Determinants of care for maternal near-miss cases at Kamuzu and Queen Elizabeth Central Hospitals in Malawi
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Date
2021-08-01
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Kamuzu University of Health Sciences
Abstract
Maternal near-miss cases which are more frequent than maternal deaths can lead to more robust conclusions on problems and obstacles that have to be overcome during the process of maternal health care. In Malawi, there is little information on the circumstances surrounding maternal near-misses. The aim of the study was to describe determinants of care for maternal near-miss cases at Kamuzu and Queen Elizabeth Central Hospitals in Malawi. This study used a mixed methods approach to collect data on determinants of care for maternal near-miss cases at Kamuzu and Queen Elizabeth Central hospitals in Malawi. This was a convergent design in which both quantitative and qualitative data were collected simultaneously from February to July 2017. Quantitative and qualitative data were integrated through merging the two data sets with an aim to balance the respective strengths and weaknesses as well as maximizing the yield of the complementary sources of evidence. This study has found that the magnitude of maternal near-miss in the local setting is very high (35.1%, n=161). The demographic characteristics that were significantly linked to maternal near-misses in the local setting are marital status, occupation, admission mode, means of transport and age. The obstetric characteristics that were significantly associated with maternal near-miss were fetal presentation, mode of birth, birth status and child sex. However, age and mode of birth were strong determinants of maternal near-miss. Women aged 31-35 years had significantly 4 chances of experiencing maternal near-miss. Women who had laparotomy for uterine rupture had 83 chances of being a maternal near-miss case while those who had emergency caesarean had 4 times chances compared with those who had a vaginal birth. Using the adapted World Health Organization Quality of Care Assessment tool, the quality of care offered to women was found to be below standard and this was corroborated by reports from midwives who stated that some patients were not checked blood pressure, emergency care was not performed within 30 minutes of diagnosis, no handovers were made when transferring patients from theatre to postnatal ward. The magnitude of maternal near-miss was very high compared to other parts of Africa and numerous preventable determinant factors were identified. In addition, the quality of care provided to maternal near-miss cases was below standard. It is essential that Malawi should include maternal near-miss ratio as an indicator for evaluating its maternal health services.