DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20193539

A longitudinal study of near-miss and maternal mortality at a tertiary centre in rural Uttarakhand: addressing the fourth delay

Mishu Mangla, Ruchira Nautiyal, Deepmala .

Abstract


Background: India is a signatory of the sustainable development goals and is committed to reduce the maternal mortality ratio to less than 70 per lakh live births. Review of maternal deaths and near miss cases is a very important step towards achieving this aim.

Methods: A prospective observational study was carried out in a tertiary care centre in rural Uttarakhand for a period of one and half year using WHO criteria for maternal near-miss, in an attempt to assess the quality of obstetric care in the region and to identify the possible delays leading to this.

Results: Haemorrhage was the most common cause leading to severe maternal outcome, followed by early pregnancy complications and hypertensive disorders of pregnancy. The mortality index was 15% and maternal near miss to mortality ratio was 7:1. We could identify some type of delay in at least 70% of near miss and mortality cases. Although delay in seeking healthcare was the most common, lack of community participation was identified as an important fourth delay.

Conclusions: For substantive reduction of maternal mortality in this region of Uttarakhand, the main action needed is strengthening of primary health care, educating the patients regarding warning signs of pregnancy and strengthening the social status of women in society, increasing community support in women health care.

 


Keywords


Delays in health care, Maternal death, Maternal mortality, Near miss, Rural Uttarakhand, Severe maternal morbidity

Full Text:

PDF

References


World Health Organization World Health Statistics 2016: Monitoring Health for the SDGs, Sustainable Development Goals. 2016. Available at: http://www.who.int/gho/publications/world_health_statistics/2016/EN_WHS2016_TOC.pdf?ua=1

World Health Organization. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015. Available at: http://apps.who.int/iris/bitstream/10665/194254/1/9789241565141_eng.pdf?ua=1

Parmar NT, Parmar AG, Mazumdar VS. Incidence of maternal “Near-miss” events in a tertiary care hospital of central Gujarat India. J Obstet Gynaecol India. 2016;66:315-20.

Say L, Souza JP, Pattinson RC. WHO working group on maternal mortality and morbidity classifications. Maternal near misses towards a standard tool for monitoring the quality of maternal health care. Best Pract Res Clin Obstet Gynecol. 2009;23(3):375-88.

Ministry of Statistics and Programme Implementation. Millennium Development Goals India Country Report 2015. New Delhi: Government of India; 2015.

Bansal M, Lagoo J, Pujari K. Study of near miss cases in obstetrics and maternal mortality in Bastar, Chhattisgarh, India. Int J Reprod Contracept Obstet Gynecol. 2016;5:620-3.

Rathod AD, Chavan RP, Bhagat V, Pajai S, Padmawar A, Thool P. Analysis of near-miss and maternal mortality at tertiary referral centre of rural India. J Obstetrics Gynaecol India. 2016;66(Suppl 1):295-300.

Gebrehiwot Y, Tewolde BT. Improving maternity care in Ethiopia through facility based review of maternal deaths and near misses. Int J Gynecol Obstet. 2014;127:S29-S34.

Berhane G, Gessessew A, Roosmalen JV. Obstetric near miss and maternal death: the case of Ayder teaching hospital, Mekelle, Ethiopia. Ethiopian J Reproduct Health. 2012;6(1):56-63.

Roost M, Altamirano VC, Liljestrand J, Essen B. Does antenatal care facilitate utilization of emergency obstetric care? A case-referent study of near-miss morbidity in Bolivia. Acta Obstet Gynecol Scand. 2010;89(3):335-42.

Ghazal-Aswad S, Badrinath P, Sidky I, Safi TH, Gargash H, Abdul-Razak Y, et al. Severe acute maternal morbidity in a high-income developing multiethnic country. Maternal Child Health J. 2013;17(3):399-404.

Tallapureddy S, Velagaleti R, Palutla H, Satti CV. "Near-Miss" Obstetric events and maternal mortality in a Tertiary Care Hospital. Indian J Public Health. 2017;61(4):305-8.

MacDonald T, Jackson S, Charles MC. The fourth delay and community-driven solutions to reduce maternal mortality in rural Haiti: a community-based action research study. BMC Pregnancy Childbirth. 2018;18:254.