Consequences of severe obstetric complications on women's health in Morocco: please, listen to me!
OBJECTIVE
In Morocco, medical care for women with severe obstetric complications (near-miss cases) ends at discharge from the hospital. Little information exists regarding what happens after returning home. The aim of the study was to assess the physical and mental health consequences of near-miss events on Moroccan women 8 months after childbirth.


METHODS
A prospective cohort study of 76 near-miss women was conducted in three hospitals. For every case, we recruited at least two women from the same hospital who had uncomplicated deliveries (n = 169). We used a mixed-methods approach. For the quantitative part, we analysed sociodemographic characteristics collected via a questionnaire and medical complications extracted from the medical records during a medical consultation at 8 months post-partum. Forty in-depth interviews were also conducted with 20 near-miss cases and 20 women with uncomplicated deliveries.


RESULTS
The near-miss women were poorer and less educated than those who had uncomplicated deliveries. The proportion of physical consequences (serious illness) was higher among near-miss cases (22%) than uncomplicated deliveries (6%, P = 0.001). The risk of depression was significantly higher among near-miss cases with perinatal death (OR = 7.16; [95% CI: 2.85-17.98]) than among those who had an uncomplicated delivery. Interviews revealed that the economic burden of near-miss care contributed to social problems among the women and their households.


CONCLUSIONS
A near-miss event has consequences that go beyond the first days after delivery. Developing new mechanisms for maternal and newborn health follow-up is essential and should address the mother's physical and mental health problems and involve husbands and family members.
Ministry of Health, National School of Public Health, Rabat, Morocco.|Woman & Child Health Research Centre, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
Bouchra
B
Assarag
School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
Bruno
B
Dujardin
Ministry of Health, National School of Public Health, Rabat, Morocco.
Amina
A
Essolbi
Ministry of Health, Directorate of Epidemiology and Disease Control, Rabat, Morocco.
Imad
I
Cherkaoui
Woman & Child Health Research Centre, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Vincent
V
De Brouwere
Maroc; Marruecos; Morocco; cas de décès maternel évité de justesse; casos de morbilidad materna extrema (near miss); consecuencias físicas; consecuencias mentales; conséquences mentales; conséquences physiques; maternal near-miss case; mental consequences; physical consequences