Prevalence, Underlying Causes, and Determinants of Maternal Near Miss in Ethiopia: a Systematic Review and Meta-analysis

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2024 Oct 23

PMID 39440038

Authors

Neamin Tesfay

Girmay Hailu

Dumesa Begna

Medhanye Habtetsion

Fitsum Taye

Fitsum Woldeyohannes

Ruxana Jina

Affiliations

Soon will be listed here.

Abstract

Background: Maternal near miss (MNM) is one of the newly adopted assessment parameters to gauge the quality of maternity care. In Ethiopia, several studies have been conducted to investigate the incidence, underlying causes, and determinants of MNM. However, the findings from those studies vary greatly and are largely inconsistent. Thus, this review aims to more robustly estimate the pooled prevalence, identify underlying causes, and single out determinants of MNM in Ethiopia.

Methods: Studies were searched from international databases (PubMed/ Medline, Cochrane Library, and Embase databases) and other potential sites. All observational studies were included. Heterogeneity between studies was checked using Cochrane Q test statistics and I test statistics and small study effects were checked using Egger's statistical test at a 5% significance level. Outcome measures were overall and specific underlying causes (obstetrics hemorrhage, hypertensive disorder pregnancy, pregnancy-related infection) rates of MNMs per 10,000 live births.

Result: The meta-analysis included 43 studies consisting of 77240 MNM cases. The pooled prevalence MNM per 1000 live births in Ethiopia was 54.33 (95% CI: 33.93 to 85.89). Between-study heterogeneity was high (I = 100%, < 0.0001), with the highest rate observed in Amhara region (384.54 per 1000). The prevalence of obstetrics hemorrhage (14.56 per 1000) was higher than that of hypertensive disorder pregnancy (12.67 per 1000) and pregnancy-related infections (3.55 per 1000) were identified as underlying causes. Various factors, including socio demographic characteristics, previous medical and obstetrics history as well as access to and quality of care obtained, were associated with MNM.

Conclusion: Almost six women encounter near miss among a hundred live births in Ethiopia. Obstetric hemorrhage and hypertensive disorder pregnancy were the most common underlying causes of MNM. Both individual and facility level determinants were found to be associated with MNM. Considering the magnitude and identified factors, tailored measures should be taken at every stage of the continuum of care.

Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023395259.

Citing Articles

Inequality in maternal delays related to maternal death at home and en route to a health facility in Ethiopia: insights from national mortality surveillance data.

Tesfay N, Hailu G, Tariku R, Firde H, Woldeyohannes F BMJ Open. 2025; 15(2):e083962.

PMID: 39933803 PMC: 11815434. DOI: 10.1136/bmjopen-2024-083962.

Implementation status of maternal death surveillance and response system in Ethiopia: Evidence from a national-level system evaluation.

Tesfay N, Zenebe A, Dejene Z, Tadesse H, Woldeyohannes F, Gebreyesus A PLoS One. 2024; 19(12):e0312958.

PMID: 39625947 PMC: 11614257. DOI: 10.1371/journal.pone.0312958.

References

Tura A, Scherjon S, Stekelenburg J, van Roosmalen J, van den Akker T, Zwart J . Severe Hypertensive Disorders of Pregnancy in Eastern Ethiopia: Comparing the Original WHO and Adapted sub-Saharan African Maternal Near-Miss Criteria. Int J Womens Health. 2020; 12:255-263. PMC: 7152537. DOI: 10.2147/IJWH.S240355. View

Alemu F, Fuchs M, Martin Vitale T, Abdalla Mohamed Salih M . Severe maternal morbidity (near-miss) and its correlates in the world's newest nation: South Sudan. Int J Womens Health. 2019; 11:177-190. PMC: 6429996. DOI: 10.2147/IJWH.S160022. View

Dasa T, Okunlola M, Dessie Y . Effect of grand multiparity on adverse maternal outcomes: A prospective cohort study. Front Public Health. 2022; 10:959633. PMC: 9608575. DOI: 10.3389/fpubh.2022.959633. View

Aliyi A, Deyessa N, Dilnessie M . Effect of maternal near miss on neonatal mortality in selected hospitals: Prospective cohort study, Southeast Ethiopia. SAGE Open Med. 2021; 9:20503121211042219. PMC: 8411626. DOI: 10.1177/20503121211042219. View

Moola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K . Conducting systematic reviews of association (etiology): The Joanna Briggs Institute's approach. Int J Evid Based Healthc. 2015; 13(3):163-9. DOI: 10.1097/XEB.0000000000000064. View

Tesfaye G, Chojenta C, Smith R, Loxton D . Delaying factors for maternal health service utilization in eastern Ethiopia: A qualitative exploratory study. Women Birth. 2019; 33(3):e216-e226. DOI: 10.1016/j.wombi.2019.04.006. View

Lindquist A, Knight M, Kurinczuk J . Variation in severe maternal morbidity according to socioeconomic position: a UK national case-control study. BMJ Open. 2013; 3(6). PMC: 3686175. DOI: 10.1136/bmjopen-2013-002742. View

Morgan R, Whaley P, Thayer K, Schunemann H . Identifying the PECO: A framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int. 2018; 121(Pt 1):1027-1031. PMC: 6908441. DOI: 10.1016/j.envint.2018.07.015. View

Croke K . The origins of Ethiopia's primary health care expansion: The politics of state building and health system strengthening. Health Policy Plan. 2020; 35(10):1318-1327. PMC: 7886436. DOI: 10.1093/heapol/czaa095. View

10.

. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study. Lancet Glob Health. 2020; 8(5):e661-e671. PMC: 7196885. DOI: 10.1016/S2214-109X(20)30109-1. View

11.

Tesfay N, Tariku R, Zenebe A, Habtetsion M, Woldeyohannes F . Place of death and associated factors among reviewed maternal deaths in Ethiopia: a generalised structural equation modelling. BMJ Open. 2023; 13(1):e060933. PMC: 9884926. DOI: 10.1136/bmjopen-2022-060933. View

12.

Demisse G, Sifer S, Kedir B, Fekene D, Bulto G . Determinants of puerperal sepsis among post partum women at public hospitals in west SHOA zone Oromia regional STATE, Ethiopia (institution BASEDCASE control study). BMC Pregnancy Childbirth. 2019; 19(1):95. PMC: 6423770. DOI: 10.1186/s12884-019-2230-x. View

13.

Bayou Y, Mashalla Y, Thupayagale-Tshweneagae G . Patterns of caesarean-section delivery in Addis Ababa, Ethiopia. Afr J Prim Health Care Fam Med. 2016; 8(2):e1-6. PMC: 4948062. DOI: 10.4102/phcfm.v8i2.953. View

14.

Nigussie J, Girma B, Molla A, Tamir T, Tilahun R . Magnitude of postpartum hemorrhage and its associated factors in Ethiopia: a systematic review and meta-analysis. Reprod Health. 2022; 19(1):63. PMC: 8905908. DOI: 10.1186/s12978-022-01360-7. View

15.

Munn Z, Stern C, Aromataris E, Lockwood C, Jordan Z . What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC Med Res Methodol. 2018; 18(1):5. PMC: 5761190. DOI: 10.1186/s12874-017-0468-4. View

16.

Kamangira B, Ayele G, Dube P, Melaku K, Vushoma E . Maternal near miss hospitalizations in the Borana Zone, Ethiopia: A facility-based longitudinal cross-sectional study. J Public Health Res. 2024; 13(1):22799036241238665. PMC: 10960350. DOI: 10.1177/22799036241238665. View

17.

Mekonnen A, Fikadu G, Seyoum K, Ganfure G, Degno S, Lencha B . Factors associated with maternal near-miss at public hospitals of South-East Ethiopia: An institutional-based cross-sectional study. Womens Health (Lond). 2021; 17:17455065211060617. PMC: 8606979. DOI: 10.1177/17455065211060617. View

18.

Kasahun A, Wako W . Predictors of maternal near miss among women admitted in Gurage zone hospitals, South Ethiopia, 2017: a case control study. BMC Pregnancy Childbirth. 2018; 18(1):260. PMC: 6019215. DOI: 10.1186/s12884-018-1903-1. View

19.

Nemomsa A, Wirtu D, Getachew M, Kejela G, Merdassa E, Diriba W . Quality of antenatal care in selected public health facilities of West Ethiopia. Contracept Reprod Med. 2022; 7(1):18. PMC: 9526352. DOI: 10.1186/s40834-022-00186-9. View

20.

Wagnew Meazaw M, Chojenta C, Taddele T, Loxton D . Audit of Clinical Care for Women with Preeclampsia or Eclampsia and Perinatal Outcome in Ethiopia: Second National EmONC Survey. Int J Womens Health. 2022; 14:297-310. PMC: 8896042. DOI: 10.2147/IJWH.S350656. View