Cargando…
Severe maternal outcomes and quality of care at district hospitals in Rwanda– a multicentre prospective case-control study
BACKGROUND: Despite 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 char...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702108/ https://www.ncbi.nlm.nih.gov/pubmed/29178885 http://dx.doi.org/10.1186/s12884-017-1581-4 |
_version_ | 1783281456516169728 |
---|---|
author | Sayinzoga, Felix Bijlmakers, Leon van der Velden, Koos van Dillen, Jeroen |
author_facet | Sayinzoga, Felix Bijlmakers, Leon van der Velden, Koos van Dillen, Jeroen |
author_sort | Sayinzoga, Felix |
collection | PubMed |
description | BACKGROUND: Despite 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. METHODS: A 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. RESULTS: The 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. CONCLUSIONS: Despite 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-017-1581-4) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5702108 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57021082017-12-04 Severe maternal outcomes and quality of care at district hospitals in Rwanda– a multicentre prospective case-control study Sayinzoga, Felix Bijlmakers, Leon van der Velden, Koos van Dillen, Jeroen BMC Pregnancy Childbirth Research Article BACKGROUND: Despite 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. METHODS: A 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. RESULTS: The 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. CONCLUSIONS: Despite 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-017-1581-4) contains supplementary material, which is available to authorized users. BioMed Central 2017-11-25 /pmc/articles/PMC5702108/ /pubmed/29178885 http://dx.doi.org/10.1186/s12884-017-1581-4 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Sayinzoga, Felix Bijlmakers, Leon van der Velden, Koos van Dillen, Jeroen Severe maternal outcomes and quality of care at district hospitals in Rwanda– a multicentre prospective case-control study |
title | Severe maternal outcomes and quality of care at district hospitals in Rwanda– a multicentre prospective case-control study |
title_full | Severe maternal outcomes and quality of care at district hospitals in Rwanda– a multicentre prospective case-control study |
title_fullStr | Severe maternal outcomes and quality of care at district hospitals in Rwanda– a multicentre prospective case-control study |
title_full_unstemmed | Severe maternal outcomes and quality of care at district hospitals in Rwanda– a multicentre prospective case-control study |
title_short | Severe maternal outcomes and quality of care at district hospitals in Rwanda– a multicentre prospective case-control study |
title_sort | severe maternal outcomes and quality of care at district hospitals in rwanda– a multicentre prospective case-control study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702108/ https://www.ncbi.nlm.nih.gov/pubmed/29178885 http://dx.doi.org/10.1186/s12884-017-1581-4 |
work_keys_str_mv | AT sayinzogafelix severematernaloutcomesandqualityofcareatdistricthospitalsinrwandaamulticentreprospectivecasecontrolstudy AT bijlmakersleon severematernaloutcomesandqualityofcareatdistricthospitalsinrwandaamulticentreprospectivecasecontrolstudy AT vanderveldenkoos severematernaloutcomesandqualityofcareatdistricthospitalsinrwandaamulticentreprospectivecasecontrolstudy AT vandillenjeroen severematernaloutcomesandqualityofcareatdistricthospitalsinrwandaamulticentreprospectivecasecontrolstudy |