title: Characteristics of neonatal near miss in hospitals in Benin, Burkina Faso and Morocco in 2012-2013.
abstract: OBJECTIVE
  The objective of this study is to explore the usefulness of neonatal near miss in low- and middle-income countries by examining the incidence of neonatal near miss and pre-discharge neonatal deaths across various obstetric risk categories in 17 hospitals in Benin, Burkina Faso and Morocco.
  
  
  METHODS
  Data were collected on all maternal deaths, maternal near miss, neonatal near miss (based on organ-dysfunction markers), Caesarean sections, stillbirths, neonatal deaths before discharge and non-cephalic presentations, and on a sample of births not falling in any of the above categories.
  
  
  RESULTS
  The burden of stillbirth, pre-discharge neonatal death or neonatal near miss ranged from 23 to 129 per 1000 births in Moroccan and Beninese hospitals, respectively. Perinatal deaths (range 17-89 per 1000 births) were more common than neonatal near miss (range 6-43 per 1000 live births), and between a fifth and a third of women who had suffered a maternal near miss lost their baby. Pre-discharge neonatal deaths and neonatal near miss had a similar distribution of markers of organ dysfunction, but unlike pre-discharge neonatal deaths most neonatal near miss (63%, 81% and 71% in Benin, Burkina Faso and Morocco, respectively) occurred among babies who were not considered premature, low birthweight or with a low 5-min Apgar score as defined by WHO's pragmatic markers of severe neonatal morbidity.
  
  
  CONCLUSIONS
  Whether the measurement of neonatal near miss adds useful insights into the quality of perinatal or newborn care in settings where facility-based intrapartum and early newborn mortality is very high is uncertain. Perhaps the greatest advantage of adding near miss is the shift in focus from failure to success so that lessons can be learned on how to save lives even when clinical conditions are life-threatening.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Carine
authors.initials: C
authors.lastname: Ronsmans
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jenny A
authors.initials: JA
authors.lastname: Cresswell
authors.affiliation: CERRHUD, Cotonou, Benin.
authors.forename: Sourou
authors.initials: S
authors.lastname: Goufodji
authors.affiliation: CERRHUD, Cotonou, Benin.
authors.forename: Schadrac
authors.initials: S
authors.lastname: Agbla
authors.affiliation: Centre Muraz, Bobo Dioulasso, Burkina Faso.
authors.forename: Rasmané
authors.initials: R
authors.lastname: Ganaba
authors.affiliation: INAS, Rabat, Morocco.
authors.forename: Bouchra
authors.initials: B
authors.lastname: Assarag
authors.affiliation: CERRHUD, Cotonou, Benin.
authors.forename: Oscar
authors.initials: O
authors.lastname: Tonouhéoua
authors.affiliation: Centre Muraz, Bobo Dioulasso, Burkina Faso.
authors.forename: Cheick
authors.initials: C
authors.lastname: Diallo
authors.affiliation: INAS, Rabat, Morocco.
authors.forename: Fatima-Zahra
authors.initials: FZ
authors.lastname: Meski
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Véronique
authors.initials: V
authors.lastname: Filippi
mesh_terms: D001541:Benin / Q000453:epidemiology; D002050:Burkina Faso / Q000453:epidemiology; D002585:Cesarean Section; D003906:Developing Countries; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D009018:Morocco / Q000453:epidemiology; D063305:Organ Dysfunction Scores; D018743:Perinatal Care / Q000592:standards; D066087:Perinatal Death / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications; D050497:Stillbirth
keywords: Africa; Afrique; morbilidad extrema; near miss; neonatal; néonatal; África; évité de justesse