Department of Public Health, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia.
BMC Pregnancy Childbirth. 2018 Jun 26;18(1):260. doi: 10.1186/s12884-018-1903-1.
Maternal mortality and morbidity remain unacceptably high in developing countries. Behind every maternal death, many other women suffered from acute and chronic obstetric complications. Women who survive severe acute maternal morbidities/near miss have many characteristics in common with maternal death events particularly on risk factors. Ethiopia is among countries with high maternal mortality and morbidities in sub-Saharan Africa. However there is scarce evidence on risk factors of severe acute maternal morbidities in Ethiopia. Therefore this study aimed to identify predictors of maternal near miss among women admitted in Gurage zone hospitals, south Ethiopia, 2017.
Hospital based case control study was conducted to assess predictors of maternal near miss among women admitted in five hospitals of Gurage zone, South Ethiopia. Data of 229 (77 cases and 152 controls) women were included in the analysis. Cases were women admitted due to severe acute maternal morbidity while controls were women admitted for normal labor or women admitted due to mild to moderate obstetric complications. Cases were identified by validated-disease specific criteria. Then, two controls were selected for each verified case using lottery method among eligible women. Data were collected using interviewer administered questionnaire and reviewing patients' records. Data were entered using Epi Info 7 and analyzed by SPSS 21. Multivariable logistic regression analysis was done to identify independent predictors of maternal near miss.
Majority of cases were admitted due to dystocia (57.1%) and obstetric hemorrhage (26%). The median first delay (delay to seek health care) among cases and controls was six and 4 h respectively. Prior history of cesarean section {AOR 7.68, 95%CI, 3.11-18.96}, first delay {AOR 2.79, 95%CI, 1.42-5.50}, and being referred from other health facilities {AOR 7.47, 95% CI, 2.27-24.51} were independent predictors of maternal near miss.
Prior history of cesarean section, being referred from other health facilities and first delay were factors associated with maternal near miss. Timely health care seeking behavior of women is uncommon in the study area. Therefore primary health care programs need to enhance the existing efforts to improve timely health care seeking behavior of women.
孕产妇死亡率和发病率在发展中国家仍然高得令人无法接受。每一例孕产妇死亡背后，都有许多其他妇女患有急性和慢性产科并发症。患有严重急性产科危象/接近危象的妇女与孕产妇死亡事件有许多共同特征，尤其是在危险因素方面。埃塞俄比亚是撒哈拉以南非洲孕产妇死亡率和发病率较高的国家之一。然而，关于埃塞俄比亚严重急性产科危象的危险因素的证据很少。因此，本研究旨在确定 2017 年在埃塞俄比亚古拉格地区医院住院的妇女发生孕产妇接近危象的预测因素。
采用医院病例对照研究，评估了 229 名（77 例病例和 152 例对照）妇女在埃塞俄比亚古拉格地区 5 家医院住院期间发生孕产妇接近危象的预测因素。病例是因严重急性产科危象住院的妇女，而对照是因正常分娩或因轻度至中度产科并发症住院的妇女。病例是根据经过验证的疾病特异性标准确定的。然后，在合格的妇女中，通过抽签法为每个确诊病例选择 2 名对照。使用访谈者管理的问卷和查阅患者记录收集数据。数据使用 Epi Info 7 输入并使用 SPSS 21 进行分析。多变量逻辑回归分析用于确定孕产妇接近危象的独立预测因素。
大多数病例是由于难产（57.1%）和产科出血（26%）而住院。病例和对照组的中位数首次延误（寻求医疗保健的延误）分别为 6 小时和 4 小时。剖宫产史（AOR 7.68，95%CI，3.11-18.96）、首次延误（AOR 2.79，95%CI，1.42-5.50）和从其他卫生机构转诊（AOR 7.47，95%CI，2.27-24.51）是孕产妇接近危象的独立预测因素。
剖宫产史、从其他卫生机构转诊和首次延误是与孕产妇接近危象相关的因素。妇女及时寻求医疗保健的行为在研究地区并不常见。因此，初级卫生保健方案需要加强现有的努力，以改善妇女及时寻求医疗保健的行为。
