Incidence and causes of severe maternal outcomes in Somaliland using the sub‐Saharan Africa maternal near‐miss criteria: A prospective cross‐sectional study in a national referral hospital

• Published in: International journal of gynecology and obstetrics Vol. 159; no. 3; pp. 856 - 864
• Main Authors: Egal, Jama Ali, Kiruja, Jonah, Litorp, Helena, Osman, Fatumo, Erlandsson, Kerstin, Klingberg‐Allvin, Marie
• Format: Journal Article
• Language: English
• Published: United States John Wiley and Sons Inc 01.12.2022
• Subjects: Clinical; Cross-Sectional Studies; Female; Hospitals; Humans; Incidence; low-income country; maternal death; Maternal Mortality; Medicin och hälsovetenskap; Near Miss, Healthcare; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Complications, Infectious; Prospective Studies; Referral and Consultation; Sub‐Saharan Africa criteria; WHO maternal near-miss; maternal death; Sub-Saharan Africa criteria; WHO maternal near-miss; low-income country
• ISSN: 0020-7292; 1879-3479; 1879-3479
• DOI: 10.1002/ijgo.14236

Objective To describe the incidence and causes of severe maternal outcomes and the unmet need for life‐saving obstetric interventions among women admitted for delivery in a referral hospital in Somaliland. Methods A prospective cross‐sectional study was conducted from April 15, 2019 to March 31, 2020, with women admitted during pregnancy or childbirth or within 42 days after delivery. Data were collected using the World Health Organization (WHO) and sub‐Saharan Africa (SSA) maternal near‐miss (MNM) tools. Descriptive analysis was performed by computing frequencies, proportions, and ratios. Results The MNM ratios were 56 (SSA criteria) and 13 (WHO criteria) per 1000 live births. The mortality index was highest among women with medical complications (63%), followed by obstetric hemorrhage (13%), pregnancy‐related infection (10%), and hypertensive disorders (7.9%) according to the SSA MNM criteria. Most women giving birth received prophylactic oxytocin for postpartum hemorrhage prevention (97%), and most laparotomies (60%) for ruptured uterus were conducted after 3 h. Conclusion There is a need to improve the quality of maternal health services through implementation of evidence‐based obstetric interventions and continuous in‐service training for healthcare providers. Using the SSA MNM criteria could facilitate such preventive measures in this setting as well as similar low‐resource contexts.