Abstract
Introduction: Maternal morbidity and mortality in India continues to remain high despite concerted efforts during the past decades. Objective of this study was to determine the prevalence and indicator of Potentially Lie Threatening Conditions (PLTC) and near miss obstetric cases at different tiers of health care. Material and Methods: A cross-sectional epidemiological study was carried out over a period of 12 months as per the WHO criteria for near miss. Probability sampling was done to systematically and randomly select health facilities i.e. two primary health centers (PHC), one community health centre (CHC) and a tertiary hospital all from Doiwala block of Dehradun, Uttarakhand, India. The study included all the women attending health-care facilities, who were pregnant, in labour, or who had delivered or aborted up to 42 days ago arriving at the facility. A convenient sampling was done (a hundred percent enumeration of eligible study subjects) for the audit. Result: A total of 937 pregnant women who accessed health care had 688 live births and 231 women had one or more of the Potentially Life Threatening Conditions (PLTC). Among them, 61 women had Severe Maternal Outcome (SMO) - 51 with maternal near-miss and 10 maternal deaths. The Severe Maternal Outcome Ratio (per 1000 live births) was 88.66. The Maternal near miss Mortality Ratio (MNM-MR) and Mortality Index (MI) were 5.1 and 16.39% respectively. Conclusion: The WHO near miss approach has been found to be an effective measure to assess quality of care in maternal health across countries including India.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.254-257
Highlights
Maternal morbidity and mortality in India continues to remain high despite concerted efforts during the past decades
One of the eight Millennium Development Goals (MDG) adopted following the Millennium Summit involves improving maternal health (MDG5) and Maternal Mortality Rate (MMR) was assumed a key indicator set for monitoring progress towards the achievement of MDG5 5
Material and Methods: The present cross sectional study was carried out over a period of 12 months under the Department of Community Medicine, HIHT University that included all the women attending health-care facilities, at all levels of health care i.e. Primary, Secondary & Tertiary level in Doiwala block of Dehradun district, who were pregnant, in labour, or who had delivered or aborted up to 42 days ago arriving at the facility with any of the listed conditions or those who developed any of those conditions during their stay at the health-care facility after taking written informed consent from incharge of the facility.Probability sampling was done to systematically and randomly select health facilities from first referral units (FRUs) i.e Primary & Community Health Centres (PHC, community health centre (CHC)) and Tertiary facility
Summary
Maternal mortality has recently become yet another indicator of disadvantage within and between the developing and developed countries 2. CHC – Community Health Centre; TH – Tertiary Hospital Percentage are mentioned in parenthesis Out of these 231 women with PLTC, women who presented with severe post-partum haemorrhage were 103 (42.42%) as the most common morbidity condition, followed by 62 (26.83%) with severe preeclampsia and 53 (22.94%) with sepsis (Table 1). There was significant association seen between severe post-partum haemorrhage, severe pre-eclampsia, eclampsia and sepsis or severe systemic infections as morbidity conditions in women with potentially life threatening condition and levels of health care. Levels of health care and development of potentially life threatening condition were not found to be significantly associated
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