title: Maternity wards or emergency obstetric rooms? Incidence of near-miss events in African hospitals.
abstract: BACKGROUND
  This study examines near-miss obstetric events in African hospitals as to the frequency, nature, and ratio of near miss to death and considers whether these could become useful indicators for monitoring the performance of obstetric services in Africa.
  
  
  METHODS
  Prospective or retrospective reviews of medical records were conducted in nine referral hospitals in three countries (Benin, Côte d'Ivoire, and Morocco). We calculated the incidence of near-miss obstetric events, near-miss cases, and maternal deaths related to hemorrhage, hypertensive diseases of pregnancy, dystocia, infections, and anemia and analyzed these according to hospital and timing relative to admission.
  
  
  RESULTS
  The incidence of near-miss cases was varied, and in some hospitals extremely large: from 1% to almost a quarter of all deliveries were near misses. Near-miss cases were 15 times more common than deaths (ranging from a ratio of 9:1-108:1). Most of the women with near-miss events (NMEs) (83%) were already in a critical condition on arrival at the hospital (range 54-90%), and two in three were referred from another facility. The most frequent types of NMEs were hemorrhage and hypertensive diseases of pregnancy, but anemia was the leading cause in three first referral level hospitals in Benin and Côte d'Ivoire. Near-miss events due to infections were rare.
  
  
  CONCLUSIONS
  Near-miss events are extremely common in some African hospitals, with a high proportion arriving in critical conditions. Near-miss events must be estimated separately for those already in a critical condition on arrival and those developing after admission; the first as a good indicator of the effectiveness of emergency referrals and the second as a potential tool for monitoring the performance of obstetric services.
authors.affiliation: Maternal Health Programme, London School of Hygiene and Tropical Medicine, London, United Kingdom. veronique.filippi@lshtm.ac.uk
authors.forename: Veronique
authors.initials: V
authors.lastname: Filippi
authors.forename: Carine
authors.initials: C
authors.lastname: Ronsmans
authors.forename: Valerie
authors.initials: V
authors.lastname: Gohou
authors.forename: Sourou
authors.initials: S
authors.lastname: Goufodji
authors.forename: Mohamed
authors.initials: M
authors.lastname: Lardi
authors.forename: Amina
authors.initials: A
authors.lastname: Sahel
authors.forename: Jacques
authors.initials: J
authors.lastname: Saizonou
authors.forename: Vincent
authors.initials: V
authors.lastname: De Brouwere
mesh_terms: D001541:Benin; D007560:Cote d'Ivoire; D003906:Developing Countries; D004630:Emergencies; D005260:Female; D006801:Humans; D015994:Incidence; D008428:Maternal Mortality; D009018:Morocco; D009775:Obstetrics and Gynecology Department, Hospital; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology