Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 Dec;147(3):389-396.
doi: 10.1002/ijgo.12976. Epub 2019 Oct 17.

Rethinking the definition of maternal near-miss in low-income countries using data from 104 health facilities in Tanzania and Uganda

Andrea B Pembe  1   2 , Atsumi Hirose  3   4 , Fadhlun Alwy Al-Beity  1   2   3 , Susan Atuhairwe  5   6 , Jessica L Morris  7 , Frank Kaharuza  6   8 , Gaetano Marrone  3 , Claudia Hanson  3   9
Affiliations
Multicenter Study

Rethinking the definition of maternal near-miss in low-income countries using data from 104 health facilities in Tanzania and Uganda

Andrea B Pembe et al. Int J Gynaecol Obstet. 2019 Dec.

Abstract

Objective: To assess the consistency of maternal near-miss incidence and mortality index between two definitions across 104 facilities in Tanzania and Uganda.

Methods: Based on WHO guidance, cross-sectional near-miss data were collected in Tanzania (July 2015 to October 2016) and Uganda (June 2016 to September 2017). Prepartum hemorrhage and abortion were included as additional screening events and the number of blood units transfused was recorded. Near-miss incidence and mortality index were determined by using two near-miss definitions: the WHO standard definition, and a modified definition including women receiving at least 1 unit of blood. A sensitivity analysis excluded the additional screening events.

Results: Near-miss incidence differed between Tanzania and Uganda (1.79 and 4.00, respectively, per 100 deliveries) when estimated by the standard definition, but was similar (5.24 and 4.94, respectively) by the modified definition. The mortality index was higher in Tanzania than in Uganda when estimated by the standard definition (8.56% vs 3.54%), but was similar by the modified definition (3.10% vs 2.89%).

Conclusion: The modified definition provided a more consistent estimate of near-miss incidence and mortality index. Lowering the threshold for units of blood transfusion might improve comparability between settings, but more research is needed.

Keywords: Near-miss; Organ dysfunction; Severe maternal morbidity; Tanzania; Uganda.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

REFERENCES

    1. WHO, Human reproduction programme (HRP). Strategies Toward Ending Preventable Maternal Mortality (EPMM). Geneva: WHO; 2015. http://who.int/repro​ducti​vehea​lth/topic​s/mater​nal_perin​atal/epmm/en/. Accessed August 31, 2016.
    1. WHO. Evaluating the Quality of Care for Severe Pregnancy Complications. The WHO Near-Miss Approach for Maternal Health. Geneva: WHO; 2011.
    1. Tunçalp Ö, Hindin M, Souza J, Chou D, Say L. The prevalence of maternal near miss: A systematic review. BJOG. 2012;119:653-661.
    1. Kaye D, Kakaire O, Osinde M. Systematic review of the magnitude and case fatality ratio for severe maternal morbidity in sub-Saharan Africa between 1995 and 2010. BMC Pregnancy Childbirth. 2011;11:65.
    1. Tura AK, Trang TL, van den Akker T, et al. Applicability of the WHO maternal near miss tool in sub-Saharan Africa: A systematic review. BMC Pregnancy Childbirth. 2019;19:79.

Publication types

Grants and funding