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. 2018 Nov 26;18(1):458.
doi: 10.1186/s12884-018-2092-7.

Incidence of maternal near miss in the public health sector of Harare, Zimbabwe: a prospective descriptive study

Henry Chikadaya  1 , Mugove Gerald Madziyire  2 , Stephen P Munjanja  2
Affiliations

Incidence of maternal near miss in the public health sector of Harare, Zimbabwe: a prospective descriptive study

Henry Chikadaya et al. BMC Pregnancy Childbirth. .

Abstract

Background: Maternal 'near miss' can be a proxy for maternal death and it describes women who nearly died due to obstetric complications. It measures life threatening pregnancy related complications and allows the assessment of the quality of obstetric care.

Methods: A prospective descriptive study was carried out from October 1 2016 to 31 December 2016, using the WHO criteria for maternal 'near miss' at the two tertiary public hospitals which receive referrals of all obstetric complications in Harare city, Zimbabwe. The objective was to calculate the ratio of maternal 'near miss' and associated factors. All pregnant women who developed life threatening complications classified as maternal near miss using the WHO criteria were recruited and followed up for six weeks from discharge, delivery or termination of pregnancy or up to the time of death.

Results: During this period there were 11,871 births. One hundred and twenty three (123) women developed severe maternal outcomes, 110 were maternal 'near miss' morbidity and 13 were maternal deaths. The maternal 'near miss' ratio was 9.3 per 1000 deliveries, the mortality index (MI) was 10.6% and the maternal mortality ratio was 110 per 100,000 deliveries. The major organ dysfunction among cases with severe maternal outcomes (SMO) was cardiovascular dysfunction (76.9%). The major causes of maternal near miss were obstetric haemorrhage (31.8%), hypertensive disorders (28.2%) and complications of miscarriages (20%). The intensive care unit (ICU) admission rate was 7.3 per 100 cases of SMO and 88.8% of maternal deaths occurred without ICU admission.

Conclusion: The MNM ratio was comparable to that in the region. Obstetric haemorrhage was a leading cause of severe maternal morbidity though with less mortality when compared to hypertensive disorders and abortion complications. Zimbabwe should adopt maternal near miss ratio as an indicator for evaluating its maternal health services.

Keywords: Maternal mortality; Maternal near miss; Mortality indexs; Severe maternal morbidity; Severe maternal outcome.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical clearance was sought and obtained from: Harare Central Hospital Ethics Committee (11 July 2016, HCHEC 240616/40); The Director, City of Harare Department of Health (25 August 2016); The Joint Research Ethics Committee (1 September 2016, JREC Ref: 222/16); Medical Research Council of Zimbabwe (19 September 2016, MRCZ/B/1130). Written consent was obtained from conscious patients after they were stable and the ethical boards allowed us to collect anonymized information from records of those who died.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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

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