Prevalence and Risk Factors of Maternal Near Miss in Central Uganda: a Community based study

Nansubuga, Elizabeth

INTRODUCTION: Uganda has a strong health policy and programme environment. However, the maternal mortality (MM) ratio has remained high. Also, several women survive the severe pregnancy complications termed as Maternal Near Misses (MNM). In Uganda, MNM occurs six times more frequently than MM (Kaye et al., 2003) leading to knowledge gaps that need to be addressed. MNM emerged as a new paradigm of investigating maternal health. Thus the community approach more than the hospital approach will appropriately estimate the MNM prevalence and risk factors which have remained unclear. The knowledge obtained will guide the development of scientifically sound strategies thus contributing to the attainment of Millennium Development Goal 5 in Uganda.

METHODS: The study used a cross-sectional retrospective quantitative and qualitative research design. A multi-stage sampling design was employed and the sample size of 1,580 women aged 15 – 49 who had a pregnancy in the last three years was achieved. Ethical study approval was sought. The outcome variable (MNM) was defined as any woman who experienced a severe pregnancy complication. STATA was used for analysis. All statistical tests were done at 95% confidence level (CI) and 5% p-value.

RESULTS: The prevalence was 27% (0.027 per 1,000 pregnancies). Binary logistic regression preliminary results showed that women with: a history of complications (CI 0.221 - 0.439); unwanted pregnancies (CI 1.086 - 1.986); and adolescents (CI 1.235 - 7.881); primigravida women (CI 1.056 - 5.212) were at risk of MNM events. Health facility deliveries (CI 1.393 - 2.730), rural residence (CI 1.511 - 3.972), uneducated male partners (CI 0.302 - 0.961) were significantly associated with occurrence of MNM events. This can be attributed to poor and delayed access to Emergency obstetric care (EmoC).

CONCLUSIONS: There is need for: increased access to: family planning services; EmoC services in rural areas; and skilled birth attendance.