Maternal near miss in low-resource areas.

Robert L. Goldenberg, Columbia University School of Medicine, New York, NY, USA.
Sarah Saleem, Aga Khan UniversityFollow
Sumera Aziz Ali, Aga Khan UniversityFollow
Janet L. Moore, RTI International, Durham, NC, USA.
Adrien Lokangako, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Antoinette Tshefu, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Musaku Mwenechanya, University of Zambia, Lusaka, Zambia.
Elwyn Chomba, University of Zambia, Lusaka, Zambia.
Ana Garces, INCAP, Guatemala City, Guatemala.
Lester Figueroa, INCAP, Guatemala City, Guatemala.
Shivaprasad Goudar, KLE University, Belagavi, India.
Bhalachandra Kodkany, KLE University, Belagavi, India.
Archana Patel, Lata Medical Research Foundation, Nagpur, India.
Fabian Esamai, Moi University, Eldoret, Kenya.
Paul Nsyonge, Moi University, Eldoret, Kenya.
Margo S. Harrison, Columbia University School of Medicine, New York, NY, USA.
Melissa Bauserman, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Carl L. Bose, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Nancy F. Krebs, University of Colorado, Denver, CO, USA.
K. Michael Hambidge, University of Colorado, Denver, CO, USA.
Richard J. Derman, Thomas Jefferson University, Philadelphia, PA, USA.
Patricia L. Hibberd, Boston University, Boston, MA, USA.
Edward A. Liechty, Indiana University, Indianapolis, IN, USA.
Dennis D. Wallace, RTI International, Durham, NC, USA.
Jose M. Belizan, IECS University of Buenos Aires, Buenos Aires, Argentina.
Menachem Miodovnik, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA.
Marion Koso-Thomas, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA.
Waldemar A. Carlo, University of Alabama at Birmingham, Birmingham, AL, USA.
Alan H. Jobe, Cincinnati Hospital for Children, Cincinnati, OH, USA.
Elizabeth M. McClure, RTI International, Durham, NC, USA.

Document Type

Article

Department

Community Health Sciences

Abstract

OBJECTIVE:

To describe the Global Network Near-Miss Maternal Mortality System and its application in seven sites.

METHODS:

In a population-based study, pregnant women eligible for enrollment in the Maternal and Newborn Health Registry at seven sites (Democratic Republic of the Congo; Guatemala; Belagavi and Nagpur, India; Kenya; Pakistan; and Zambia) between January 2014 and April 2016 were screened to identify those likely to have a near-miss event. The WHO maternal near-miss criteria were modified for low-resource settings. The ratio of near-miss events to maternal deaths was calculated.

RESULTS:

Among 122 707 women screened, 18 307 (15.0%) had a potential near-miss event, of whom 4866 (26.6%; 4.0% of all women) had a near-miss maternal event. The overall maternal mortality ratio was 155 per 100 000 live births. The ratio of near-miss events to maternal deaths was 26 to 1. The most common factors involved in near-miss cases were the hematologic/coagulation system, infection, and cardiovascular system.

CONCLUSION:

By using the Global Network Near-Miss Maternal Mortality System, large numbers of women were screened for near-miss events, including those delivering at home or a low-level maternity clinic. The 4.0% incidence of near-miss maternal mortality is similar to previously reported data. The ratio of 26 near-miss cases to 1 maternal death suggests that near miss might evaluate the impact of interventions more efficiently than maternal mortality.

Publication (Name of Journal)

International Journal of Gynecology and Obstetrics

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