Incidence and causes of maternal near-miss in selected hospitals of Addis Ababa, Ethiopia

BACKGROUND: Because maternal mortality is a rare event, it is important to study maternal near-miss as a complement to evaluate and improve the quality of obstetric care. Thus, the study was conducted with the aim of assessing the incidence and causes of maternal near-miss. METHODS: A facility-based cross-sectional study was conducted in five selected public hospitals of Addis Ababa, Ethiopia from May 1, 2015 to April 30, 2016. All maternal near-miss cases admitted to the selected hospitals during the study period were prospectively recruited. World Health Organization criteria were used to identify maternal near-miss cases. The number of maternal near-miss cases over one year per 1000 live births occurring during the same year was calculated to determine the incidence of maternal near-miss. Underlying and contributing causes of maternal near-miss were documented from each participant's record. RESULTS: During the one-year period, there were a total of 238 maternal near-miss cases and 29,697 live births in all participating hospitals, which provides a maternal near-miss incidence ratio of 8.01 per 1000 live births. The underlying causes of the majority of maternal near-miss cases were hypertensive disorders and obstetric hemorrhage. Anemia was the major contributing cause reported for maternal near-miss. Most of the maternal near-miss cases occurred before the women's arrival at the participating hospitals. CONCLUSION: The study demonstrated a lower maternal near-miss incidence ratio compared to previous country-level studies. The majority of the near-miss cases occurred before the women's arrival at the participating hospitals, which underscores the importance of improving pre-hospital barriers. Efforts made toward improvement in the management of life-threatening obstetric complications could reduce the occurrence of maternal near-miss problems that occur during hospitalization

Distant and proximate factors associated with maternal near-miss: : a nested case-control study in selected public hospitals of Addis Ababa, Ethiopia

Background: Ethiopia is one of the sub-Saharan Africa countries with the highest maternal mortality. Maternalnear-misses are more common than deaths and statistically stronger for a comprehensive analysis of thedeterminants. The study aimed to identify the factors associated with maternal near-miss in selected publichospitals of Addis Ababa, Ethiopia. Methods: We conducted a nested case-control study in five selected public hospitals of Addis Ababa, Ethiopiafrom May 1, 2015 to April 30, 2016. Participants were interviewed by well-trained data collectors using pre-testedquestionnaire. Medical records were also reviewed to gather relevant information. World Health Organizationcriteria were used to identify maternal near-miss cases. A total of three controls matched for age and study areawas selected for each maternal near-miss case. Bivariate and multivariable conditional logistic regressions wereperformed using Stata version 13.0. Results: A total of 216 maternal near-miss cases and 648 controls were included in the study. The main factorsassociated with maternal near-miss were: history of chronic hypertension (AOR = 10.80,95% CI; 5.16–22.60), ruralresidency (AOR = 10.60,95% CI;4.59–24.46), history of stillbirth (AOR = 6.03,95% CI;2.09–17.41), no antenatal careattendance (AOR = 5.58,95% CI;1.94–16.07) and history of anemia (AOR = 5.26,95% CI;2.89–9.57). Conclusions: There is a need for appropriate interventions in order to improve the identified factors. The factorscan be modified through a better access to medical and maternity care, scaling up of antenatal care in rural areas,improve in infrastructure to fulfill referral chain from primary level to secondary and tertiary health care levels, andhealth education to pregnant women

Maternal near-miss and the risk of adverse perinatal outcomes : a prospective cohort study in selected public hospitals of Addis Ababa, Ethiopia.

BACKGROUND: Presence of maternal near-miss conditions in women is strongly associated with the occurrence of adverse perinatal outcomes, but not well-understood in low-income countries. The study aimed to ascertain the effect of maternal near-miss on the risk of adverse perinatal outcomes in Ethiopia. METHODS: A prospective cohort study was conducted in five public hospitals of Addis Ababa, Ethiopia. Women admitted from May 1, 2015 to April 30, 2016 were recruited for the study. We followed a total of 828 women admitted for delivery or treatment of pregnancy-related complications along with their singleton newborn babies. Maternal near-miss was the primary exposure and was ascertained using the World Health Organization criteria. Women who delivered without complications were taken as the non-exposed groups. The main outcome was adverse perinatal outcomes. Data on maternal near-miss and perinatal outcomes were abstracted from medical records of the participants. Exposed and non-exposed women were interviewed by well-trained data collectors to obtain information about potential confounding factors. Logistic regressions were performed using Stata version 13.0 to determine the adjusted odds of adverse perinatal outcomes. RESULTS: A total of 207 women with maternal near-miss and 621 women with uncomplicated delivery were included in the study. After adjusting for potential confounders, women with maternal near-miss condition had more than five-fold increased odds of adverse perinatal outcomes compared to women who delivered without any complications (AOR = 5.69: 95% CI; 3.69-8.76). Other risk factors that were independently associated with adverse perinatal outcomes include: rural residence, history of prior stillbirth and primary educational level. CONCLUSIONS: Presence of maternal near-miss in women is an independent risk factor for adverse perinatal outcomes. Hence, interventions rendered at improvement in maternal health of Ethiopia can lead to an improvement in perinatal outcomes

Characteristics of women with maternal near-miss in five selected public hospitals of Addis Ababa, Ethiopia from May 1, 2015 to April 30, 2016.

<p>Characteristics of women with maternal near-miss in five selected public hospitals of Addis Ababa, Ethiopia from May 1, 2015 to April 30, 2016.</p

Organ dysfunction in maternal near-miss cases in five selected public hospitals of Addis Ababa, Ethiopia, May 2015 to April 30, 2016.

<p>Organ dysfunction in maternal near-miss cases in five selected public hospitals of Addis Ababa, Ethiopia, May 2015 to April 30, 2016.</p

Underlying causes of maternal near-miss in five selected public hospitals, Addis Ababa, Ethiopia May1, 2015 to April 30, 2016.

<p>Underlying causes of maternal near-miss in five selected public hospitals, Addis Ababa, Ethiopia May1, 2015 to April 30, 2016.</p

Contributing causes of maternal near-miss in five selected public hospitals, Addis Ababa, Ethiopia May1, 2015 to April 30, 2016.

<p>Contributing causes of maternal near-miss in five selected public hospitals, Addis Ababa, Ethiopia May1, 2015 to April 30, 2016.</p

Incidence of maternal near-miss in five selected public hospitals of Addis Ababa, Ethiopia from May 1, 2015 to April 30, 2016.

<p>Incidence of maternal near-miss in five selected public hospitals of Addis Ababa, Ethiopia from May 1, 2015 to April 30, 2016.</p

Spatial heterogeneity in mass drug administration from a longitudinal epidemiological study assessing transmission interruption of soil transmitted helminths in the Wolaita zone of southern Ethiopia (Geshiyaro Project).

ObjectivesDeworming programmes of soil-transmitted helminths are generally monitored and evaluated by aggregating drug coverage and infection levels at a district level. However, heterogeneity in drug coverage at finer spatial scales means indicators may remain above thresholds for elimination as a public health problem or of transmission in some areas. This paper aims to highlight the misleading information that aggregating data at larger spatial scales can have for programme decision making.MethodsDrug coverage data from the Geshiyaro project were compared at two spatial scales with reference to the World Health Organisation's targets. District (woreda) and village (kebele) level were compared. The association between infection levels and drug coverage was analysed by fitting a weighted least-squares function to the mean intensity of infection (eggs per gram of faeces) against drug coverage.ResultsThe data show clearly that when the evaluation of coverage is aggregated to the district level, information on heterogeneity at a finer spatial scale is lost. Infection intensity decreases significantly (p = 0.0023) with increasing drug coverage.ConclusionAggregating data at large spatial scales can result in prematurely ceasing deworming, prompting rapid infection bounce-back. There is a strong need to define context-specific spatial scales for monitoring and evaluating intervention programmes

Maps of the Geshiyaro study region within the Wolaita zone.

(a) village level MDA coverage in School Aged Children (SAC) populations; (b) standard error of MDA coverage; (c) villages that were above or below WHO’s target threshold (75%) for MDA coverage; (d) the aggregated MDA coverage at the district level. Abbreviations: SAC–school-aged children. Shapefile data from GADM (https://gadm.org/download_country.html).</p