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Multicenter Study
. 2017 Nov 25;17(1):394.
doi: 10.1186/s12884-017-1581-4.

Severe maternal outcomes and quality of care at district hospitals in Rwanda- a multicentre prospective case-control study

Felix Sayinzoga  1 , Leon Bijlmakers  2 , Koos van der Velden  3 , Jeroen van Dillen  4
Affiliations
Multicenter Study

Severe maternal outcomes and quality of care at district hospitals in Rwanda- a multicentre prospective case-control study

Felix Sayinzoga et al. BMC Pregnancy Childbirth. .

Abstract

Background: Despite a significant decrease in maternal mortality in the last decade, Rwanda needs further progress in order to achieve Sustainable Development Goals (SDG)3 which addresses among others maternal mortality. Analysis of severe maternal outcomes (SMO) was performed to identify their characteristics, causes and contributory factors, using standard indicators for quality of care.

Methods: A prospective case-control study was conducted for which data were collected between November 2015 and April 2016 in four rural district hospitals. The occurrence of SMO with near miss incidence ratios was established, followed by an analysis of the characteristics, clinical outcomes, causes and contributory factors.

Results: The SMO incidence ratio was 38.4 per 1000 live births (95% CI 33.4-43.4) and the maternal near-miss incidence ratio was 36 per 1000 live births (95% CI 31.1-40.9). The leading causes of SMO were postpartum haemorrhage (23.4%), uterine rupture (22.9%), abortion related complications (16.8%), malaria (13.6%) and hypertensive disorders (8.9%). The case fatality rate was high for women with hypertensive disorders (10.5%; CI 3.3-24.3) and severe postpartum haemorrhage (8%; CI 0.5-15.5). Stillbirth (OR = 181.7; CI 43.5-757.9) and length of stay at the hospital (OR = 7.9; CI 4.5-13.8) were strongly associated with severe outcomes.

Conclusions: Despite the use of life saving interventions, SMO are frequent. Mortality index was found to be low at the level of district hospitals. SMO were associated with long stay at the hospital and stillbirth. There is a need for improvement of quality of care, referral practices and certain types of infrastructure, especially blood banks, which would ensure truly comprehensive emergency obstetric care and reduce the occurrence of SMO.

Keywords: Maternal near miss; Obstetrics; Quality of care; Severe maternal outcome.

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Conflict of interest statement

Ethics approval and consent to participate

The protocol for this study was approved both by the National Health Research Committee (NHRC/2015/PROT/006) and the Rwanda National Ethics Committee (105/RNEC/2015). Data collection did not require any direct interaction with patients. All needed data were extracted from health-facility records without any patient identification, no information was obtained directly from patients and no patient was interviewed. Some staff at participating district hospitals or at health centres that referred patients were interviewed to clarify certain information about individual cases. Confidential information about the identity of individual participants like identification number and patient file number were kept undisclosed by the data collector and were used only to complete forms in case of doubt or missing data. According to the Health Sector Research Policy on availability and data used and given the above precautions and that individual participants were not approached directly for data collection, informed consent from individual patients was considered not necessary.

Consent for publication

Not Applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

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