Mortality after near-miss obstetric complications in Burkina Faso: medical, social and health-care factors.
OBJECTIVE
To investigate mortality in women in Burkina Faso in the 4 years following a life-threatening near-miss obstetric complication and to identify the medical, social and health-care-related causes of death.


METHODS
In total, 1014 women were recruited after hospital discharge and followed for up to 4 years: 337 had near-miss complications and 677 had uncomplicated pregnancies. Significant differences in mortality between the groups were assessed using Fisher's exact test. The medical causes of death were identified from medical records and verbal autopsy data; social and health-care-related factors associated with death were identified from interviews with the deceased women's relatives.


RESULTS
In the 4 years, 15 (5.3%) women died in the near-miss group and 5 (0.9%) died after uncomplicated pregnancies (P < 0.001). More than half the deaths after a near miss, but none after an uncomplicated delivery, were pregnancy-related. Indirect factors contributed to many of these deaths, particularly human immunodeficiency virus infection. Relatives' accounts suggested that the high cost and poor quality of health care, a lack of follow-up care and an unmet need for contraception contributed to the excess mortality in the near-miss group.


CONCLUSIONS
Women in Burkina Faso who initially survived a near-miss obstetric complication had an increased risk of all-cause and pregnancy-related death in the ensuing 4 years. The likelihood of survival over the longer term could be increased by offering a continuum of care that addresses the indirect and social causes of death and supplements the emergency intrapartum obstetric care provided by current safe motherhood programmes.
Centre for Development and the Environment, University of Oslo, PB 1116 Blindern, Oslo 0317, Norway. Katerini.storeng@sum.uio.no
Katerini T
KT
Storeng
Seydou
S
Drabo
Rasmané
R
Ganaba
Johanne
J
Sundby
Clara
C
Calvert
Véronique
V
Filippi
D000328:Adult; D001344:Autopsy; D002050:Burkina Faso / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006293:Health Promotion; D006801:Humans; D007398:Interpersonal Relations; D008428:Maternal Mortality; D008429:Maternal Welfare; D009774:Obstetrics / Q000379:methods / Q000706:statistics & numerical data*; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D012946:Social Welfare; D013223:Statistics as Topic; D013997:Time Factors; D055815:Young Adult