Table 1 Studies on near-miss obstetric morbidity in sub-Saharan Africa
Study | Country | Study design | Setting | Population | Sample size | Studied condition | Definition of near-miss morbidity | Comments |
|---|---|---|---|---|---|---|---|---|
West Africa | ||||||||
Prual et al, 2000 [28] | 6 countries of West Africa | Cohort population-based prospective | Total population | Mixed (rural and urban) | 20326 | Haemorrhage, dystocia, sepsis, rupture of uterus, severe liver disorders, eclampsia, sepsis, cesarean section, thrombo-embolism, vesicovaginal fistula | Clinical diagnoses (such as haemorrhage with blood transfusion, sepsis - septicaemia, peritonitis or odorous vaginal discharge | Assessed quality of obstetric care. |
Prual et al 1998 [29] | Niger | Cross-sectional | 6 medical facilities | Unknown | 4081 | Severe obstetric morbidity: dystocia, uterine rupture, preeclampsia, eclampsia, haemorrhage, puerperal sepsis, infectious diseases and others | Based on clinical examination. Haemorrhage - hypovolemic shock requiring urgent blood transfusion | Severe complications from 28th week of gestation to42nd day post partum that would have resulted in death or disability without medical intervention. |
De Bernis et al 2000 [31] | Senegal | Population- based cohort | 2 regions | Urban | 3777 | Maternal morbidity: haemorrhage, hypertensive disorders, sepsis, obstructed labour, others | Clinical diagnosis and medical or obstetrical interventions. | Compare outcomes and management in two different regions. |
Filippi et al 1998 [16] | Benin | Cross-sectional | Hospital | Unknown | 4291 | Near-misses: eclampsia, haemorrhage, dystocia, puerperal infections. | Not specified | Assessed quality of care for the near miss cases |
Saizonou et al 2006 [34] | Benin | Prospective observational study | Health facility two teaching, two regional and three district hospitals | Mixed | 557 | All obstetric conditions including ectopic pregnancy | Criteria of signs and symptoms of obstetric complications | Assessed quality of care for the near miss cases |
Oladapo et al 2005 [27] | Nigeria | Retrospective review of records | Health facilities | Mixed | 1501 | All obstetric conditions | Criteria of symptoms and signs and management-based criteria | Assessed quality of care. Calculated the maternal mortality index. |
Mayi-Tsonga et al 2007[33] | Gabon | Prospective 6-month study | Health facility | Mixed | 4350 | All obstetric conditions as well as ectopic pregnancy and abortions | Criteria of symptoms and signs and management-based criteria | Assessed quality of care |
Southern Africa | ||||||||
Mantel et al 1998 [11] | South Africa | Cross-sectional prospective multicentre 2 year audit | Hospital | Unknown | 13429 | Near-misses: vascular, cardiac, immunological, coagulation, renal, respiratory dysfunctions, all ICU admissions, emergency hysterectomies, anaesthetic accidents | Clear definitions of haemorrhage, abortion complications, sepsis, pulmonary oedema and others | Based on organ dysfunction and management A near-miss describes a patient with an acute organ system dysfunction, which if not treated appropriately, could result in death. |
Schoon 1999 South Africa [32] | South Africa | Incidence/prevalence, population-based cohort study | Region | Mixed | 34100 | Vascular, cardiac, immunological, coagulation, renal, respiratory dysfunctions, all ICU admissions, emergency hysterectomies, anaesthetic accidents | Clear definitions of haemorrhage, abortion complications, sepsis and others | Near-miss - all cases with organ dysfunction or organ failure during pregnancy of any gestation until 42 days after termination of pregnancy. |
Vandecruys et al 2002 South Africa [35] | South Africa | Incidence/prevalence multicentric population-based prospective study | Region | Unknown | 40006 | Severe acute maternal morbidity (SAMM): hypertensive disorders, pregnancy related and not related sepsis, haemorrhage, abortions complications, embolism and others. | Clinical. | Audit of maternal death. Calculated the mortality index (MI)†defined as Maternal death divided by SAMM and maternal death. Compared data of different years. |
Eastern Africa | ||||||||
Kaye et al 2003, Uganda [18] | Uganda 2002-2003 | Cross-sectional | Hospital | Women admitted in labor or pueperium | 983 | Severe life-threatening complications among emergency obstetric referrals | Severe acute morbidity from acute organ/system dysfunction, | Compared the utility of using organ/system dysfunction criteria to criteria of clinical signs/symptoms |
Okong et al 2006, Uganda [6] | Uganda 2003-2005 | Cross-sectional | Hospital | Women admitted in labor or puerperium | 685 | All obstetric conditions | Life-threatening complications | Assessed the quality of care and the three delays |