nigeria – looking beyond individual and household factors. BMC Pregnancy Childbirth 2009, 9(1):43. BioMed Central Full Text
• [37]Adewuyi AA: Pregnancy care: Understanding male involvement in maternal emergency. Ede, Nigeria: Centre for Research, Evaluation Resources and Development (CRERD); 1999:1-37.