Abstract
BackgroundThe maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria.MethodsWe conducted a cross sectional study of maternal near-miss cases in the four contexts beginning in 2011, where we collected data on severe maternal morbidity in the four study hospitals, using the WHO form (Individual Form HRP A65661). In each hospital, a research team including trained hospital healthcare providers carried out the data collection.ResultsA total of 9,063 live birth deliveries were reported during the data collection period across the four settings, with a total of 77 cases of severe maternal outcomes (71 maternal near-miss cases and 6 maternal deaths). Higher indices for the maternal mortality index were found in both Al Galaa hospital, in Egypt (8.6 %) and Dar Al Tawleed hospital in Syria (14.3 %), being large referral hospitals, compared to Ramallah hospital in Palestine and Rafik Hariri University hospital in Lebanon. Compared to the WHO’s Multicountry Survey using the same data collection tool, our study’s mortality indices are higher than the index of 5.6 % among countries with a moderate maternal mortality ratio in the WHO Survey. Overall, haemorrhage-related complications were the most frequent conditions among maternal near-miss cases across the four study hospitals. In all hospitals, coagulation dysfunctions (76.1 %) were the most prevalent dysfunction among maternal near-miss cases, followed by cardiovascular dysfunctions. The coverage of key evidence-based interventions among women experiencing a near-miss was either universal or very high in the study hospitals.ConclusionsFindings from this formative stage confirmed the need for quality improvement interventions. The high reported coverage of the main clinical interventions in the study hospitals would appear to be in contradiction with the above findings as the level of coverage of key evidence-based interventions was high.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0733-7) contains supplementary material, which is available to authorized users.
Highlights
The maternal near miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health [1, 2].A Maternal Near Miss (MNM) is defined by the World Health Organization (WHO) as a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy [1]
An increasing volume of research has been carried out with the aim of identifying maternal near-miss cases in order to understand health system failures in relation to obstetric care and to help determine solutions to address them [7].WHO’s own multicountry survey (MCS) of near-miss cases in 359 hospitals located in 29 countries, detailed analysis of which is included in a special supplement of the British Journal of Obstetrics and Gynaecology, provides a great deal of understanding about the number, severity and associated obstetric factors of near-miss cases in those settings, the personal characteristics of women who experience severe morbidity, as well as the types of interventions associated with those cases in the contributing health facilities [6]
In this paper we report on the prevalence of maternal near-miss cases in the four major public hospitals in Egypt, Lebanon, Palestine and Syria during the formative stage of a larger study that was designed to test the acceptability, feasibility and effectiveness of a multifaceted strategy combining clinical audit, feedback and engaging opinion leaders to improve quality of care in the four major public hospitals
Summary
The maternal near miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health [1, 2].A Maternal Near Miss (MNM) is defined by the World Health Organization (WHO) as a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy [1].Despite increased interest in the near miss concept, the measurement of maternal near-miss cases and severe maternal outcomes remained non-standardized [3] and WHO undertook a collaborative international process to establish internationally agreed criteria for near-miss cases [4,5,6,7]. The maternal near miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health [1, 2].A Maternal Near Miss (MNM) is defined by the World Health Organization (WHO) as a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy [1]. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria
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