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. 2016 May;123(6):928-38.
doi: 10.1111/1471-0528.13450. Epub 2015 May 14.

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

O T Oladapo  1 , O O Adetoro  2 , B A Ekele  3 , C Chama  4 , S J Etuk  5 , A P Aboyeji  6 , H E Onah  7 , A M Abasiattai  8 , A N Adamu  9 , O Adegbola  10 , A S Adeniran  6 , C O Aimakhu  11 , O Akinsanya  12 , L D Aliyu  13 , A B Ande  14 , A Ashimi  15 , M Bwala  16 , A Fabamwo  17 , A D Geidam  4 , J I Ikechebelu  18 , J O Imaralu  19 , O Kuti  19 , D Nwachukwu  20 , L Omo-Aghoja  21 , K Tunau  22 , J Tukur  23 , Ouj Umeora  24 , A C Umezulike  25 , O A Dada  26 , Ӧ Tunçalp  1 , J P Vogel  1 , A M Gülmezoglu  1 ; Nigeria Near-miss and Maternal Death Surveillance Network
Collaborators, Affiliations

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

O T Oladapo et al. BJOG. 2016 May.

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.

Keywords: Clinical audit; WHO near-miss criteria; maternal death; maternal near miss; quality of care; severe acute maternal morbidity.

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Figures

Figure 1
Figure 1
Relative contribution of key groups of complications by outcome severity.
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References

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