Great saves or near misses? Severe maternal outcome in Metro East, South Africa: A region-wide population-based case-control study

Anke Heitkamp*, Linda Vollmer, Thomas van den Akker, Gabriel S. Gebhardt, Evelien M. Sandberg, Jos van Roosmalen, Marieke M. ter Wee, Johanna I. de Vries, Gerhard Theron

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: To assess the incidence of severe maternal outcome (SMO), comprising maternal mortality (MM) and maternal near miss (MNM), in Metro East health district, Western Cape Province, South Africa between November 2014 and November 2015 and to identify associated determinants leading to SMO with the aim to improve maternity care. Methods: Region-wide population-based case-control study. Women were included in the study, if they were maternal deaths or met MNM criteria, both as defined by WHO. Characteristics of women with SMO were compared with those of a sample of women without SMO, matched for age and parity, taken from midwifery-led obstetrical units from two residential areas in Metro East, using multivariate regression analysis. Results: Incidence of SMO was 9.1 per 1000 live births, and incidence of MNM was 8.6 per 1000 live births. Main causes of SMO were obstetrical hemorrhage and hypertensive disorders. Factors associated with SMO were HIV (adjusted odds ratio [aOR] 24.8; 95% confidence interval [CI] 10.0–61.6), pre-eclampsia (aOR 17.5; 95% CI 7.9–38.7), birth by cesarean section (aOR 8.4; 95% CI 5.8–12.3), and chronic hypertension (aOR 2.4; 95% CI 1.1–5.1). Conclusion: Evaluation of SMO incidence and associated determinants supports optimizing tailored guidelines in Metro-East health district to improve maternal health.
Original languageEnglish
JournalInternational Journal of Gynecology and Obstetrics
Early online date2021
Publication statusE-pub ahead of print - 2021

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