Maternal and Child Health Program, Burnet Institute, Melbourne, Vic., Australia.
Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria.
BJOG. 2019 Jun;126 Suppl 3:49-57. doi: 10.1111/1471-0528.15698. Epub 2019 May 14.
To compare severe maternal outcomes (SMOs) from two multi-centre surveys in Nigerian hospitals, and to evaluate how the SMO burden affects quality of secondary and tertiary hospital care.
Two facility-based surveys of women experiencing SMO (maternal near-miss or maternal deaths).
Sixteen secondary and five tertiary facilities in Nigeria [WHO Multi-Country Survey on Maternal and Newborn Health (WHOMCS)] and 42 public tertiary facilities in Nigeria (Nigeria Near-Miss and Maternal Death Survey).
371 women in WHOMCS-Nigeria and 2449 women in Nigeria Near-Miss and Maternal Death Survey who experienced SMO.
Secondary analysis and comparison of SMO data from two surveys, stratified by facility level.
Maternal mortality ratio (MMR) per 100 000 livebirths (LB), maternal near-miss (MNM) ratio per 1000 LB, SMO ratio per 1000 LB and mortality index (deaths/SMO).
Maternal mortality ratio and mortality indices were highest in tertiary facilities of the WHOMCS-Nigeria (706 per 100 000; 26.7%) and the Nigeria Near-Miss and Maternal Death Survey (1088 per 100 000; 40.8%), and lower in secondary facilities of the WHOMCS-Nigeria (593 per 100 000; 17.9%). The MNM ratio and SMO ratio were highest in secondary WHOMCS-Nigeria facilities (27.2 per 1000 LB; 33.1 per 1000 LB).
Tertiary-level facilities in Nigeria experience unacceptably high maternal mortality rates, but secondary-level facilities had a proportionately higher burden of severe maternal outcomes. Common conditions with a high mortality index (postpartum haemorrhage, eclampsia, and infectious morbidities) should be prioritised for action. Surveillance using SMO indicators can guide quality improvement efforts and assess changes over time.
2820 Nigerian women with severe maternal outcomes: high mortality in tertiary level hospitals, higher burden in secondary level.
比较尼日利亚两家多中心医院严重孕产妇结局（SMEs），评估SME 负担如何影响二级和三级医院的护理质量。
对经历 SME（产妇接近死亡或产妇死亡）的妇女进行的两项基于机构的调查。
尼日利亚的 16 家二级和 5 家三级医疗机构[世卫组织多国家产妇和新生儿健康调查（WHOMCS）]和尼日利亚的 42 家公立三级医疗机构（尼日利亚接近死亡和产妇死亡调查）。
WHOMCS-尼日利亚的 371 名经历 SME 的妇女和尼日利亚接近死亡和产妇死亡调查的 2449 名经历 SME 的妇女。
对两项调查的 SME 数据进行二级分析和比较，按机构级别分层。
每 10 万活产儿（LB）的孕产妇死亡率（MMR）、每 1000LB 的产妇接近死亡（MNM）率、每 1000LB 的 SME 率和死亡率指数（死亡/SME）。
WHOMCS-尼日利亚和尼日利亚接近死亡和产妇死亡调查的三级医疗机构的孕产妇死亡率和死亡率指数最高（分别为每 100000 例 706 例和每 100000 例 26.7%和每 100000 例 1088 例和每 100000 例 40.8%），二级医疗机构的 WHOMCS-尼日利亚最低（每 100000 例 593 例，每 100000 例 17.9%）。MNM 比率和 SME 比率在 WHOMCS-尼日利亚的二级机构中最高（每 1000LB 为 27.2，每 1000LB 为 33.1）。
尼日利亚的三级医疗机构经历了不可接受的高孕产妇死亡率，但二级医疗机构的严重孕产妇结局负担比例更高。应优先考虑具有高死亡率指数（产后出血、子痫、传染性疾病）的常见疾病采取行动。使用 SME 指标进行监测可以指导质量改进工作并评估随时间的变化。
2820 名尼日利亚妇女出现严重孕产妇结局：三级医院死亡率高，二级医院负担重。
