The WHO maternal near miss approach: consequences at Malawian District level.
BACKGROUND
WHO proposes a set of organ-failure based criteria for maternal near miss. Our objective was to evaluate what implementation of these criteria would mean for the analysis of a cohort of 386 women in Thyolo District, Malawi, who sustained severe acute maternal morbidity according to disease-based criteria.


RESULTS
A WHO Maternal Near Miss (MNM) Tool, created to compare disease-, intervention- and organ-failure based criteria for maternal near miss, was completed for each woman, based on a review of all available medical records. Using disease-based criteria developed for the local setting, 341 (88%) of the 386 women fulfilled the WHO disease-based criteria provided by the WHO MNM Tool, 179 (46%) fulfilled the intervention-based criteria, and only 85 (22%) the suggested organ-failure based criteria.


CONCLUSIONS
In this low-resource setting, application of these organ-failure based criteria that require relatively sophisticated laboratory and clinical monitoring underestimates the occurrence of maternal near miss. Therefore, these criteria and the suggested WHO approach may not be suited to compare maternal near miss across all settings.
Thyolo District Health Office, Ministry of Health, Thyolo, Malawi.
Thomas
T
van den Akker
Jogchum
J
Beltman
Joey
J
Leyten
Beatrice
B
Mwagomba
Tarek
T
Meguid
Jelle
J
Stekelenburg
Jos
J
van Roosmalen
D015331:Cohort Studies; D005260:Female; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008428:Maternal Mortality; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000401:mortality