Quality of maternal health care and factors Associated with maternal death at jimma University medical center, south west ethiopia Retrospective study using near-miss approach

Abstract

Background: “Poor quality of maternal health care becomes a paramount roadblock to end preventable maternal mortality and morbidity worldwide. Thus, maternal mortality is a significant public health problem with high burden in developing countries such as Ethiopia. Thus, world health organization recommended quality of maternal health care should be evaluated with certain maternal near miss indicators as it is better than using maternal mortality alone for designing, monitoring, follow up and evaluation of quality of maternal health care Objective: To assess quality of maternal health care and factors associated with maternal death at Jima University Medical Center using near-miss approach from January 1/2017 to December 30/2017 Methods: Facility based retrospective cohort study was conducted from March to April 2018. All individual records in Obstetrics and gynecology department from January 1/2017 to December 30/2017 included. Data were extracted using structured checklist adopted from tool validate in sub Saharan Africa and entered in to Epi Data version 3.1and then analyzed using SPSS version 21. Descriptive statistics and maternal near miss indexes were computed. Logistic regressions analysis was done to assess factors associated with maternal death. Results are presented using narration, tables, figures and graphs. Results: 3835 records reviewed of which 400(10.43%) were near miss. Maternal near miss ratio was 107:7 whereas Mortality index was 6.54% and mortality rate 0.73%. For all 150(25.09%) near misses with hypertensive disorders either magnesium sulfate or other anti-convalescent was given. 89.1% of sepsis treated with parenteral antibiotics and Prophylactic antibiotics given for 93.8% before cesarean section. Laparotomy was done for 80.36% of uterine rupture within three hours of arrival. Prophylactic antibiotics (AOR 0.1, CI= 0.02-0.5), shock (AOR 9.9, CI=2.29-42.81) and severe pre-eclampsia(AO 7.3, CI=1.49-35.87) associated with maternal death. Conclusion: Low mortality index (<20%), maternal mortality rate (<5%), higher Maternal near miss ratio and first line drug given for all hypertensive disorders show good quality maternal health care. But, parenteral antibiotics for infection, prophylactics for caesarean delivery and laparotomy for ruptured uterus within 3hurs of arrival done < 95% shows poor maternal health care quality. Thus, case management process needs upgrading of the services at study institu