title: Application of WHO 'Near-Miss' Tool Indicates Good Quality of Maternal Care in Rural Healthcare Setting in Uttarakhand, Northern India.
abstract: BACKGROUND
  Women who experienced and survived a severe health condition during pregnancy, childbirth or postpartum are considered as 'near-miss' or severe acute maternal morbidity (SAMM) cases. Women who survive life-threatening conditions arising from complications related to pregnancy and childbirth have many common aspects with those who die of such complications.
  
  
  OBJECTIVE
  To evaluate health-care facility preparedness and perfor-mance in reducing severe maternal out comes at all levels of health care.
  
  
  METHODS
  The present study was carried out over a period of 12 months under the Department of Community Medicine. The cross-sectional study included all the women (937) attending health-care facilities, at all levels of health care i.e. Primary, Secondary & Tertiary level in Doiwala block of Dehradun district. This study was conducted as per the WHO criteria for 'near-miss' by using probability sampling for random selection of health facilities. All eligible study subjects visiting health-care facilities during the study period were included, i.e. who were pregnant, in labour, or who had delivered or aborted up to 42 days ago.
  
  
  RESULTS
  It was found that all women delivering at the THC received oxytocin to prevent postpartum haemorrhage. Treatment of severe post-partum haemorrhage by removal of retained products was significantly associated with levels of health care. Majority (94.73%) women who had eclampsia received magnesium sulfate as primary treatment.
  
  
  CONCLUSIONS
  Application of WHO 'near-miss' tool indicates good quality of maternal care in rural healthcare setting in Uttarakhand, North India. The women would have otherwise died due to obstetrics complications, had proper care not been provided to them in time.
authors.affiliation: Demonstrator, Department of Community Medicine, Government Medical College and Hospital , Chandigarh, India .
authors.forename: Ravleen Kaur
authors.initials: RK
authors.lastname: Bakshi
authors.affiliation: Professor, Department of Community Medicine, Himalayan Institute of Medical Sciences, HIHT University , Swami Ram Nagar, Doiwala, Dehradun, Uttarakhand, India .
authors.forename: Debabrata
authors.initials: D
authors.lastname: Roy
authors.affiliation: Professor, Department of Community Medicine, Himalayan Institute of Medical Sciences, HIHT University , Swami Ram Nagar, Doiwala, Dehradun, Uttarakhand, India .
authors.forename: Pradeep
authors.initials: P
authors.lastname: Aggarwal
authors.affiliation: Associate Professor, Department of Obstetrics & Gynecology, Himalayan Institute of Medical Sciences, HIHT University , Dehradun, India .
authors.forename: Ruchira
authors.initials: R
authors.lastname: Nautiyal
authors.affiliation: Professor, Department of Obstetrics & Gynecology, AIIMS , Rishikesh, Uttarakhand, India .
authors.forename: Jaya
authors.initials: J
authors.lastname: Chaturvedi
authors.affiliation: Professor, Department of Community Medicine, Himalayan Institute of Medical Sciences, HIHT University , Swami Ram Nagar, Doiwala, Dehradun, Uttarakhand, India .
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kakkar
keywords: Health-care facility; Maternal mortality; Preparedness