Determinants of maternal near miss events among women admitted to tertiary hospitals in Mogadishu, Somalia: A facility-based case-control study

Background: A maternal near-miss is a situation in which a woman was on the verge of death but survived a life-threatening obstetric complication that happened during pregnancy, childbirth, or within 42 days after the pregnancy's termination. Maternal near-misses are now seen as a suitable indicator of maternal care services compared to maternal death reviews, owing to the fact that maternal death is commonly regarded as the tip of the iceberg, whereas maternal near-miss as the base. Therefore, this study was designed to identify determinants of maternal near miss incidents among women hospitalized to tertiary hospitals in Mogadishu, Somalia. Methods: A facility-based unmatched case-control study was undertaken from May 1 to July 31, 2021. A total of five hundred thirty-three (178 cases and 355 controls) study participants were involved in the study. Cases were recruited consecutively as they appeared, whereas controls were chosen by systematic sampling approach. Women who were hospitalized during pregnancy, delivery, or within 42 days of termination of pregnancy and met at least one of the maternal near-miss disease specific criteria were classified as cases, while women who were admitted and gave birth by normal vaginal delivery were considered controls. Participants were interviewed by well-trained research assistants using pre-tested questionnaire and the medical records were reviewed to identify maternal near-miss cases. Data were entered into and analyzed with SPSS 25.0. Logistic regression was used, and the significance level was set at p value ≤ 0.05. Results: The most common maternal near-miss morbidities identified were severe anemia (32%), severe pre-eclampsia (19.6%), severe ante partum haemorrhage (15.0%), abortion complications (8.4%) eclampsia (6.1%), ICU admission (5.6%), severe PPH (2.8%) and severe systemic infection (2.8%). The main factors associated with maternal near-miss were rural residency [OR=2.685, 95%CI: (1.702-4.235)], early marriage [OR=2.728, 95%CI: (1.604-4.5640)], unmarried [OR=2.18, 2.18, 95%CI (1.247-3.81)], lack of formal education [OR=2.829, 95%CI: (1.262-6.341)], husband’s unemployment [OR=2.992, 95%CI: (1.886-4.745)], low family income [OR=3.333, 95%CI (1.055-10.530)], early marriage [OR=3.413, 95%CI: (1.912-6.091)], first pregnancy before 18 years of age [OR=3.091, 95% CI: (2.044-4.674)] , short birth interval [OR=5.922, 95%CI: (3.891-9.014)], previous history of obstetric complication [OR=6.568, 95%CI: (4.286-10.066)], never attended ANC services [OR=2.687, 95%CI: (1.802-4.006)] , lack of autonomy in seeking medical help [OR=3.538, 95%CI: (1.468-8.524)], delivery at non-health facility setting [OR=4.672, 95%CI: (3.105-7.029)], experiencing the second delay [OR=1.773, 95% CI: (1.212-2.595)] and stillbirth of the last pregnancy [OR=5.543, 95%CI: (2.880-10.668)]. Conclusion: and recommendation Early marriage, lack of maternal education, lack of antenatal care, lack of autonomy to seek medical assistance, short birth interval, rural residence and delay in accessing obstetric services were identified as factors associated with maternal near-miss morbidity. As a result, the study suggests that those modifiable characteristics must be improved in order to avoid severe maternal complications and consequent maternal death.