ArticlePloS one2017
Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 5 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Maternal near miss incidence ratio, its causes and risk factors in East Africa: a systematic review and meta-analysis.Reproductive health · 2025Pooled it
- Global burden of potentially life-threatening maternal conditions: a systematic review and meta-analysis.BMC pregnancy and childbirth · 2024Pooled it
- Global and regional estimates of maternal near miss: a systematic review, meta-analysis and experiences with application.BMJ global health · 2022Pooled it
- Human Development Index of the maternal country of origin and its relationship with maternal near miss: A systematic review of the literature.BMC pregnancy and childbirth · 2020Pooled it
- Applicability of the WHO maternal near miss tool in sub-Saharan Africa: a systematic review.BMC pregnancy and childbirth · 2019Pooled it
- Trial
- Determinants of potential life-threatening maternal conditions (PLTCs) in Tigray, northern Ethiopia: a case‒control study.Scientific reports · 2024Article
- Factors affecting the provision of high-quality postnatal care services in Zanzibar: a qualitative study.BMC pregnancy and childbirth · 2023Article
- The multidimensional impact of maternal near-miss on the lives of women in Zanzibar, Tanzania: a prospective, 1-year follow-up study.AJOG global reports · 2023Article
- Auditing the readiness of healthcare facilities for referral and management of pre-eclampsia cases in Zanzibar- a study protocol.PloS one · 2023Article
- Article
- Trends of and Factors Associated with Maternal Near-Miss in Selected Hospitals in North Shewa Zone, Central Ethiopia.Journal of pregnancy · 2022Article
- Retrospective validation study of miniPIERS prediction model in Zanzibar.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2021Article
- Maternal near miss among women admitted in major private hospitals in eastern Ethiopia: a retrospective study.BMC pregnancy and childbirth · 2021Article
- Article
- Mental Health and Quality of Life of Women One Year after Maternal Near-Miss in Low and Middle-Income Countries: The Case of Zanzibar, Tanzania.International journal of environmental research and public health · 2020Article
- "I lost my happiness, I felt half dead and half alive" - a qualitative study of the long-term aftermath of obstetric near-miss in the urban district of Zanzibar, Tanzania.BMC pregnancy and childbirth · 2020Article
- Prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar: a cross-sectional study.BMC public health · 2020Article
- Effect of locally tailored clinical guidelines on intrapartum management of severe hypertensive disorders at Zanzibar's tertiary hospital (the PartoMa study).International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2019Article
- Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveto analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital.
settingMnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania.
methodsWe identified all cases of morbidity and mortality in women admitted within 42 days after the end of pregnancy at Mnazi Mmoja Hospital in the period from April to October 2016. The severity of complications was classified using WHO's near-miss approach definitions: potentially life-threatening condition (PLTC), maternal near-miss (MNM) or maternal death (MD). Quality of in-hospital care was assessed using the mortality index (MI) defined as ratio between mortality and severe maternal outcome (SMO) where SMO = MD + MNM, cause-specific case facility rates and comparison with predicted mortality based on the Maternal Severity Index model. MAIN OUTCOMES: 5551 women were included. 569 (10.3%) had a potentially life-threatening condition and 65 (1.2%) a severe maternal outcome (SMO): 37 maternal near-miss cases and 28 maternal deaths. The mortality index was high at 0.43 and similar for women who developed a SMO within 12 hours of admission and women who developed a SMO after 12 hours. A standardized mortality ratio of 6.03 was found; six times higher than that expected in moderate maternal mortality settings given the same severity of cases. Obstetric haemorrhage was found to be the main cause of SMO. Ruptured uterus and admission to ICU had the highest case-fatality rates. Maternal death cases seemed to have received essential interventions less often.
conclusionsWHO's near-miss approach can be used in this setting. The high mortality index observed shows that in-hospital care is not preventing progression of disease adequately once a severe complication occurs. Almost one in two women experiencing life-threatening complications will die. This is six times higher than in moderate mortality settings.
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