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Maternal near-miss and death incidences - Frequencies, causes and the referral chain in Somaliland: A pilot study using the WHO near-miss approach.
College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland.
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell kvinno- & mödrahälsovård och migration/Essén)
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2017 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 12, p. 30-36Article in journal (Refereed) Published
Abstract [en]

Background: Somaliland is a self-declared country with a population of 3.5 million. Most of its population reside in rural areas. The objective of this pilot near-miss study was to monitor the frequency and causes of maternal near-miss and deaths and the referral chain for women to access Skilled Birth Attendants (SBA).

Method: A facility-based study of all maternal near-miss and mortality cases over 5months using the WHO near-miss tool in a main referral hospital. Reasons for bypassing the Antenatal Care facility (ANC) and late arrival to the referral hospital were investigated through verbal autopsy.

Results: One hundred and thirty-eight (138) women with severe maternal complications were identified: 120 maternal near-miss, 18 maternal deaths. There were more near-miss cases on arrival (74.2%) compared with events that developed inside the hospital (25.8%). Likewise, there were more maternal deaths (77.8%) on arrival than was the case during hospitalization (22.2%). The most common mode of referral among maternal near-miss events was family referrals (66.7%). Of 18 maternal deaths, 15 were family referrals. Reasons for bypassing ANC were as follows: lack of confidence in the service provided; lack of financial resources; and lack of time to visit ANC. Reasons for late arrival to the referral hospital were as follows: lack of knowledge and transportation; and poor communication.

Conclusion and clinical implication: To increase the utilization of ANC might indirectly lower the number of near-miss and death events. Collaboration between ANC staff and referral hospital staff and a more comprehensive near-miss project are proposed.

Place, publisher, year, edition, pages
2017. Vol. 12, p. 30-36
Keywords [en]
Maternal death, Maternal near-miss, Referral chain, Somaliland
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-327069DOI: 10.1016/j.srhc.2017.02.003ISI: 000401884100006PubMedID: 28477929OAI: oai:DiVA.org:uu-327069DiVA, id: diva2:1129211
Available from: 2017-08-01 Created: 2017-08-01 Last updated: 2017-12-04Bibliographically approved

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