| dc.description.abstract | Introduction: The maternal near misses (MNM) are used as a proxy for, and exceeds maternal deaths by upto 20 times, yet studying them is more advantageous at improving the quality of maternal and perinatal care. They have, however, received less attention, especially in Uganda, with a high MNM incidence of 40 per 1000 live births and maternal mortality ratio of 189 per 100,000 live births. Different previous MNM case definitions have had challenges, therefore, this study assessed risk factors and immediate perinatal outcomes among MNM at Kawempe National Referral Hospital, Uganda, using a more sensitive MNM case definition, suitable for low-income settings.
Methods: A facility-based unmatched case–control study was conducted on 252 women (84 cases and 168 controls) from January to March 2025. The study was approved by the Makerere University School of Medicine Research and Ethics Committee. Data were collected using pretested interviewer-administered questionnaires on cases and controls at hospital discharge. Statistical analyses, including bivariate and multivariable logistic regression (P<0.05) for risk factors for MNM, while descriptive statistics for immediate perinatal outcomes were used. Results: Obstetric haemorrhage (72.6%) and preeclampsia/eclampsia (39.3%) were the commonest presentations in MNM. Grand-multiparity (aOR: 5.06, 95 % CI: 1.124- 22.741, P value=0.035), occurrence of a danger sign in pregnancy (aOR: 11.35, 95 % CI: 1.796-71.780, p-value=0.006), and staying at a distance >5km from a health facility were significant risk factors for MNM. Whereas being aware of danger signs in pregnancy significantly decreased the risks of MNM by 96% (aOR:0.04, 95 %CI:0.007-0.245, P value<0.001). Significantly higher proportions of cases than controls had adverse immediate perinatal outcomes such as fresh still births (cases: 27.9% Vs controls: 0.6%), macerated still births (cases: 8.8 % Vs controls:1.8%), low birth weight (cases: 37.3 % Vs controls: 8.3 %), Apgar score <7 at 5 minutes (cases: 29.0% Vs controls: 1.9 %), admission to NICU (cases: 53.5 % Vs controls: 14.6 %). Conclusion: Grand-multiparity, the occurrence of obstetric danger signs, limited awareness of these danger signs, and a longer distance from a health facility were significant risk factors for maternal near miss, who eventually have adverse immediate perinatal outcomes. Emphasizing antenatal care attendance, community sensitization on the obstetric risks of grand multiparity, and improving access to health facilities are recommended to reduce maternal near-misses. | en_US |
