School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
School of Environmental Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
BMC Womens Health. 2023 Jul 19;23(1):380. doi: 10.1186/s12905-023-02523-9.
One of the most challenging problems in developing countries including Ethiopia is improving maternal health. About 303,000 mothers die globally, and one in every 180 is at risk from maternal causes. Developing regions account for 99% of maternal deaths. Maternal near miss (MNM) resulted in long-term consequences. A systematic review and meta-analysis was performed to assess the prevalence and predictors of maternal near miss in Ethiopia from January 2015 to March 2023.
A systematic review and meta-analysis cover both published and unpublished studies from different databases (PubMed, CINHAL, Scopus, Science Direct, and the Cochrane Library) to search for published studies whilst searches for unpublished studies were conducted using Google Scholar and Google searches. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Duplicated studies were removed using Endnote X8. The paper quality was also assessed based on the JBI checklist. Finally, 21 studies were included in the study. Data synthesis and statistical analysis were conducted using STATA Version 17 software. Forest plots were used to present the pooled prevalence using the random effect model. Heterogeneity and publication bias was evaluated using Cochran's Q test, (Q) and I squared test (I). Subgroup analysis based on study region and year of publication was performed.
From a total of 705 obtained studies, twenty-one studies involving 701,997 pregnant or postpartum mothers were included in the final analysis. The national pooled prevalence of MNM in Ethiopia was 140/1000 [95% CI: 80, 190]. Lack of formal education [AOR = 2.10, 95% CI: 1.09, 3.10], Lack of antenatal care [AOR = 2.18, 95% CI: 1.33, 3.03], history of cesarean section [AOR = 4.07, 95% CI: 2.91, 5.24], anemia [AOR = 4.86, 95% CI: 3.24, 6.47], and having chronic medical disorder [AOR = 2.41, 95% CI: 1.53, 3.29] were among the predictors of maternal near misses from the pooled estimate.
The national prevalence of maternal near miss was still substantial. Antenatal care is found to be protective against maternal near miss. Emphasizing antenatal care to prevent anemia and modifying other chronic medical conditions is recommended as prevention strategies. Avoiding primary cesarean section is recommended unless a clear indication is present. Finally, the country should place more emphasis on strategies for reducing MNM and its consequences, with the hope of improving women's health.
发展中国家（包括埃塞俄比亚）面临的最具挑战性问题之一是改善孕产妇健康。全球约有 33 万名母亲死亡，每 180 名产妇中就有 1 名死于产妇原因。发展中地区占产妇死亡人数的 99%。孕产妇严重并发症（near miss）会导致长期后果。本系统评价和荟萃分析旨在评估 2015 年 1 月至 2023 年 3 月埃塞俄比亚孕产妇严重并发症的发生率和预测因素。
本系统评价和荟萃分析涵盖了来自不同数据库（PubMed、CINHAL、Scopus、Science Direct 和 Cochrane Library）的已发表和未发表的研究，以搜索已发表的研究，同时使用 Google Scholar 和 Google 搜索未发表的研究。采用 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 指南。使用 Endnote X8 去除重复的研究。还根据 JBI 清单评估了论文质量。最终，有 21 项研究纳入了本研究。使用 STATA 版本 17 软件进行数据合成和统计分析。使用随机效应模型的森林图呈现汇总的患病率。使用 Cochran's Q 检验（Q）和 I 平方检验（I）评估异质性和发表偏倚。根据研究区域和发表年份进行了亚组分析。
从总共获得的 705 项研究中，有 21 项研究共纳入了 701997 名孕妇或产后母亲。埃塞俄比亚孕产妇严重并发症的全国患病率为 140/1000[95% CI: 80, 190]。缺乏正规教育（AOR=2.10，95% CI: 1.09, 3.10）、缺乏产前护理（AOR=2.18，95% CI: 1.33, 3.03）、剖宫产史（AOR=4.07，95% CI: 2.91, 5.24）、贫血（AOR=4.86，95% CI: 3.24, 6.47）和慢性疾病（AOR=2.41，95% CI: 1.53, 3.29）是孕产妇严重并发症的预测因素。
埃塞俄比亚孕产妇严重并发症的全国患病率仍然很高。产前护理被发现可预防孕产妇严重并发症。建议强调产前护理以预防贫血和改善其他慢性疾病，作为预防策略。除非有明确的指征，否则应避免初次剖宫产。最后，该国应更加重视减少孕产妇严重并发症及其后果的策略，以期改善妇女健康。
