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dc.contributor.authorNelissen, Ellen J. T.en_US
dc.contributor.authorMduma, Estomihen_US
dc.contributor.authorErsdal, Hegeen_US
dc.contributor.authorEvjen-Olsen, Bjørgen_US
dc.contributor.authorvan Roosmalen, Jos JMen_US
dc.contributor.authorStekelenburg, Jelleen_US
dc.date.accessioned2014-03-21T13:44:17Z
dc.date.available2014-03-21T13:44:17Z
dc.date.issued2013-07-04eng
dc.identifier.issn1471-2393
dc.identifier.urihttp://hdl.handle.net/1956/7880
dc.description.abstractBackground: Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. In order to lower maternal morbidity and mortality in the immediate term, reduction of delay in the provision of quality obstetric care is of prime importance. The aim of this study is to assess the occurrence of severe maternal morbidity and mortality in a rural referral hospital in Tanzania as proposed by the WHO near miss approach and to assess implementation levels of key evidence-based interventions in women experiencing severe maternal morbidity and mortality. Methods: A prospective cross-sectional study was performed from November 2009 until November 2011 in a rural referral hospital in Tanzania. All maternal near misses and maternal deaths were included. As not all WHO near miss criteria were applicable, a modification was used to identify cases. Data were collected from medical records using a structured data abstraction form. Descriptive frequencies were calculated for demographic and clinical variables, outcome indicators, underlying causes, and process indicators. Results: In the two-year period there were 216 maternal near misses and 32 maternal deaths. The hospital-based maternal mortality ratio was 350 maternal deaths per 100,000 live births (95% CI 243–488). The maternal near miss incidence ratio was 23.6 per 1,000 live births, with an overall case fatality rate of 12.9%. Oxytocin for prevention of postpartum haemorrhage was used in 96 of 201 women and oxytocin for treatment of postpartum haemorrhage was used in 38 of 66 women. Furthermore, eclampsia was treated with magnesium sulphate in 87% of all cases. Seventy-four women underwent caesarean section, of which 25 women did not receive prophylactic antibiotics. Twenty-eight of 30 women who were admitted with sepsis received parenteral antibiotics. The majority of the cases with uterine rupture (62%) occurred in the hospital. Conclusion: Maternal morbidity and mortality remain challenging problems in a rural referral hospital in Tanzania. Key evidence-based interventions are not implemented in women with severe maternal morbidity and mortality. Progress can be made through up scaling the use of evidence-based interventions, such as the use of oxytocin for prevention and treatment of postpartum haemorrhage.en_US
dc.language.isoengeng
dc.publisherBioMed Centraleng
dc.rightsAttribution CC BYeng
dc.rights.urihttp://creativecommons.org/licenses/by/2.0/eng
dc.subjectMaternal near misseng
dc.subjectSevere acute maternal morbidityeng
dc.subjectMaternal mortalityeng
dc.subjectQuality of obstetric careeng
dc.subjectWHO near miss approacheng
dc.subjectWHO near miss criteriaeng
dc.titleMaternal near miss and mortality in a rural referral hospital in northern Tanzania: a cross-sectional studyen_US
dc.typePeer reviewed
dc.typeJournal article
dc.date.updated2013-08-23T08:38:20Z
dc.description.versionpublishedVersionen_US
dc.rights.holderEllen JT Nelissen et al.; licensee BioMed Central Ltd.
dc.rights.holderCopyright 2013 Nelissen et al.; licensee BioMed Central Ltd.
dc.identifier.doihttps://doi.org/10.1186/1471-2393-13-141
dc.identifier.cristin1052137
dc.source.articlenumber141
dc.source.journalBMC Pregnancy and Childbirth
dc.source.volume13


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