ArticleBMC pregnancy and childbirth2017
Severe maternal outcomes and quality of care at district hospitals in Rwanda- a multicentre prospective case-control study.
Article in BMC pregnancy and childbirth, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 8 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
27 citing papers in PubMed, 8 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- Maternal near miss incidence ratio, its causes and risk factors in East Africa: a systematic review and meta-analysis.Reproductive health · 2025Pooled it
- Worldwide Wellness of Mothers and Babies (WWOMB): program overview and lessons learned from Ethiopia.Archives of public health = Archives belges de sante publique · 2024Pooled it
- Prevalence, underlying causes, and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis.Frontiers in medicine · 2024Pooled it
- Global and regional estimates of maternal near miss: a systematic review, meta-analysis and experiences with application.BMJ global health · 2022Pooled it
- Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020.Journal of global health · 2021Pooled 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
- Severe maternal outcomes and their underlying causes in Ethiopia. Systematic review and meta-analysis.Women's health (London, England)Pooled it
- Effectiveness of Intermittent Screening and Treatment of Malaria in Pregnancy on Maternal and Birth Outcomes in Selected Districts in Rwanda: A Cluster Randomized Controlled Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Trial
- Obstetric complications and socio-demographic characteristics associated with severe maternal morbidity at Mbeya Zonal Referral Hospital, Tanzania: a case-control study.Frontiers in global women's health · 2026Article
- Clinical factors associated with severe maternal outcomes in two South African hospitals: A case-control study.PloS one · 2026Article
- Prediction of adverse pregnancy outcomes using machine learning techniques: evidence from analysis of electronic medical records data in Rwanda.BMC medical informatics and decision making · 2025Article
- Healthcare-Seeking Behaviour for Obstetric Complications in Ethiopia: A Multilevel Mixed-Effect Analysis.Health services insights · 2025Article
- Article
- Magnitude of maternal near-misses and associated factors in Arsi Zone public hospitals in Oromia, Ethiopia, 2022.Heliyon · 2024Article
- Incidence of Adverse Perinatal Outcomes among Women Exposed to Maternal Near-Misses in Arsi Zone in Ethiopia: Prospective Cohort Study in 2022.Journal of pregnancy · 2024Article
- Quality and timeliness of emergency obstetric care and its association with maternal outcome in Keren Hospital, Eritrea.Scientific reports · 2022Article
- The effect of a decision-support mHealth application on maternal and neonatal outcomes in two district hospitals in Rwanda: pre - post intervention study.BMC pregnancy and childbirth · 2022Article
- Severe Maternal Outcomes and Quality of Maternal Health Care in South Ethiopia.International journal of women's health · 2022Article
- Incidence, mortality, and factors associated with primary postpartum haemorrhage following in-hospital births in northwest Ethiopia.PloS one · 2022Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundDespite a significant decrease in maternal mortality in the last decade, Rwanda needs further progress in order to achieve Sustainable Development Goals (SDG)3 which addresses among others maternal mortality. Analysis of severe maternal outcomes (SMO) was performed to identify their characteristics, causes and contributory factors, using standard indicators for quality of care.
methodsA prospective case-control study was conducted for which data were collected between November 2015 and April 2016 in four rural district hospitals. The occurrence of SMO with near miss incidence ratios was established, followed by an analysis of the characteristics, clinical outcomes, causes and contributory factors.
resultsThe SMO incidence ratio was 38.4 per 1000 live births (95% CI 33.4-43.4) and the maternal near-miss incidence ratio was 36 per 1000 live births (95% CI 31.1-40.9). The leading causes of SMO were postpartum haemorrhage (23.4%), uterine rupture (22.9%), abortion related complications (16.8%), malaria (13.6%) and hypertensive disorders (8.9%). The case fatality rate was high for women with hypertensive disorders (10.5%; CI 3.3-24.3) and severe postpartum haemorrhage (8%; CI 0.5-15.5). Stillbirth (OR = 181.7; CI 43.5-757.9) and length of stay at the hospital (OR = 7.9; CI 4.5-13.8) were strongly associated with severe outcomes.
conclusionsDespite the use of life saving interventions, SMO are frequent. Mortality index was found to be low at the level of district hospitals. SMO were associated with long stay at the hospital and stillbirth. There is a need for improvement of quality of care, referral practices and certain types of infrastructure, especially blood banks, which would ensure truly comprehensive emergency obstetric care and reduce the occurrence of SMO.
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