Prevalence of maternal near misses, associated factors and capacity of lower-level public health facilities to offer related care in western Uganda Bunyoro Sub-Region

Abstract

Introduction: Maternal mortality remains a global challenge with maternal mortality ratio of 216/100,000 live births yet for every maternal death, there are more than 100 maternal near misses implying that the burden severe maternal morbidity is considerably very high. General objective: The study was designed to determine the prevalence of maternal near miss among pregnant women in Bunyoro sub region, the associated factors and lower level health facility capacity to offer care to the women with maternal near misses. Methods: This was a retrospective cross-sectional study with analytical and descriptive approaches carried out in three health centre fours in Bunyoro sub region using data extracted from delivery registers, health facility inventories and patients’ medical charts. A total of 726 of pregnant women who delivered or were attended to due to maternal morbidity during pregnancy, delivery or 42 days post-delivery in Bwijanga, Kibaale and Kyangwali health centre IVs were selected for the study using systematic sampling. Data was entered in Epidata 14 version 4.2.00 and exported to STATA 13 for analysis. Data for univariate analysis was summarized into means, and standard deviations (continuous data) and proportions, percentages and frequencies (categorical data). Logistic regression was used to analyse the data at both bivariate and multivariate level. Testing for interaction and confounding was done. Results: Out of 726 mothers, 176 (24.2%) were near misses. Among near miss cases, postpartum haemorrhage was the most common event 38.1%, followed by sepsis/systemic infection 30.7%, complications of abortion 25.7%, severe pre-eclampsia 3.6% and eclampsia 1.4%. The factors significantly associated with maternal near misses were: Age (35 and above OR 0.88 CI 0.78-0.99), parity ([2-5 OR 0.59 CI 0.52-0.69], [6 and above OR 0.35 CI 0.13-0.89]), gravida 2-5 (OR 1.20 CI 1.02-1.42), gravida (6 and above OR 2.56 CI 1.27-5.17), pre-existing medical conditions, anaemia (OR 16.50 CI 5.19-52.48), chronic hypertension(OR 7.30 CI 1.55-34.39), HIV/AIDS (OR 2.72 CI 2.21-3.34) and mode of delivery; caesarean section (OR 0.13 CI 0.09-0.21), vaginal delivery (OR 0.02 CI 0.01-0.06). The overall mean score of the lower level public health facility capacity to provide comprehensive emergence obstetric care (0.38) and basic emergence obstetric (0.33) were below average and thus classified as poor or limited capacity. Conclusion: There is a high prevalence of maternal near misses in Bunyoro sub-region whereas the lower level public health facilities have limited capacity to offer related care to mothers with near miss conditions. All the factors found to be associated with maternal near misses are modifiable through rigorous public health interventions such as HIV prevention, malaria in pregnancy prevention, equitable accesses to family planning services, treatment and prevention of anaemia and prevention of chronic hypertension through life style modification.