Background
Methods
Data collection and inclusion criteria
Quality of methods and data abstraction
Results
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 |
Study | Location | Loss to follow-up (%) | Description of population characteri-stics | Data source | Description of study setting | Forms of reporting data | Case definition | Maternal deaths definition | Comments |
---|---|---|---|---|---|---|---|---|---|
Prual et al 2000 [28] | 6 countries in West Africa | 5.7% | Yes | Multiple source: interview, clinical examinations, records | Yes | Adjusted and standardized, used multivariate logistic regression | Clear | yes | special effort to capture all deaths |
Prual et al 1998 [29] | Niger | - | Yes | Multiple source: medical records and interview | No | adjusted | No | No | Only definition of hemorrhage |
Bernis et al 2000 [31] | Senegal | 2.3% | Yes | Multiple source: case records and interview | Yes | adjusted and standardized, used multivariate logistic regression | Clear | yes | special effort to capture all deaths |
Filippi et al 1998 [16] | Benin | - | No | Medical records | No | Crude estimates (frequencies and percentages) | No | No | special effort to capture all deaths |
Oladapo et al 2005 [27] | Nigeria | - | Yes | Multiple source: case records and interview | Yes | Crude estimates (frequencies and percentages) | Clear | yes | special effort to capture all deaths |
Mayi-Tsonga et al 2007 [33] | Gabon 2006 | - | Yes | Multiple source: case records and interview | Yes | Crude estimates (frequencies and percentages) | Clear | yes | Special effort to capture all deaths |
Mantel et al 1998 [ | South Africa | - | No | Medical records and every morning audit meetings | Yes | Crude | Yes | yes | special effort to capture all deaths |
Schoon 1999 [32] | South Africa | 2.20% | Yes (Mixed) | Multiple: interview and case records | No | Standardised | Yes | yes | special effort to capture all deaths |
Vandecruys et al 2002 [35] | South Africa | - | Yes | Multiple: daily audit meetings, case records | Yes | Adjusted and standardized | Yes | yes | special effort to capture all deaths |
Kaye et al 2003, Uganda [18] | Uganda | - | Yes | Multiple: interview, investigations and case records | Yes | Crude estimates (frequencies and percentages) | Clear | Clear | special effort to capture all deaths |
Okong et al 2006 [6] Uganda | Uganda | - | Yes | Multiple: interview, investigations and case records | Yes | Crude estimates (frequencies and percentages) | Clear | Clear | special effort to capture all deaths |
Study | Denominator | Severe maternal morbidity | Rupture of the uterus | *Haemorrhage | Sepsis | Eclampsia | Obstructed labor | Thrombo- embolism | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 1 | 2 | 1 | 2 | 1 | 2 | 1 | 2 | 1 | 2 | 1 | 2 | ||
Prual et al 1998, Niger | Live births | 6.4 | 13.7 | 0.1 | 0 | 0.9 | 14.5 | 0.2 | 50 | 0.22 | 5.9 | 3.4 | 3.2 | na | na |
Mayi-Tsonga, gabon | Deliveries | 3.15 | Na | na | Na | na | Na | na | na | na | na | na | Na | na | na |
Filippi et al 1998, Benin | Deliveries | 8.2 | 8.5 | na | na | 2.3 | 9.2 | 0.4 | 21 | 1 | 4.7 | 4.5 | 3.6 | na | na |
Mantel et al 1998, South Africa | Deliveries | 1.1 | 20.4 | na | na | 0.3 | 5.3 | 0.2 | 27.6 | Na | na | na | Na | na | na |
Schoon 1999, South Africa | Deliveries | 5.3 | 37.4 | na | na | 0.06 | 27.3 | 0.03 | 72.7 | Na | na | na | Na | 0.02 | 83.3 |
Prual et al 2000, West Africa | Live births | 6.6 | 3.1 | 0.1 | 30 | 3.05 | 2.8 | 0.09 | 18 | 0.19 | 18 | 2.05 | 0 | 0.02 | 50 |
Bernis et al 2000, Senegal | Deliveries | 7.1 | 5.4 | na | na | 2.3 | 6.0 | 0.2 | 0 | 1.7 | 4.8 | 2.2 | 0 | na | na |
Vandecruys et al 2002, South Africa | Deliveries | 1.1 | 20.0 | na | na | 0.83 | Na | 0.7 | na | Na | na | Na | Na | na | 100 |
Kaye et al 2003, Uganda | Pregnancies | 10.1 | 1.7 | 3.7 | 11.8 | 6.2 | 6.3 | 2.9 | 3.6 | 8.8 | 3.4 | 20.1 | 2.0 | na | na |
Oladapo et al 2005, Nigeria | Deliveries | 14.1 | 20.9 | 4.5 | 60.0 | 30.2 | 12.3 | 8.3 | 0.4 | 17.6 | 17.1 | 19.4 | 12.7 | na | na |
Okong et al 2006, Uganda | Pregnancies | 33.4 | na | na | Na | na | Na | na | na | na | na | na | na | na | na |
Saizonou et al 2006, Benin | Pregnancies | 26.7 | na | na | Na | 12.9 | Na | 3.4 | na | 24.9 | na | 8.7 | na | na | na |