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Facility-based maternal deaths: Their prevalence, causes and underlying circumstances. A mixed method study from the national referral hospital of Somaliland
Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing.
University of Hargeisa, Somaliland.
Dalarna University, School of Health and Welfare, Caring Science/Nursing.ORCID iD: 0000-0002-0038-9402
Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Karolinska Institutet, Stockholm.ORCID iD: 0000-0002-8947-2949
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2023 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, article id 100862Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Somaliland has one of the highest rates of maternal deaths in the world. An estimated 732 women die for every 100,000 live births. This study aims to identify the prevalence of facility-based maternal deaths, the causes and their underlying circumstances by interviewing relatives and health care providers at the main referral hospital.

METHOD: A hospital-based mixed method study. The prospective cross-sectional design of the WHO Maternal Near Miss tool was combined with narrative interviews with 28 relatives and 28 health care providers in direct contact with maternal deaths. The quantitative data was analysed with descriptive statistics using SPSS and the qualitative part of the study was analysed with content analysis using NVivo.

RESULTS: From the 6658 women included 28 women died. The highest direct cause of maternal death was severe obstetric haemorrhage (46.4%), followed by hypertensive disorders (25%) and severe sepsis (10.7%). An indirect obstetric cause of death was medical complications (17.9%). Twenty-five per cent of these cases were admitted to ICU and 89% had referred themselves to the hospital for treatment. The qualitative data identifies two categories of missed opportunities that could have prevented these maternal mortalities: poor risk awareness in the community and inadequate interprofessional collaboration at the hospital.

CONCLUSION: The referral system needs to be strengthened utilizing Traditional Birth Attendants as community resource supporting the community facilities. The communication skills and interprofessional collaboration of the health care providers at the hospital needs to be addressed and a national maternal death surveillance system needs to be commenced.

Place, publisher, year, edition, pages
2023. Vol. 37, article id 100862
Keywords [en]
Low-income country, Maternal deaths, Maternal near miss, Mixed methods, Somaliland
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:du-46125DOI: 10.1016/j.srhc.2023.100862ISI: 001013205700001PubMedID: 37269618Scopus ID: 2-s2.0-85165675469OAI: oai:DiVA.org:du-46125DiVA, id: diva2:1763946
Available from: 2023-06-08 Created: 2023-06-08 Last updated: 2023-08-07Bibliographically approved

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Egal, Jama AliOsman, FatumoKlingberg-Allvin, MarieErlandsson, Kerstin

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CiteExportLink to record
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