Maternal near Miss Morbidity: Results From a Hospital-Based Study in Accra, Ghana

The identification of cases of severe maternal morbidity has emerged as a promising complementary or alternative strategy to the measurement of maternal mortality and has been viewed as a useful outcome measure for evaluation and improvement of maternal health services in developing countries. Our study examined the incidence, risk factors and feasibility of collecting near miss surveillance data at a teaching hospital in Accra. The maternal mortality ratio was 1185 per 100,000 live births during the study period. Maternal near miss rates for disease-specific, intervention-specific and WHO criteria were 11.4, 12.2 and 2.9 per 100 live births, respectively. The most common disease-specific near miss events were severe preeclampsia (60%), followed by severe postpartum hemorrhage (27%), whereas the most common intervention-specific near miss event was use of blood products (76%). The most common identified WHO near miss criteria were coagulation/hematologic dysfunction (50%) and cardiovascular dysfunction (25%). After multivariate adjustment, gestational age and final mode of delivery remained significantly associated with being a near miss case for all three criteria. There is a need to utilize a uniform criteria and standard tool, which are both epidemiologically sound and feasible to use in developing countries to classify the very severe form of maternal morbidity: maternal near miss. Thus, summary estimates for near miss can be developed and serve as a measure of maternal health and quality of care indicator. WHO Criteria are more specific in identifying the severe cases and we observed that with sufficient capacity building within the facility, it is feasible to collect data prospectively using these criteria in a Sub-Saharan African facility setting.