Maternal near miss incidence ratio, its causes and risk factors in East Africa: a systematic review and meta-analysis.

backgroundMaternal Near-Miss (MNM) is a woman who nearly dies but survives complications during pregnancy, childbirth, or 42 days following termination of pregnancy. MNM has emerged as a proxy indicator for the quality of maternal health services. For every maternal death, there are 20-30 MNM cases. However, there is a dearth of comprehensive evidence on MNM according to the WHO's MNM approach, as well as inconsistencies in risk factors from primary studies. Hence, we conducted a systematic review and meta-analysis on the maternal near-miss incidence ratio, causes, and risk factors in East Africa.

methodsThe review was conducted according to PRISMA 2020 checklist guidelines. Studies were identified from MEDLINE, Scopus, CNIAHL, PsycINFO, ProQuest, Web of Science, Emcare, and Google Scholar. Random-effect meta-analyses were conducted to produce pooled estimates. Further, an influential leave-one-out sensitivity analyses were conducted to investigate the impact of each study on the pooled estimates.

resultsThirty-nine primary studies on the MNM incidence ratio and/or causes and/or factors associated with MNM were included. The pooled MNM incidence ratio was 37.12 per 1,000 live births (95% CI: 20.22-54.03), ranging from 12 per 1,000 live births in Kenya to 53 per 1,000 live births in Ethiopia. The pooled proportion of direct causes of MNM were as follows: obstetric haemorrhage 29.9% (95%CI: 25.7%-34%), hypertensive disorder of pregnancy 27.8% (95%CI: 22.3%-33.3%), uterine rupture 13.8% (95%CI: 7.9%-19.6%), sepsis 9.9% (95%CI: 7.1-12.8%), abortion complications 8.1% (95%CI: 5.9%-10.3%), and ectopic pregnancy 7.3% (95%%CI: 3.1-11.5%). Several factors were significantly associated with MNM. Low-income women had higher odds of MNM (AOR 2.95, 95% CI: 1.28-4.61), while employed women had lower odds (AOR 0.53, 95% CI: 0.21-0.81). Parity ≥ 5 (AOR 1.65, 95% I: 1.14-2.16), history of abortion (AOR 1.63, 95%CI: 1.04-2.22), history of pregnancy complications (AOR 4.09, 95%CI: 1.43-6.78), history of cesarean section (CS) (AOR = 5.04, 95%CI: 3.17-6.90), lack of antenatal care (AOR 2.91, 95%CI: 2.02-3.78), lack of birth preparedness and complication readiness (AOR 4.18, 95%CI: 2.64-5.72), and long distance to health facility (AOR 3.06, 95%CI:1.09-5.03) were positively associated with MNM. Conversely, women admitted by provider referral had lower odds of MNM (AOR 0.31, 95% CI: 0.07-0.55).

conclusionsThe MNM incidence ratio in East Africa was high. Obstetric haemorrhage, hypertensive disorder of pregnancy, and uterine rupture were the three leading obstetric causes of MNM. Income, employment status, parity, ANC, history of CS, and distance to health facilities were found to be associated with MNM. Policymakers and healthcare workers need to consider these identified risk factors in interventions aimed at improving maternal health.