DETERMINANTS, OUTCOMES AND COMPLICATIONS OF NEAR MISS MATERNAL MORBIDITY IN A TERTIARY HOSPITAL IN SOUTH WEST, NIGERIA

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DETERMINANTS, OUTCOMES AND COMPLICATIONS OF NEAR MISS MATERNAL MORBIDITY IN A TERTIARY HOSPITAL IN SOUTH WEST, NIGERIA

Abstract

The analysis of near miss maternal morbidity has emerged as a useful tool for understanding the dynamics of maternal health and services. Experts have described it as a ‘promising complement or alternative to the investigation of maternal deaths’. Although studies have been conducted in several countries, very little work has been done in Nigeria. The study examined the determinants, outcomes and complications of near miss maternal morbidity in a tertiary hospital in South-West Nigeria. The specific objectives were to determine the burden of near miss in the study area, to explore the social and environmental factors surrounding the event as well as describe the perinatal outcomes and complications of near miss maternal morbidity. The study also sought to measure the in- hospital delay experienced by the near misses.
The study was conducted in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) using a case control design. Both quantitative and qualitative data collection methods were employed. The near misses cases were serially recruited based on locally validated disease specific selection criteria and appropriate but unmatched controls were also selected. The ratio of cases to controls employed was one to four.43 A total of 75 near misses and 300 controls were recruited into the study.
The burden of near miss in the study area was 12%. Severe haemorrhage and severe hypertension were the commonest direct causes of near misses reported in this study, but, severe anaemia secondary to malaria was also important. The significant determinants were extremes of reproductive age (X2= 7.98; p= 0.05), husband’s level of education (X2= 10.63; p= 0.005), marital status (X2= 18.064; p< 0.001), knowledge of obstetric complications(X2= 30.992; p< 0.001). Marital status was the most significant
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determinant of near miss found in this study; with the unmarried ( a correlate of lack of male support) having a four fold likelihood of experiencing near miss morbidity compared with those that were currently married [OR=3.71; CI (1.02 – 13.4); p= 0.05] . On the other hand, a good knowledge of obstetric complication was found to be protective of having a near miss [OR=0.34; CI (0.12 – 0.98); p= 0.05] .
The adverse perinatal outcomes significantly associated with near miss morbidity were; stillbirth [OR=7.154; CI (2.6 – 19.7); p<0.001] and severe birth asphyxia [OR=2.92; CI (1.1 – 7.4); p= 0.024] . Severe complications like pulmonary edema, acute renal failure were experienced by one in every four near miss. Delay in making definitive diagnosis was most recurrent phase three delay observed among the near misses.
In conclusion, modifiable factors like male involvement, access to essential obstetric care and knowledge of obstetric complications are important determinants of life threatening complications in developing countries.

Title Page———i

Certification——–ii

Dedication———iii

Acknowledgement——-iv

Abstract ———vi

Table of Content——–vii

 

Chapter One

1.0 Introduction ——-1

1.1 Statement of Problem——4

1.2 Purpose of the Study——5

1.3 Significance of Study——8

1.4 Limitation——–9

1.5 Scope of Study——-11

 

Chapter Two

2.0 Review of Related Literature —-12

2.6 Summary of Literature Review—- 19

 

Chapter Three

3.0 Research Methodology and Procedure—22

3.1 Population ——–22

3.2 Sample and Sampling Technique—-22

3.3 Validation of the Instrument —-23

3.4 Reliability of the Instrument —–23

3.5 Data Analysis——-23

 

Chapter Four

4.0 Presentation and Discussion of Result—24

4.1 Analysis and interpretaion of Data—25

4.2 Discussion of Results——38

 

Chapter Five

5.0. Summary, Conclusion, and Recommendation  –40

5.1 Summary——–40

5.2 Conclusion——–41

5.3 Recommendation——42

References ———45

Appendix 1——–47

Appendix ———50

DETERMINANTS, OUTCOMES AND COMPLICATIONS OF NEAR MISS MATERNAL MORBIDITY IN A TERTIARY HOSPITAL IN SOUTH WEST, NIGERIA

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