Prevalence, risk factors and outcomes of maternal near Miss in the central region of Uganda : a community based study

Abstract

Despite the commendable reduction in global maternal mortality ratios, more women continue to suffer from severe maternal morbidities, which poses serious health risks to survivors (maternal near misses) and their new-born babies. In Uganda, maternal near miss events occur frequently. As such, the Government of Uganda has implemented numerous programmes and initiatives in order to improve maternal and child health. Despite such investment in maternal health programmes, less attention has been paid to the occurrence of maternal near miss situation causing extensive vulnerability on maternal health well-being. Therefore, the study sought to estimate the prevalence and examine the causes, risk factors and birth outcomes of maternal near misses, in addition to the role of spouses in women's access to emergency obstetric care in Central Uganda. The information obtained will guide development of strategies for reduction of maternal near miss morbidity and mortality. The study employed a cross-sectional design and a multi stage sampling technique to select respondents. Data was collected from Rakai district using both quantitative and qualitative methods. As such, 1,557 women were interviewed. Additionally, 40 women and men were purposefully selected for in-depth interviews, while 9 focus group discussions were conducted. The disease and management criteria were used to identify maternal near misses. The prevalence rate was computed and binary logistic regression was used to predict the risk factors and birth outcomes of maternal near misses. Furthermore, content analysis was employed for qualitative analysis in examining of men's roles. · Overall, majority of the study respondents had a low-socio-economic status, were married, Catholics, resided in rural areas, and were of Baganda ethnicity. Their partners had similar characteristics. Additionally, utilization of maternal health services was low. Women who were less likely to attend antenatal care were also less likely to deliver from a health facility, and consequently less likely to receive postnatal care. The prevalence of maternal near miss was 287 .7 per 1000 pregnancies. Haemorrhage was the main cause of maternal near miss. Women with unwanted pregnancies (odds ratio (OR): 1.379), hi story of pregnancy · complications (OR: 0.295), first birth order (OR: 1.827), who experienced pregnancy danger signs (OR: l. 725) were at higher risk of experiencing maternal near miss. Ethnicity and partner's edi1cation were also associated with occurrence of maternal near miss. Additionally, men's roles were three-fold including: suppo1tive roles, contraceptive uptake and management of obstetric complications at household level. Maternal near miss morbidity in Central Uganda is high and is majorly caused by postpartum haemorrhage. To reduce these events, supervised deliveries, access to emergency obstetric care, access to postnatal care services and contraceptives should be· increased. Maternal health needs of ethnic minorities should also be taken into account. More importantly the need to encourage male involvement in maternal health programmes is paramount.