MATERNAL NEAR MISS IN SUDAN

Geneva Foundation for Medical Education and Research GFMER Sudan 2012Forum No: ( 1 )

Name of presentersName Position Institution

Aida Ahmed Head, Department Obstetrics & Gynaecology Nursing

UMST

Amal Khalil Coordinator, Reproductive & Child Health Research Unit

UMST

Name of contributorsName Position Institution

Aida Ahmed Head, Department Obstetrics & Gynaecology Nursing

UMST

Amal Khalil Coordinator, Reproductive & Child Health Research Unit

UMST

Contents of the presentation

1. Definition2. Maternal morbidity rate3. Health system failures in relation to obstetric

care4. MDGs5. Severe life threatening obstetric complication 6. Sudan policy and identification criteria for near

miss

Maternal Near Miss is:

a severe life threatening obstetric complication necessitating an urgent medical intervention in order to prevent likely death of the mother.

any pregnant or recently delivered woman, in whom immediate survival is threatened and who survives by chance or because of the hospital care she received.

Women who experienced and survived a severe health condition during pregnancy, childbirth or postpartum are considered as near miss or severe acute maternal morbidity (SAMM) cases.

Why maternal near miss?

two decades ago. In low maternal mortality

settings

morbidity usefulindicator of obstetric care

in recent years analyzing near miss/SAMM cases

understanding health system failures in

relation to obstetric care

Near miss/SAMM cases share many characteristics with maternal deaths and can directly inform on obstacles that had to be overcome after the onset of an acute complication. Corrective actions for identified problems can be taken to reduce related mortality and long-termmorbidity.

Why maternal near miss?

Moreover, countries are increasingly adopting policies that encourage births in institutions. Instruments must therefore, be available to assess the quality of care within the institutions. Routine assessments of maternal near miss cases will help answer that need.

It is expected that the implementation of the maternal near miss process provide an important contribution to assessing and improving quality of obstetric care and to the reduction of maternal deaths.

The care of critically ill women will be analyzed, not only deaths. This is important given the emphasis that emergency obstetric care is currently receiving, and allows for monitoring the quality of these programs. A proportion of women with life-threatening conditions survive. They can be interviewed and areas of breakdown in the health system can be identified. Indicators of maternal near miss and maternal deaths as exemplified in can allow for comparison between institutions and countries and changes over time.

The advantages

maternal morbidity rate

Medical complications in a woman caused by

pregnancy , labor , or delivery

Obstetric Haemorrhage Eclampsia Sepsis Pulmonary embolism Ruptured uterus Anemia related conditions & Heart Failure Abortion Malaria Anesthesia Amniotic fluid embolism ruptured ectopic pregnancy Fever and convulsionsJaundice

severe life threatening obstetric complication

is calling for improving maternal health

World wide.

5th MDG

Sudan policy and identification criteria for near miss

Health system failures in relation to obstetric care

Maternal near-miss in a rural hospital in Sudan

The first report of maternal near-miss in Sudan Medical files of pregnant women and who

delivered recently at Kassala Maternity Hospital from January 2008 to December 2010 were studied.

Results

Hemorrhage (40.8%) Infection (21.5%), Hypertensive disorders (18.0%), Anaemia (11.8%)

Conclusion

high frequency of maternal morbidity and mortality at the level of this facility. Therefore maternal health policy needs to be concerned not only with averting the loss of life, but also with preventing or ameliorating maternal-near miss events (hemorrhage, infections, hypertension and anemia) at all care levels including primary level.

Qualitative Study

Determinants of maternal morbidity and mortality in post conflict areas.

Aim

to gain in-depth understanding of the interacting determinants behind maternal mortality

to investigate the methods of survival of maternal near miss in crises without professional health care.

Method

Qualitative study design using Critical Incident Technique [CIT].

11 near miss events. Interviews were conducted with husbands,

mothers, in laws, sisters, midwives of the deceased and in case of survival the maternal near misses.

Results

Socio-demographic: education, family, age at marriage, poverty

Cultural: perceptions about pregnancy and delivery

Health facilities: willingness to pay, unacceptability

Conflict/ post conflict: fear, insecurity, weak infrastructure, lack of transportation.

Their stories…

Maternal Near Miss PPH

A house-wife & mother of four children started her story “It happened 5 years ago. First of all I had pain in my tummy/belly. I sent my mother to the village midwife. I never deliver by a traditional birth attendant ever. The VMW examined me & said this is labour! We waited for 2 hours but the baby didn’t come& after 3 hours the baby came. I delivered & the bleeding started & the placenta didn’t come out”.

She was rolling in pain, bleeding and started to get weak and restless. By then her husband decided to take her to Renk. It was the rainy season autumn; he went to fetch a car. Luckily he found a pickup truck immediately that charged a ridiculous amount of money SDG100. It was a long and bumpy trip on the dirt road to Renk taking them 4 hours to reach the hospital from their village Gabarona.The minute she entered the maternity ward safely delivered the placenta. She was discharged after a week diagnosed as having Malaria and was on medication. Later on they moved to Renk where she went to antenatal care/ follow up and delivered her children at the hospital.

THANKS