Maternal Near Miss and quality of care in a rural Rwandan hospital.

Richard Kalisa,Thomas Van Den Akker,Jos Van Roosmalen,Stephen Rulisa

doi:10.1186/s12884-016-1119-1

Abstract

BackgroundThe WHO Maternal Near Miss (MNM) approach was developed to evaluate and improve quality of obstetric care worldwide. This study aimed to study the incidence of MNM and quality of care at a district hospital in rural Rwanda by applying this approach.MethodsA facility based, prospective cohort study conducted at a district hospital in rural Rwanda between June 2013 and December 2014. Subjects were followed from time of admission to discharge or death.ResultsIn 3979 deliveries, 3827 singletons and 152 twins pairs were born. Among the 4131 neonates, there were 3994 live births and 137 stillbirths. Ninety-nine women suffered severe maternal outcome (SMO): 86 maternal near misses and 13 deaths. This adds up to a maternal near miss ratio of 21.5 per 1000 live births (95 % CI 17.3-26.5), a maternal mortality ratio of 325 per 100 000 live births (95 % CI 181–543) and a mortality index of 13.1 % (95 % CI 7.3–21.9). Hemorrhage (n = 49, 57 %) and hypertensive disorders (n = 27, 31.4 %) were the commonest MNM conditions. Eclampsia (n = 4/13; 30.7 %) was the leading cause of maternal mortality, while sepsis/peritonitis following cesarean section (n = 2/6; 33.3 %) had the highest mortality index. Seventy-seven out of 99 SMO cases (77.9 %) were referred from other facilities with critical conditions and 28 out of 99 SMO cases (28.3 %) were admitted into the Intensive Care Unit. Several indicators such as administration of oxytocin, magnesium sulfate and antibiotics were found to be suboptimal.ConclusionsMNM is common at district level in Rwanda. The MNM approach enabled us to identify shortfalls in clinical practice and the referral system.

Highlights

The World Health Organization (WHO) Maternal Near Miss (MNM) approach was developed to evaluate and improve quality of obstetric care worldwide
The majority of these women die in low-income countries, and several countries in sub-Saharan Africa have very high maternal mortality ratios (MMR), often double the estimated global MMR of 400 per 100,000 live births [2]
This study aimed to assess MNM characteristics and process indicators related to quality of care at a district hospital in rural Rwanda, by applying the WHO MNM approach

Summary

Introduction

The WHO Maternal Near Miss (MNM) approach was developed to evaluate and improve quality of obstetric care worldwide. The aim was to facilitate comparisons between different studies, and between countries and regions [7], in order to address shortcomings in quality of obstetric care and improve pregnancy outcome [8]. Within this approach, an MNM refers to ‘a woman who almost died but survived a complication during pregnancy, childbirth, or within 42 days after termination of pregnancy’ [9, 10], and organ failure based criteria reflect critical illness and allow for identification of MNM.

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Results

Discussion

Conclusion