Maternal near-miss (MNM) is recognized as a new concept and has emerged as an adjunct to
investigation of maternal deaths as the two represent similar pathways. A conceptual model
that had helped us to explain the underlying preventable causes of MNM by examining three
phases of delay on maternal healthcare utilization was developed by Thaddeus and Maine. By
identifying and reducing the three delays, we will have the greatest impact in reducing MNM
and hence maternal deaths.
Aim
The aim of this study was to describe the extent, main types, and contributed factors for three
delays in care associated with MNM among women admitted in Women’s Health Hospital,
Assiut University, Egypt.
Methods
A prospective case–control study was conducted over a period of 1 year from 1 May 2014
to 30 April 2015 at Women’s Health Hospital, Assiut University; 342 MNM women and
684 age-matched control women were included in the study. The criteria we used for the
identification of MNM were generally based on the presence of different levels of organ
dysfunction, which have been identified as recommended by WHO. Data were collected through
two approaches: record review and direct interview before discharge. Delays experienced by
the study population were collected according to the three-delay model of Thaddeus and Maine.
Results
A high proportion of the MNM group had experienced delay irrespective of the type, with statically
significant differences from their controls. Nearly 50% of near-miss cases were more likely
to have experienced two or more types of delays compared with 7.7% of controls. Financial
problems, fear of being maltreated in hospitals, lack of awareness about signs of obstetric
complications, lack of participation in decision making, lack of antenatal care, negative attitude of
healthcare worker, and lack of blood availability were associated with delays among MNM cases
compared with controls. Having experienced third delay within the intermediate facilities (referral
status) was the highest significant predictor that contributed to MNM by delay types.
Conclusion and recommendations
Third delay experienced by the women within the intermediate facilities (referral status) was the
most prevalent delay among studied women. Reformation of healthcare system on multiple
levels and improvement of the socioeconomic status of women are necessary in Upper Egypt
to overcome causes of delay among MNM cases.