Applicability of the WHO maternal near miss tool in sub-Saharan Africa: A systematic review

Abera Kenay Tura, To Lam Trang, Thomas Van Den Akker, Jos Van Roosmalen, Sicco Scherjon, Joost Zwart, Jelle Stekelenburg

Research output: Contribution to JournalReview articleAcademicpeer-review

Abstract

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.

LanguageEnglish
Article number2225
Pages1-9
Number of pages9
JournalBMC Pregnancy and Childbirth
Volume19
DOIs
Publication statusPublished - 26 Feb 2019

Fingerprint

Africa South of the Sahara
Mothers
Rural Hospitals
Private Hospitals
Live Birth
Nigeria
South Africa
PubMed
Blood Transfusion
Population

Keywords

  • Maternal near miss
  • Severe acute maternal morbidity
  • Severe maternal outcomes
  • Sub-Saharan Africa
  • Systematic review

Cite this

Tura, Abera Kenay ; Trang, To Lam ; Van Den Akker, Thomas ; Van Roosmalen, Jos ; Scherjon, Sicco ; Zwart, Joost ; Stekelenburg, Jelle. / Applicability of the WHO maternal near miss tool in sub-Saharan Africa : A systematic review. In: BMC Pregnancy and Childbirth. 2019 ; Vol. 19. pp. 1-9.
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Applicability of the WHO maternal near miss tool in sub-Saharan Africa : A systematic review. / Tura, Abera Kenay; Trang, To Lam; Van Den Akker, Thomas; Van Roosmalen, Jos; Scherjon, Sicco; Zwart, Joost; Stekelenburg, Jelle.

In: BMC Pregnancy and Childbirth, Vol. 19, 2225, 26.02.2019, p. 1-9.

Research output: Contribution to JournalReview articleAcademicpeer-review

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T1 - Applicability of the WHO maternal near miss tool in sub-Saharan Africa

T2 - BMC Pregnancy and Childbirth

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.

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KW - Severe acute maternal morbidity

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KW - Systematic review

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SN - 1471-2393

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