TY - JOUR
T1 - Applicability of the WHO maternal near miss tool in sub-Saharan Africa
T2 - A systematic review
AU - Tura, Abera Kenay
AU - Trang, To Lam
AU - Van Den Akker, Thomas
AU - Van Roosmalen, Jos
AU - Scherjon, Sicco
AU - Zwart, Joost
AU - Stekelenburg, Jelle
PY - 2019/2/26
Y1 - 2019/2/26
N2 - Background: Applicability of the World Health Organization (WHO) maternal near miss criteria in low-income settings is not systematically addressed in the literature. The objective of this review was to determine the applicability of the WHO maternal near miss tool in sub-Saharan Africa. Methods: We searched PubMed, Embase, Popline, CINAHL, AJOL, and Google scholar using key words for maternal near miss and sub-Saharan Africa. Studies which applied the WHO maternal near miss criteria, containing clear definitions, and published between January 1st, 2009 and December 31st, 2017 were included. Two authors independently extracted data. Quantitative analysis and narrative synthesis were conducted, and medians with interquartile range (IQR) were calculated for summarizing the findings. Methodological quality of the studies was assessed using the Estabrook's quality assessment and validity tool. Results: Fifteen studies from nine countries comprising 227,077 participants were included. Median maternal near miss ratio was 24.2 (IQR: 12.4-35.8) per 1000 live births ranging from 4.4 in a population-based study in South Africa to 198 in a rural private hospital in Nigeria. Eight studies reported challenges in implementing the WHO maternal near miss tool, especially related to the threshold for blood transfusion, and availability of several laboratory-based criteria. In three studies, local adaptations were made. Conclusion: This review showed that the WHO maternal near miss tool is not uniformly applied in sub-Saharan Africa. Therefore, a common adaptation for the region is required to increase its applicability.
AB - Background: Applicability of the World Health Organization (WHO) maternal near miss criteria in low-income settings is not systematically addressed in the literature. The objective of this review was to determine the applicability of the WHO maternal near miss tool in sub-Saharan Africa. Methods: We searched PubMed, Embase, Popline, CINAHL, AJOL, and Google scholar using key words for maternal near miss and sub-Saharan Africa. Studies which applied the WHO maternal near miss criteria, containing clear definitions, and published between January 1st, 2009 and December 31st, 2017 were included. Two authors independently extracted data. Quantitative analysis and narrative synthesis were conducted, and medians with interquartile range (IQR) were calculated for summarizing the findings. Methodological quality of the studies was assessed using the Estabrook's quality assessment and validity tool. Results: Fifteen studies from nine countries comprising 227,077 participants were included. Median maternal near miss ratio was 24.2 (IQR: 12.4-35.8) per 1000 live births ranging from 4.4 in a population-based study in South Africa to 198 in a rural private hospital in Nigeria. Eight studies reported challenges in implementing the WHO maternal near miss tool, especially related to the threshold for blood transfusion, and availability of several laboratory-based criteria. In three studies, local adaptations were made. Conclusion: This review showed that the WHO maternal near miss tool is not uniformly applied in sub-Saharan Africa. Therefore, a common adaptation for the region is required to increase its applicability.
KW - Maternal near miss
KW - Severe acute maternal morbidity
KW - Severe maternal outcomes
KW - Sub-Saharan Africa
KW - Systematic review
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U2 - 10.1186/s12884-019-2225-7
DO - 10.1186/s12884-019-2225-7
M3 - Review article
C2 - 30808325
AN - SCOPUS:85062288287
SN - 1471-2393
VL - 19
SP - 1
EP - 9
JO - BMC Pregnancy and Childbirth
JF - BMC Pregnancy and Childbirth
M1 - 2225
ER -