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Determinants of Maternal Near Miss: A Facility-Based Case-Control Study in Luanda, Angola
Maria Castelo1, Paulo Campos1, Pedro Magalhães1
1Faculty of Medicine of Agostinho Neto University, Luanda, Angola.
Introduction:
Understanding the determinants of maternal near miss is crucial for designing preventive strategies and health policies to reduce preventable maternal deaths. This study aimed to identify the determinants of maternal near miss among women admitted to two tertiary hospitals in Luanda, Angola.
Methods:
A facility-based case-control study was conducted at two referral hospitals from June to September 2022. Case participants were recruited among women admitted who met at least one of the WHO near miss criteria. The controls were women admitted for vaginal birth, without any criteria for severe maternal morbidity. For each maternal near-miss case, three age-matched controls were selected. Bivariate analysis was used to evaluate the differences between these two groups. Multivariate unconditional logistic analysis models were constructed to identify determinants of maternal near miss. Reduced models (forward technique) were adjusted, and adjusted odds ratios and 95% confidence intervals were obtained. The level of significance was set at p < 0.05.
Results:
In this study, 245 cases of maternal near miss and 735 controls were included. Maternal near miss was strongly associated with a long delay in seeking care (AOR = 27.38; 95% CI: 12.60-59.47), being referred to referral hospitals (AOR = 11.07; 95% CI: 7.25-16.91), having a preexisting medical disorder (AOR = 12.00; 95% CI: 6.25-23.04), having a previous cesarean section (AOR = 2.42; 95% CI: 1.43-4.10), and consuming alcohol (AOR = 1.59; 95% CI: 1.04-2.43).
Discussion/Conclusion:
Delay in seeking care and being referred to referral hospitals were the main determinants of maternal near miss. Decision makers and health system managers must provide primary and secondary healthcare facilities with resources to manage obstetric complications before and during transfer to tertiary hospitals. Additionally, community interventions focused on overcoming barriers and constraints in seeking healthcare should be prioritized as they can positively impact the prevention of maternal near miss.
