Retrospective validation study of miniPIERS prediction model in Zanzibar.

OBJECTIVE: To perform a retrospective external validation of miniPIERS in Zanzibar's referral hospital. METHODS: From February to December 2017, data were collected retrospectively on all cases of hypertensive disorders of pregnancy (HDP) admitted to Mnazi Mmoja Hospital, Zanzibar, Tanzania. The primary outcome was the predictive performance of miniPIERS by examining measures of discrimination, calibration, and stratification accuracy. The secondary outcome was the applicability of miniPIERS within the referral hospital setting. RESULTS: During this period, 2218 of 13 395 (21%) patients were identified with HDP, of whom 594 met the inclusion criteria. Sixty per cent of patients with adverse outcomes were excluded because they had experienced one of the adverse outcomes before admission. The discriminative ability of miniPIERS was inaccurate. It was not likely to aid risk stratification because of low sensitivity and low positive predictive value. The model showed fair discrimination in HDP before 34 weeks of gestation (area under the receiver operating characteristics curve 0.72, 95% confidence interval 0.63-0.82). CONCLUSIONS: The benefit of miniPIERS appeared to be limited, although clinical conditions make any validation challenging. Its application for risk stratification in preterm pregnancies should be further investigated.

"I lost my happiness, I felt half dead and half alive" - a qualitative study of the long-term aftermath of obstetric near-miss in the urban district of Zanzibar, Tanzania.

BACKGROUND: This study aims to explore the stories of three women from Zanzibar, Tanzania, who survived life-threatening obstetric complications. Their narratives will increase understanding of the individual and community-level burden masked behind the statistics of maternal morbidity and mortality in Tanzania. In line with a recent systematic review of women-centred, qualitative maternal morbidity research, this study will contribute to guidance of local and global maternal health agendas. METHODS: This two-phased qualitative study was conducted in July-August 2017 and July-August 2018, and involved three key informants, who were recruited from a maternal near-miss cohort in May 2017 in Mnazi Mmoja Hospital, Zanzibar. The used methods were participant observation, interviews (informal, unstructured and semi-structured), participatory methods and focus group discussions. Data analysis relied primarily on grounded theory, leading to a theoretical model, which was validated repeatedly by the informants and within the study team. The findings were then positioned in the existing literature. Approval was granted by Zanzibar's Medical Ethical Research Committee (reference number: ZAMREC/0002/JUN/17). RESULTS: The impact of severe maternal morbidity was found to be multi-dimensional and to extend beyond hospital discharge and thus institutionalized care. Four key areas impacted by maternal morbidities emerged, namely (1) social, (2) sexual and reproductive, (3) psychological, and (4) economic well-being. CONCLUSIONS: This study showed how three women's lives and livelihoods were profoundly impacted by the severe obstetric complications they had survived, even up to 16 months later. These impacts took a toll on their physical, social, economic, sexual and psychological well-being, and affected family and community members alike. These findings advocate for a holistic, dignified, patient value-based approach to the necessary improvement of maternal health care in low-income settings. Furthermore, it emphasizes the need for strategies to be directed not only towards quality of care during pregnancy and delivery, but also towards support after obstetric complications.