Determinants of maternal near-miss cases at two selected central hospitals in Malawi

BACKGROUND: Maternal near-miss cases occur in larger numbers than maternal deaths hence they require comprehensive analysis when studied. However, there is scarcity of information on determinants of maternal near-miss cases in Malawi. Therefore, this study aimed at establishing the determinants of maternal near-miss cases at two selected central hospitals in Malawi. METHODS: This was a case control study that utilized a quantitative approach. A random sample of 458 case files comprising maternal near-miss cases (161) and non-cases (297) was drawn using a ratio of 1:1.8. Data were analyzed using Stata 14 to generate descriptive statistics, Chi Square values to describe the data and determine associations among variables and logistic regression was conducted to determine the determinants of maternal near-miss. RESULTS: We found significant differences between demographic characteristics (marital status, occupation, admission mode, means of transport and age) of maternal near-miss cases and the non-cases (P<0.05). Age and mode of birth were found to be significantly associated (P<0. 05) with maternal near-miss. Women aged 31–35 years were 3.14 times more likely to experience maternal near-miss [OR=3.14, 95% CI: 1.09, 9.02, p=0.03] compared to those aged less than 20 years. Furthermore, emergency caesarean [OR=4.08, 95% CI: 2.34, 7.09, p=0.001] and laparotomy for uterine rupture [OR=83.49, 95% CI: 10.49, 664.55, P=0.001] were significantly associated with maternal near-miss. CONCLUSION: Among pregnant women, health workers need to pay close attention to factors such as age and mode of birth for them to implement targeted maternal health services in order to reduce incidence of maternal near-miss cases.