Abstract
BackgroundWomen from low-income settings have higher risk of maternal near miss (MNM) and suboptimal care than natives in high-income countries. Iran is the second largest host country for Afghan refugees in the world. Our aim was to investigate whether care quality for MNM differed between Iranians and Afghans and identify potential preventable attributes of MNM.MethodsAn MNM audit study was conducted from 2012 to 2014 at three university hospitals in Tehran. Auditors evaluated the quality of care by reviewing the hospital records of 76 MNM cases (54 Iranians, 22 Afghans) and considering additional input from interviews with patients and professionals. Main outcomes were frequency of suboptimal care and the preventable attributes of MNM. Crude and adjusted odds ratios with confidence intervals for the independent predictors were examined.ResultsAfghan MNM faced suboptimal care more frequently than Iranians after adjusting for educational level, family income, and insurance status. Above two-thirds (71%, 54/76) of MNM cases were potentially avoidable. Preventable factors were mostly provider-related (85%, 46/54), but patient- (31%, 17/54) and health system-related factors (26%, 14/54) were also important. Delayed recognition, misdiagnosis, inappropriate care plan, delays in care-seeking, and costly care services were the main potentially preventable attributes of MNM.ConclusionsAfghan mothers faced inequality in obstetric care. Suboptimal care was provided in a majority of preventable near-miss events. Improving obstetric practice and targeting migrants’ specific needs during pregnancy may avert near-miss outcomes.
Highlights
Women from low-income settings have higher risk of maternal near miss (MNM) and suboptimal care than natives in high-income countries
We sought to identify potentially preventable factors predisposing to MNM. This audit study was part of an MNM project that was conducted between March 2012 and May 2014 at three hospitals affiliated with the Shahid Beheshti University of Medical Sciences in Tehran
Audit findings Generally, inadequate care items were identified in 85% (65/76) of cases
Summary
Women from low-income settings have higher risk of maternal near miss (MNM) and suboptimal care than natives in high-income countries. Iran is the second largest host country for Afghan refugees in the world. Disparities in maternal outcomes between migrants from low-income settings and natives in high-income countries are well documented in the literature [1, 2]. Suboptimal care due to incongruent language and communication barriers, and unequal access to obstetric services are more frequent in migrant populations than European natives [3, 5]. With 79 million inhabitants, hosts refugees from neighbouring countries and accommodates an estimated one million registered and over two million unregistered migrants from Afghanistan [6, 7].
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