Maternal near misses (MNM) and their determinants among women who sought obstetric care from fort portal regional referral hospital, Western Uganda

Figures & data

Figure 1. Prevalence of MNMs among women who sought obstetric care.

Table 1. Socio demographic characteristics of the women (n =375)

Variable	Frequency	Percentage (%)
Age
15–25 years	264	70.4
26–36 years	99	26.4
37–47 years	12	3.2
		100.0
Religion
Catholic	117	31.2
Muslim	64	17.1
Anglican	106	28.3
SDA	72	19.2
Born again	16	4.3
		100.0
Marital Status
Married	236	62.9
Single	54	14.4
Cohabiting	85	22.7
		100.0
Received formal education
Yes	366	97.6
No	9	2.4
		100.0
Employment Status
Employed	99	26.4
Not employed	276	73.6
		100.0
District of residence
Kabarole	134	35.7
Kasese	37	9.9
Ntoroko	60	16.0
Bundibugyo	12	3.2
Kyenjojo	96	25.6
Kamwenge	12	3.2
Kyegegwa	24	6.4
		100.0

Table 2. Distribution of MNM Variables among Mothers

MNM Variables	MNMs		Total
	Experienced [n = 230]	Didn’t experience [n = 135]
Postpartum hemorrhage
Experienced (between 500 ml and 1000 ml)	71(30.9%)	2(1.4%)	73(19.5%)
Experienced (More than 1000 ml)	0(0.0%)	6(4.1%)	6(1.6%)
Not experienced	159(69.1%)	137(94.5%)	296(78.9%)
Severe preeclampsia
Experienced	93(40.4%)	4(2.8%)	97(25.9%)
Not experienced	137(59.6%)	141(97.2%)	278(74.1%)
Eclampsia
Experienced	105(45.7%)	3(2.1%)	108(28.8%)
Not experienced	125(54.3%)	142(97.9%)	267(71.2%)
Sepsis
Experienced	187(81.3%)	7(4.8%)	194(51.7%)
Not experienced	43(18.7%)	138(95.2%)	181(48.3%)
Severe systemic infection
Experienced	107(46.5%)	2(1.4%)	109(29.1%)
Not experienced	123(53.5%)	143(98.6%)	266(70.9%)
Ruptured uterus
Experienced	88(38.3%)	3(2.1%)	91(24.3%)
Not experienced	142(61.7%)	142(97.9%)	284(75.7%)
Severe complications of abortion
Experienced	143(62.2%)	6(4.1%)	149(39.7%)
Not experienced	87(37.8%)	139(95.9%)	226(60.3%)
Cardiovascular dysfunction
Shock	1(0.4%)	0(0.0%)	1(0.3%)
Cardiac arrest (absence of pulse/heart beat and loss of consciousness)	14(6.1%)	2(1.4%)	16(4.3%)
Not experienced	215(93.5%)	143(98.6%)	358(95.5%)
Respiratory dysfunction
Gasping	1(0.4%)	0(0.0%)	1(0.3%)
Not experienced	229(99.6%)	145(100.0%)	374(99.7%)
Renal dysfunction
Not experienced Experience	230(100.0%) 0(0.0%)	145(100.0%) 0(0.0%)	375(100.0%) 0(0.0%)
Coagulation/haematological dysfunction
Not experienced Experienced	230(100.0%) 0(0.0%)	145(100.0%) 0(0.0%)	375(100.0%) 0(0.0%)
Hepatic dysfunction
Jaundice in the presence of pre-eclampsia	47(20.4%)	2(1.4%)	49(13.1%)
Severe acute hyperbilirubinemia (bilirubin >100 µmol/l or >6.0 mg/dl)	4(1.7%)	0(0.0%)	4(1.1%)
Not experienced	179(77.8%)	143(98.6%)	322(85.9%)
Neurological dysfunction
Not experienced Experienced	230(100.0%) 0(0.0%)	145(100.0%) 0(0.0%)	375(100.0%) 0(0.0%)
Uterine dysfunction
Uterine haemorrhage or infection leading to hysterectomy	15(6.5%)	1(0.7%)	16(4.3%)
Not experienced	215(93.5%)	144(99.3%)	359(95.7%)

Table 3. Unadjusted relationships between individual variables and MNMs

Variable	Total	MNM status		cPR (95% CI)	P-value
		Experienced [n = 230]	Didn’t experience [n = 145]
Residence type
Rural	314	171(45.6%)	143(38.1%)	1.409 (1.330–1.493)	0.000
Urban	61	59(15.7%)	2(0.5%)	Ref
ANC during pregnancy
Yes	362	218(58.1%)	144(38.4%)	0.652(0.216–0.981)	0.048
No	13	12(3.2%)	1(0.3%)	Ref
Frequency of ANC attendance
One visit	46	28(7.5%)	18(4.8%)	1.026 (0.896–1.175)	0.710
Two visits	37	23(6.1%)	14(3.7%)	1.017 (0.880–1.175)	0.824
Three visits	97	64(17.1%)	33(8.8%)	0.988 (0.882–1.108)	0.841
Four visits	136	77(20.5%)	59(15.7%)	1.057 (0.950–1.177)	0.307
More than four visits	59	38(10.1%)	21(5.6%)	Ref
Trimester of Initiation of ANC
First trimester	288	173(46.1%)	114(30.4%)	0.705 (0.418–0.970)	0.001
Second trimester	32	9(2.4%)	23(6.1%)	0.329 (0.223–0.795)	0.000
Third trimester	55	47(12.5%)	8(2.1%)	Ref
Delivered recent pregnancy in health facility
Yes	324	185(49.3%)	139(37.1%)	0.647 (0.374–0.828)	0.000
No	51	45(12.0%)	6(1.6%)	Ref
Delivered at Fort Portal hospital
Yes	309	167(44.5%)	142(37.9%)	0.565 (0.217–0.821)	0.000
No	66	63(16.8%)	3(0.8%)	Ref
Length of hospital stay
More than 3 days	31	20(5.3%)	11(2.9%)	0.975 (0.856–1.110)	0.702
Less than 3 days	344	210(56.0%)	134(35.7%)	Ref
Referred from other facilities
Yes	253	20(5.3%)	11(2.9%)	1.498 (1.215–1.848)	0.000
No	122	210(56.0%)	134(35.7%)	Ref
Age
Between 15 and 25 years	264	165(44.0%)	99(26.4%)	0.152 (0.019 −1.191)	0.073
Between 26 and 36 years	99	54(14.4%)	45(12.0%)	0.109 (9.014–0.878)	0.037
Between 37 and 47 years	12	11(2.9%)	1(0.3%)	Ref
Religion
Catholic	117	67(17.9%)	50(13.3%)	1.088 (0.905–1.307)	0.372
Muslim	64	28(7.5%)	36(9.6%)	1.190 (0.985–1.439)	0.072
Anglican	106	76(20.3%)	30(8.0%)	0.978 (0.812–1.177)	0.810
SDA	72	48(12.8%)	24(6.4%)	1.016 (0.839–1.230)	0.872
Born again	16	11(2.9%)	5(1.3%)	Ref
Marital Status
Married	236	155(41.3%)	81(21.6%)	4.342 (2.546–7.406)	0.000
Single	54	49(13.1%)	5(1.3%)	22.238 (7.945–62.250)	0.000
Cohabiting	85	26(6.9%)	59(15.7%)	Ref
Received formal education
Yes	366	224(59.7%)	142(37.9%)	1.041 (0.824–1.315)	0.736
No	9	6(1.6%)	3(0.8%)	Ref
Employment Status
Employed	99	67(17.9%)	32(8.5%)	0.939 (0.866–1.018)	0.126
Not employed	276	163(43.5%)	113(30.1%)	Ref
District of residence
Kabarole	134	71(18.9%)	63(16.8%)	0.767 (0.707–0.832)	0.000
Kasese	37	35(9.3%)	2(0.5%)	0.550 (0.503–0.602)	0.000
Ntoroko	60	36(9.6%)	24(6.4%)	0.730 (0.657–0.812)	0.000
Bundibugyo	12	1(0.3%)	11(2.9%)	1.000 (0.905–1.105)	0.000
Kyenjojo	96	83(22.1%)	13(3.5%)	0.592 (0.545—.644)	0.000
Kamwenge	12	2(0.5%)	10(2.7%)	0.957 (0.841–1.088)	0.498
Kyegegwa	24	2(0.5%)	22(5.9%)	Ref

Table 4. Unadjusted relationships between obstetric variables and MNM

	Total	MNM status
Obstetric Variables		Experienced [n = 230]	Not experienced [n = 145]	cPR (95% CI)	P-value
Nature of pregnancy
Multiple	24	12(3.2%)	12(3.2%)	1.088 (0.947–1.249)	0.233
Singleton	351	218(58.1%)	133(35.5%)	Ref
Previous cesarean delivery
Yes	215	105(28.0%)	110(29.3%)	0.267 (0.169–0.424)	0.000
No	160	125(33.3%)	35(21.9%)	Ref
Number of cesarean deliveries
One	33	32(8.5%)	1(0.3%)	0.706 (0.632–0.790)	0.000
Two	124	36(9.6%)	88(23.5%)	1.172 (1.053–1.305)	0.004
Three	48	26(6.9%)	22(5.9%)	Ref
Type of most recent cesarean delivery (n =215)				N.A
Emergency	162	51(13.6%)	111(29.6%)
Elective	53	52(13.9%)	1(0.3%)
Duration of labor
Less than 5 hours	76	71(18.9%)	5(1.3%)	2.819 (2.14–3.703)	0.000
More than 5 hours	299	159(42.4%)	140(37.3%)	Ref
Labour induced
Yes	238	191(50.9%)	47(19.7%)	13.019 (5.115–33.138)	0.000
No	137	39(10.4%)	98(26.1%)	Ref
Labour obstructed
Yes	78	73(19.5%)	5(1.3%)	1.931 (1.629–2.290)	0.000
No	297	157(41.9%)	140(37.3%)	Ref
Gravidity
One	125	102(27.2%)	23(6.1%)	1.677 (1.192–2.360)	0.003
Two	117	71(18.9%)	46(12.3%)	1.247 (0.869–1.791	0.231
Three	96	39(10.4%)	57(15.2%)	0.835 (0.554–1.258	0.389
More than three	37	18(9.9%)	19(5.1%)	Ref
Still birth history
Yes	3	1(0.3%)	2(0.5%)	1.204 (0.872–1.661)	0.259
No	372	229(61.1%)	143(38.1%)	Ref
Parity
One	275	156(41.6%)	119(31.7%)	0.767 (0.656–0.895)	0.001
More than one	100	74(19.7%)	26(6.9%)	Ref
Outcomes of pregnancy				N.A
Spontaneous abortion	13	11(3.5%)	2(0.5%)
Induced abortion	24	24(6.4%)	0(0.0%)
Live birth	326	183(48.8%)	143(38.1%)
Still birth	12	12(3.2%)	0(0.0%)

Table 5. Determinants of maternal near misses among women who sought obstetric care

Variables	cPR (95% CI)	P-value	aPR (95% CI)	P-value
Residence type
Rural	1.409 (1.330–1.493)	0.000	1.470 (1.358–1.591)	0.000
Urban	Ref		Ref
ANC during pregnancy
Yes	0.652(0.216–0.981)	0.048	0.307 (0.038–2.509)	0.271
No	Ref		Ref
Trimester of Initiation of ANC
First trimester	0.705 (0.418–0.970)	0.001	0.749 (0.161–3.492)	0.713
Second trimester	0.329 (0.223–0.795)	0.000	0.480 (0.115–1.999)	0.313
Third trimester	Ref		Ref
Delivered pregnancy in health facility
Yes	0.647 (0.374–0.828)	0.000	0.342 (0.108–1.083)	0.068
No	Ref		Ref
Delivered at Fort Portal hospital
Yes	0.565 (0.217–0.821)	0.000	0.502 (0.014–0.194)	0.000
No	Ref		Ref
Referred from other facilities
Yes	1.498 (1.215–1.848)	0.000	5.431 (2.777–10.622)	0.000
No	Ref		Ref
Age
Between 15 and 25 years	0.152 (0.019 −1.191)	0.073	0.238(0.016–3.585)	0.300
Between 26 and 36 years	0.109 (9.014–0.878)	0.037	0.352(0.032–3.895)	0.395
Between 37 and 47 years	Ref		Ref
Marital Status
Married	4.342 (2.546–7.406)	0.000	7.137 (3.715–13.713	0.000
Single	22.238 (7.945–62.250)	0.000	28.436 (9.560–84.579	0.000
Cohabiting	Ref		Ref
District of residence
Kabarole	0.767 (0.707–0.832)	0.000	0.947 (0.831–1.080)	0.419
Kasese	0.550 (0.503–0.602)	0.000	0.690 (0.602–0.791)	0.000
Ntoroko	0.730 (0.657–0.812)	0.000	0.995 (0.879–1.127)	0.942
Bundibugyo	1.000 (0.905–1.105)	1.000	1.457 (1.152−1.843)	0.002
Kyenjojo	0.592 (0.545—.644)	0.000	0.744 (0.642–0.861)	0.000
Kamwenge	0.957 (0.841–1.088)	0.498	1.315 (1.062–1.627)	0.012
Kyegegwa	Ref		Ref
Previous cesarean delivery
Yes	0.267 (0.169–0.424)	0.000	0.488 (0.291–.819)	0.007
No	Ref		Ref
Number of cesarean deliveries
One	0.706 (0.632–0.790)	0.000	0.077 (0.000–16.169	0.348
Two	1.172 (1.053–1.305)	0.004	1.105 (1.110–1.282)	0.001
Three	Ref		Ref
Duration of labour
Less than 5 hours	2.819 (2.140–3.703)	0.000	7.219 (4.365–11.938)	0.000
More than 5 hours	Ref		Ref
Labor induced
Yes	13.019 (5.115–33.138)	0.000	15.676 (3.708–66.272)	0.000
No	Ref		Ref
Labor obstructed
Yes		0.000	0.973 (0.867–1.091)	0.638
No	Ref		Ref
Gravidity
One	1.677 (1.192–2.360)	0.003	1.989 (1.420–2.787	0.000
Two	1.247 (0.869–1.791)	0.231	1.247 (0.869–1.791)	0.231
Three	0.835 (0.554–1.258)	0.389	0.846 (0.562–1.274)	0.424
More than three	Ref
Parity
One	0.767 (0.656–0.895)	0.001	0.600 (0.339–1.062)	0.080
More than one	Ref		Ref

Table

S. No	Variables	Entry in patient record
01	Age	Between 15 and 25 years □ Between 26 and 36 years □ Between 37 and 47 years □ More than 47 years □
02	Religion	Catholic □ Muslim □ Anglican □ SDA □ Born again □ Other…………………….. □
03	Marital status	Married □ Single □ Cohabiting □
04	Received formal education	Yes □ No □
05	Level of education received	Primary □ Secondary □ Post-secondary □
06	Employment status	Employed □ Not employed □
07	District of residence	Kabarole □ Bunyangabu □ Kasese □ Ntoroko □ Bundibugyo □ Kyenjojo □ Kamwenge □

Table

S. No	Variables	Entry in patient record
08	Postpartum hemorrhage	Experienced (between 500ml and 1000 ml) □ Experienced (More than 1000 ml) □ Not experienced □
09	Severe pre-eclampsia	Experienced □ Not experienced □
10	Eclampsia	Experienced □ Not experienced □
11	Sepsis	Experienced □ Not experienced □
12	Severe systemic infection	Experienced □ Not experienced □
13	Ruptured uterus	Experienced □ Not experienced □
14	Severe complications of abortion	Experienced □ Not experienced □

Table

S. No	Variables	Marker of organ dysfunction entered I record
15	Cardiovascular dysfunction	Shock □ Cardiac arrest (absence of pulse/heart beat and loss of consciousness) □ Use of continuous vasoactive drugs □ Cardiopulmonary resuscitation □ Severe hypoperfusion (lactate>5 mmol/l or >45 mg/dl) □ Severe acidosis (ph <7.1) □ Not experienced □
16	Respiratory dysfunction	Acute cyanosis □ Gasping □ Severe tachypnea (respiratory rate >40 breaths per minute) □ Severe bradypnea (respiratory rate <6 breaths per minute) □ Intubation and ventilation not related to anaesthesia □ Severe hypoxemia (O2 saturation <90% for ≥60 min or PAO2/fio2 <200) □ Not experienced □
17	Renal dysfunction	Oliguria non-responsive to fluids or diuretics □ Dialysis for acute renal failure □ Severe acute azotemia (creatinine ≥300 μmol/ml or ≥3.5 mg/dl) □ Not experienced □
18	Coagulation/haematological dysfunction	Failure to form clots2. Massive transfusion of blood or red cells (≥5 units) □ Severe acute thrombocytopenia (<50 000 platelets/ml) □ Not experienced □
19	Hepatic dysfunction	Jaundice in the presence of pre-eclampsia □ Severe acute hyperbilirubinemia (bilirubin >100 μmol/l or >6.0 mg/dl) □ Not experienced □
20	Neurological dysfunction	Prolonged unconsciousness (lasting ≥12 h)/coma (including metabolic coma) □ Stroke □ Uncontrollable fits/status epilepticus □ Total paralysis □ Not experienced □
21	Uterine dysfunction	Uterine haemorrhage or infection leading to hysterectomy □ Not experienced □

Table

S. No	Variables	Entry in patient record
21	Residence type	Rural □ Urban □
22	Attended Antenatal care during pregnancy	Yes □ No □
23	Frequency of ANC attendance	One visit □ Two visits □ Three visits □ Four visits □ More than four visits □
24	Trimester of Initiation of ANC	First trimester □ Second trimester □ Third trimester □
25	Delivered pregnancy in health facility	Yes □ No □
	Delivered pregnancy at Fort Portal hospital	Yes □ No □
24	Length of hospital stay	More than 7 days □ Less than 7 days □
25	Referred from other facilities	Yes □ No □

Table

S. No	Variables	Entry in patient record
26	Nature of pregnancy	Multiple □ Singleton □
27	Previous cesarean delivery	Yes □ No □
28	Number of cesarean deliveries	One □ Two □ Three □
29	Type of most recent cesarean delivery	Emergency □ Elective □
28	Recent mode of delivery	SVD □ Cesarean birth □
29	Duration of labor	Less than 5 hours □ More than 5 hours □
30	Labor induced	Yes □ No □
31	Labor obstructed	Yes □ No □
32	Gravidity	One □ Two □ Three □ More than three □
33	Still birth history	Yes □ No □
34	Parity	Yes □ No □
35	Outcomes of pregnancy	Spontaneous abortion □ Induced abortion □ Live birth □ Still birth □