International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries - case report series and suggested actions.

Autor: Okafor O; Harvard T. H Chan School of Public Health, Boston, MA, USA., Roos N; Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden., Abdosh AA; Department of Obstetrics and Gynecology, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia., Adesina O; Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria., Alaoui Z; Regional Directorate of Health, Settat region Casablanca, Morocco., Romero WA; Department of the Gynecology and Obstetrics, Hospital Regional de Occidente, Quetzaltenango, Guatemala., Assarag B; National School of Public Health, Rabat, Morocco., Aworinde O; Department of Obstetrics and Gynecology, Bowen University, Iwo, Nigeria., de Bernis L; Independent Consultant in International Maternal and Perinatal Health, 47300, Bias, France., Castro R; Hospital Doctor Roberto Suazo Cordova, La Paz, Honduras., Chrifi H; National School of Public Health, Rabat, Morocco., Day LT; Department of Infectious Disease Epidemiology, Maternal and Newborn Health Group, London School of Hygiene & Tropical Medicine, London, UK., Demissew R; Department of Obstetrics and Gynecology, Addis Ababa University, Addis Ababa, Ethiopia., Aceituno MGF; Obstetrics, Gynecology and Obstetrics Critical Care Unit, Hospital Regional de Occidente, Quetzaltenango, Guatemala., Gadama L; Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Zomba, Malawi., Gashawbeza B; Department of Obstetrics and Gynecology, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia., Keke SG; Center of Research in Human Reproduction and Demography, Cotonou, Benin., Govule P; Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana., Gwako G; Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya., Jayaratne K; Family Health Bureau, Ministry of Health, Colombo, Sri Lanka., Komboigo EB; Training and Research Unit in Health Sciences, Nazi Boni University, Bobo-Dioulasso, Burkina Faso., Lara B; Ministry of Health of Honduras, Tegucigalpa, Honduras., Madziyire MG; Clinical Trials Research Centre, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe., Mathai M; Independent Consultant in International Maternal and Perinatal Health, St John's, Newfoundland and Labrador, Canada., Moulki R; National School of Public Health, Rabat, Morocco., Moutaouadia I; Ben Msik Prefectural Hospital Center, Casablanca, Morocco., Munjanja S; Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe., Fletes CAO; San Felipe Hospital, Tegucigalpa, Honduras., Ortiz EI; Department of Obstetrics and Gynecology, University of Valle, Cali, Colombia., Ouedraogo HG; National Center for Scientific and Technological Research: Ouagadougou, Center, Ouagadougou, Burkina Faso., Qureshi Z; Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya., Recidoro ZD; Department of Health, Disease Prevention and Control Bureau, Manila, Philippines., Senanayake H; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Soma-Pillay P; Department of Obstetrics and Gynecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa., Tin KN; Department of Public Health, Maternal and Reproductive Health Division, Ministry of Health and Sports, Naypyitaw, Myanmar., Sedami P; Ministry of Health, Cotonou, Benin., Worku D; Department of Obstetrics and Gynecology, Addis Ababa University, Addis Ababa, Ethiopia., Bonet M; Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 27 CH-1211, Geneva, Switzerland. bonetm@who.int.
Jazyk: angličtina
Zdroj: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2022 May 23; Vol. 22 (1), pp. 431. Date of Electronic Publication: 2022 May 23.
DOI: 10.1186/s12884-022-04731-x
Abstrakt: Background: Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement.
Method: An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework.
Results: Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections.
Conclusion: Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.
(© 2022. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje