title: Assessment of maternal near-miss and quality of care in a hospital-based study in Accra, Ghana.
abstract: OBJECTIVE
  To assess the baseline incidence of maternal near-miss, process indicators related to facility access, and quality of care at a tertiary care facility in urban Ghana.
  
  
  METHODS
  A prospective observational study of all women delivering at the facility, including those with pregnancy-related complications, was conducted between October 2010 and March 2011. Quality of maternal health care was assessed via a newly developed WHO instrument based on near-miss criteria and criterion-based clinical audit methodology.
  
  
  RESULTS
  Among 3438 women, 516 had potentially life-threatening conditions and 131 had severe maternal outcomes (94 near-miss cases and 37 maternal deaths). More than half (64.4%) of the women had been referred to the facility. The incidence of maternal near-miss was 28.6 cases per 1000 live births. Anemia contributed to most cases with a severe maternal outcome. More than half of all women with severe maternal outcomes developed organ dysfunction or died within the first 12 hours of hospital admission. Although preventive measures were prevalent, treatment-related indicators showed mixed results.
  
  
  CONCLUSIONS
  The WHO near-miss approach was found to represent a feasible strategy in low-resource countries. Improving referral systems, effective use of critical care, and evidence-based interventions can potentially reduce severe maternal outcomes.
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. Electronic address: otuncalp@jhsph.edu.
authors.forename: Özge
authors.initials: Ö
authors.lastname: Tunçalp
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Hindin
authors.forename: Kwame
authors.initials: K
authors.lastname: Adu-Bonsaffoh
authors.forename: Richard M
authors.initials: RM
authors.lastname: Adanu
mesh_terms: D000740:Anemia / Q000150:complications / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Audit; Health systems; Maternal mortality; Severe maternal morbidity; WHO near-miss approach; West Africa