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Maternal deaths, near misses and great saves. Severe maternal outcome in Metro East, Western Cape Province, South Africa
Thesis (PhD)--Stellenbosch University, 2023.
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| Format: | Thesis |
| Language: | en_ZA |
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Stellenbosch : Stellenbosch University
2023
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| _version_ | 1867614027933286400 |
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| access_status_str | Open Access |
| author | Heitkamp, Anke |
| author2 | Theron, Gerhardus Barnard |
| author_browse | Heitkamp, Anke Theron, Gerhardus Barnard |
| author_facet | Theron, Gerhardus Barnard Heitkamp, Anke |
| author_sort | Heitkamp, Anke |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2023. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/128975 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:45:31.220Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2023 |
| publishDateRange | 2023 |
| publishDateSort | 2023 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/128975 Maternal deaths, near misses and great saves. Severe maternal outcome in Metro East, Western Cape Province, South Africa Heitkamp, Anke Theron, Gerhardus Barnard De Vries, Johanna Inge Petra Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. Obstetrics and Gynecology. Maternal mortality -- Western Cape (South Africa) Obstetrical emergencies -- Western Cape (South Africa) Preeclampsia -- Western Cape (South Africa) Peripartum hysterectomy -- Western Cape (South Africa) Pulmonary edema -- Western Cape (South Africa) Thesis (PhD)--Stellenbosch University, 2023. PhD submitted in the form as an e-book. ENGLISH ABSTRACT: Objective To assess the incidence of Severe Maternal Outcome (SMO), comprising maternal mortality (MM) and near miss (MNM), in Metro East healthdistrict, Western Cape Province, South Africa between November 2014 and November 2015 and identify associated determinants leading to SMO with the aim to improve maternity care. Methods Design: 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 World Health Organization. Characteristics of women with SMO were compared with a sample of women without SMO, matched for age and parity, taken from midwifery-led obstetric units from two residential areas in Metro East, using multivariate regression analysis. Results Incidence of SMO was 9.1 per 1000 livebirths, of MNM 8.6 per 1000 live births. Main causes of SMO were obstetric hemorrhage and hypertensive disorders. Factors associated with SMO were HIV (adjusted odds ratio (aOR) 24.8; 95% confidence interval (95% CI) 10.0 – 61.6), preeclampsia (aOR 17.5; 95% CI 7.9-38.7), birth by caesarean 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. AFRIKAANSE OPSOMMING: Oorsig van Ernstige Moeder Uitkoms (SMO), wat die kombinasie van Moeder “Near Miss” (MNM) en Moeder Mortaliteit is, in die Metro-Oos-gesondheidsdistrik, WesKaapprovinsie, Suid-Afrika, het waardevolle inligting verskaf oor die voorkoms en faktore wat daartoe bydra. Die MNM-ratio in Metro-Oos was 8.6 per 1,000 lewend-geboortes in 2014-2015 en die Moedersterfte-Ratio 49.7 per 100,000 lewend-geboortes, met ‘n SMO-ratio van 9.1 per 1,000 lewend-geboortes. Die MNM-ratio soos gevind in Metro-Oos is vergelykbaar met die mediane MNM-ratio van 9.6 per 1,000 lewend-geboortes in middel-inkomste lande. Die MNM-ratio is 15.9 per 1,000 in laer-middel en 7.8 per 1,000 in hoër-middel inkomste lande. Die MNM-ratio in Metro-Oos was gering hoër as in ander streke van Suid-Afrika, maar die sterfgevalle van vroue met MNM was laer. Die bevinding dui moontlik op beter kwaliteit van sorg. Die hoofoorsake van SMO in Metro-Oos was hipertensiewe toestande tydens swangerskap en erge obstetriese bloeding, soortgelyk as die SMO in ander middel inkomste lande en wêreldwyd. Ander geassosieërde toestande was HIV-positiewe serostatus, keisersnit verlossings, pre-eklampsie en vetsug. Die relatief groot verskille in voorkoms van SMO in verskillende streke van Suid-Afrika en tussen verskillende middel-inkomste lande kan ten dele verduidelik word deur die gebruik van die MNM meet-instrument soos aanbeveel deur die Wêreld Gesondheidsorganisasie. Ons stel voor dat die instrument tans mees waardevol is vir die beoordeling van SMO in die eie omgewing eerder as vir vergelyking tussen streke en lande. Analise van SMO in Metro-Oos verskaf waardevolle insig oor plaaslike oorsake: obstetriese bloeding wat meer algemeen die gevolg is van abruptio placentae, dikwels in kombinasie met intrauteriene sterftes en hipertensie. In kontras met die meeste ander plekke was histerektomie vir moederlike sepsis net so algemeen as vir peripartum bloeding en beide geassosieër met keisesnit-verlossings. Ernstige komplikasies van hipertensiewe toestande van swangerskap was meer algemeen, met longedeem ‘n algemene komplikasie wat aanleiding gee tot moedersterftes. Vroeë opsporing en hantering van pre-eklampsie, monitoring van die vogbalans en kardiale evaluering wanneer longedeem nie op behandeling reageer nie, is voorgestelde voorkomende maatreëls. Audit lei tot waardevolle lesse: van alle vroue met SMO was nie-bywoning van voorgeboorte sorg ‘n moeder-verwante faktor en ‘n diagnose wat nie gemaak word nie asook onvoldoende tydige hantering van voorkombare faktore op die vlak van die gesondheidswerker. In omtrent ‘n kwart van gevalle sou ander hantering moontlik SMO 165287_Anke_Heitkamp_BNW-def.indd 210 12-3-2023 15:44:22 211 Adendum voorkom het. Leefstyl verandering, ‘n begrip van moeders se gedrag en ook vroeë herkenning van SMO met voldoende multidissiplinêre hantering in ‘n intensiewe sorg omgewing sal SMO verminder en uitkomste verbeter. Gesondheidswerkers vind die identifikasie en analise van MNM waardevol, bykomend tot die bestaande vertroulike ondersoek na moedersterftes in Suid-Afrika. ‘n Nasionale MNM audit word aanbeveel om oorsake aan te spreek en moeders se uitkomste te verbeter. ‘n Lys van oorsake bykomend tot dié wat reeds genoem is in die bestaande MNM instrument, sal help om plaaslike oosake van MNM meer akkuraat te identifiseer. Vereenvoudiging van die instrument sal plaaslik verwelkom word. Doctoral 2023-11-27T07:25:14Z 2024-01-08T17:51:21Z 2023-11-27T07:25:14Z 2024-01-08T17:51:21Z 2023-12 Thesis https://scholar.sun.ac.za/handle/10019.1/128975 en_ZA Stellenbosch University 228 pages : illustrations application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Maternal mortality -- Western Cape (South Africa) Obstetrical emergencies -- Western Cape (South Africa) Preeclampsia -- Western Cape (South Africa) Peripartum hysterectomy -- Western Cape (South Africa) Pulmonary edema -- Western Cape (South Africa) Heitkamp, Anke Maternal deaths, near misses and great saves. Severe maternal outcome in Metro East, Western Cape Province, South Africa |
| title | Maternal deaths, near misses and great saves. Severe maternal outcome in Metro East, Western Cape Province, South Africa |
| title_full | Maternal deaths, near misses and great saves. Severe maternal outcome in Metro East, Western Cape Province, South Africa |
| title_fullStr | Maternal deaths, near misses and great saves. Severe maternal outcome in Metro East, Western Cape Province, South Africa |
| title_full_unstemmed | Maternal deaths, near misses and great saves. Severe maternal outcome in Metro East, Western Cape Province, South Africa |
| title_short | Maternal deaths, near misses and great saves. Severe maternal outcome in Metro East, Western Cape Province, South Africa |
| title_sort | maternal deaths near misses and great saves severe maternal outcome in metro east western cape province south africa |
| topic | Maternal mortality -- Western Cape (South Africa) Obstetrical emergencies -- Western Cape (South Africa) Preeclampsia -- Western Cape (South Africa) Peripartum hysterectomy -- Western Cape (South Africa) Pulmonary edema -- Western Cape (South Africa) |
| url | https://scholar.sun.ac.za/handle/10019.1/128975 |
| work_keys_str_mv | AT heitkampanke maternaldeathsnearmissesandgreatsavesseverematernaloutcomeinmetroeastwesterncapeprovincesouthafrica |