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Applicability of the WHO Maternal Near Miss Criteria in a Low-Resource Setting.doc

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Applicability of the WHO Maternal Near Miss Criteria in a Low-Resource Setting

ApplicabilityoftheWHOMaternalNearMissCriteriain aLow-ResourceSetting EllenNelissen1,2*,EstomihMduma1,JacquelineBroerse2,HegeErsdal1,3,Bj?rgEvjen-Olsen4,5,Josvan Roosmalen6,7,JelleStekelenburg8 1HaydomLutheranHospital,Mbulu,Manyara,Tanzania,2AthenaInstitute,FacultyofEarthandLifeSciences,VUUniversityAmsterdam,Amsterdam,TheNetherlands, 3StavangerAcuteMedicineFoundationforEducationandResearch,StavangerUniversityHospital,Stavanger,Norway,4CentreforInternationalHealth,Universityof Bergen,Bergen,Norway,5DepartmentofObstetricsandGynaecology,S?rlandetHospital,Flekkefjord,Norway,6DepartmentofObstetrics,LeidenUniversityMedical Centre,Leiden,TheNetherlands,7EMGOInstituteforHealthandCareResearch,VUUniversityMedicalCentre,Amsterdam,TheNetherlands,8DepartmentofObstetrics andGynaecology,LeeuwardenMedicalCentre,Leeuwarden,TheNetherlands Abstract Background: Maternal near misses are increasingly used to study quality of obstetric care. Inclusion criteria for the identificationofnearmissesarediverseandstudiesnotcomparable.WHOdevelopeduniversalnearmissinclusioncriteria in2009andthesecriteriahavebeenvalidatedinBrazilandCanada. Objectives:TovalidateandrefinetheWHOnearmisscriteriainalow-resourcesetting. Methods:Aprospectivecross-sectionalstudywasperformedinaruralreferralhospitalinTanzania.FromNovember2009 untilNovember2011,allcasesofmaternaldeath(MD)andmaternalnearmiss(MNM)wereincluded.Foridentificationof MNM,alocalmodificationoftheWHOnearmisscriteriawasused,becausemostlaboratory-basedandsomemanagement- based criteria could not be applied in this setting. Disease-based criteria were added as they reflect severe maternal morbidity. In the absence of a gold standard for identification of MNM, the clinical WHO criteria were validated for identificationofMD. Results:32MDand216MNMwereidentifiedusingthelocallyadaptednearmisscriteria;casefatalityrate(CFR)was12.9%. WHOnearmisscriteriaidentifiedonly60MNM(CFR35.6%).Allclinicalcriteria,25%ofthelaboratory-basedcriteriaand50% ofthemanagement-basedcr