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Severe maternal morbidity (near-miss) and its correlates in the world’s newest nation: South Sudan

Authors Alemu FM, Fuchs MC, Martin Vitale T, Abdalla Mohamed Salih M

Received 16 December 2017

Accepted for publication 13 January 2019

Published 19 March 2019 Volume 2019:11 Pages 177—190


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Elie Al-Chaer

Fekadu Mazengia Alemu,1 Martina C Fuchs,2 Taban Martin Vitale,3 Mergani Abdalla Mohamed Salih4

1Department of Midwifery, Juba College of Nursing and Midwifery, Juba, South Sudan; 2Real Medicine Foundation, Los Angeles, CA, USA; 3Real Medicine Foundation, Juba, South Sudan; 4Department of Obstetrics and Gynecology, Juba Teaching Hospital, Juba, South Sudan

All authors contributed equally to this work

Background: This study investigates the frequency of near-miss events and compares correlates in the world’s newest nation.
Methods: A cross-sectional study was carried out to audit near-miss events and their causes. A total of 1,041 mothers were sampled. Data were gathered using World Health Organization near-miss evaluation tools according to morbidity and organ failure-based criteria. Intensive care unit admission criteria were not used (as there is no functional intensive care unit in Juba Teaching Hospital). Descriptive statistics and bivariate and multivariable logistic regression were used to analyze the data. The study adhered to the Declaration of Helsinki.
Results: Nearly half (49.7%) of the clients were young pregnant women (aged 15–24 years), with a mean age of 25.07±5.65 years. During the study period, there were 994 deliveries, 94 near-misses, and 10 maternal deaths. This resulted in maternal near-miss and mortality rates of 94.1 per 1,000 and 1,007 per 100,000 live births, respectively. Severe maternal outcome and maternal near-miss rates were 10.47 per 1,000 (morbidity-based criteria) and 41.3 per 1,000 (organ failure-based criteria), respectively. The likelihood of mortality was 25% (95% CI 10%–51%) for a ruptured uterus, 9% (95% CI 4%–17%) for severe postpartum hemorrhage, and 11% (95% CI 3%–30%) for eclampsia. Anemia, hemorrhage, and dystocia were the highest contributory factors in the occurrence of maternal near-misses.
Conclusion: The near-miss rate was high. Contributing factors were lack of resources, low quality of primary health care, and delays in care. All near-misses should be regarded as opportunities to improve the quality of maternity care. Health institutes should address delays in conducting interventions, referral barriers, and personnel gaps. Fully functional intensive-care units must be created in all facilities, including Juba Teaching Hospital and other hospitals. Notification policies for all near-miss cases should be in place in all health care units, with a “no shame, no blame” approach.

Keywords: severe maternal morbidity, near-miss, Juba Teaching Hospital, near-miss audit, severe acute morbidity, South Sudan

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