Incidence, causes and correlates of maternal near-miss morbidity: a multi-centre cross-sectional study.

OBJECTIVE: To explore the incidence and factors associated with maternal near-miss. DESIGN: Cross-sectional study with an embedded case-control study. SETTING: Three tertiary referral hospitals in southern Ghana. POPULATION: All women admitted to study facilities with pregnancy-related complications or for birth. METHODS: An adapted version of the WHO Maternal Near Miss Screening Tool was used to identify maternal near-miss cases. These were compared with unmatched controls (uncomplicated deliveries) in a ratio of 1:2. MAIN OUTCOME MEASURES: Incidence of maternal near-miss, maternal near-miss to maternal mortality ratio, and cause of and factors associated with maternal near-miss. RESULTS: Out of 8433 live births, 288 maternal near-miss cases and 62 maternal deaths were identified. In all, 454 healthy controls were recruited for comparison. Maternal near-miss and maternal death incidence ratios were 34.2 (95% CI 30.2-38.1) and 7.4 (95% CI 5.5-9.2) per 1000 live births, respectively with a maternal near-miss to mortality ratio of 4.6:1. Cause of near-miss was pre-eclampsia/eclampsia (41.0%), haemorrhage (12.2%), maternal sepsis (11.1%) and ruptured uterus (4.2%). A major factor associated with maternal near-miss was maternal fever within the 7 days before birth (OR 5.95, 95%CI 3.754-9.424). Spontaneous onset of labour was protective against near-miss (OR 0.09 95% CI 0.057-0.141). CONCLUSION: For every maternal death, there were nearly five maternal near-misses. Women having a fever in the 7 days before delivery were six times more likely to experience a near-miss than women not having fever. TWEETABLE ABSTRACT: Maternal near-miss exceeds maternal death by 5:1, with the leading cause of maternal near-miss was pre-eclampsia/eclampsia.

Asymptomatic bacteriuria in pregnant women attending Antenatal Clinic at Komfo Anokye Teaching Hospital; Kumasi; Ghana

Objective: Symptomatic bacteriuria is common in pregnant women and if untreated could lead to serious complications. Although asymptomatic bacteriuria could also lead to such complications; this fact is not so well known. This study was to determine the prevalence of asymptomatic bacteri-uria in pregnant women attending antenatal clinic at the Komfo Anokye Teaching Hospital (KATH) Kumasi.Design: A prospective study to screen antenatal attendants for asymptomatic bacteriuria.Setting: The study was undertaken at KATH.Participants: All pregnant women attending ante-natal clinic at KATH; Kumasi between February and April 2003 and who agreed to enter the study were clinically evaluated to exclude signs and symptoms of urinary tract infection (UTI).Methods: Samples of 10-15ml urine were exam-ined for pus cells; bacteria and parasitic ova. The samples were further cultured on cysteine lactose electrolyte deficient agar and colony counts yield-ing bacterial growth of 105/ml or more of pure isolates were deemed significant.Results: Of the 220 pregnant women; 16 had sig-nificant bacteriuria giving a prevalence rate of 7.3. The highest age-specific prevalence was found in the 35-39 year-olds (13) and the lowest in the 15-19 year-olds (0.0). There was no sig-nificant difference in prevalence with increasing parity. The dominant bacteria isolates were E. coli (37) and Staph aureus (31).Conclusion: The prevalence of asymptomatic bac-teriuria in pregnant women at KATH is 7.3. The predominant organisms are E.coli and Staph au-reus; and most isolates are sensitive to nitrofuran-toin; cefuroxime and gentamicin