Safe Motherhood: Severe maternal morbidity and mortality in eastern Ethiopia

Abera Kenay Tura

Safe Motherhood: Severe maternal morbidity and mortality in eastern Ethiopia

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Samenvatting

Het doel van dit proefschrift was om de frequentie van en factoren geassocieerd met ernstige maternale morbiditeit en mortaliteit in Oost-Ethiopië te beoordelen. Het omvatte studies naar de toepasbaarheid van de WHO-criteria voor het identificeren van ernstige maternale morbiditeit en het suggereren van aanpassingen om deze in sub-Sahara Afrika te vergroten. Bovendien bevat het bevindingen over de prestaties van de aangepaste tool in het oosten van Ethiopië.
Met de wereldwijde vermindering van het aantal maternale sterftes, is de behoefte aan onderzoek naar vrouwen met ernstige complicaties tijdens de zwangerschap en de bevalling toegenomen. Dergelijke studies leden aan het gebrek aan uniforme identificatiecriteria tot de publicatie van de WHO MNM-tool van 2009. Helaas waren deze criteria moeilijk te gebruiken in verschillende low-resource settings en ontstond de behoefte om de criteria aan de lokale context aan te passen. Uit een raadpleging van deskundigen op dit gebied is een nieuwe tool voorgesteld. Het aangepaste hulpmiddel functioneerde goed bij het identificeren van gevallen van ernstige morbiditeit en sterfgevallen in twee ziekenhuizen in Oost-Ethiopië. De tool ving ook een aanzienlijk aantal gevallen niet geïdentificeerd door de WHO-criteria. Bovendien was het aantal doodgeborenen en vroege neonatale sterftes hoog onder vrouwen in de WHO-groep. Dit houdt in dat strategieën voor het verbeteren van de gezondheid van moeders en kinderen de aangepaste criteria moeten gebruiken. Naast het bestuderen van de omvang van ernstige maternale morbiditeit en sterfgevallen, is het belangrijk om de zorg voor deze vrouwen grondig te evalueren, wil men een zinvolle verbetering van de kwaliteit van de zorg bereiken.

Originele taal-2	English
Kwalificatie	Doctor of Philosophy
Toekennende instantie	Rijksuniversiteit Groningen
Begeleider(s)/adviseur	Scherjon, Sicco, Supervisor Stekelenburg, Jelle, Supervisor van Roosmalen, Jos J. M., Supervisor, Externe Persoon van den Akker, T.H., Co-supervisor, Externe Persoon
Datum van toekenning	24-jun.-2019
Plaats van publicatie	[Groningen]
Uitgever	University of Groningen
Gedrukte ISBN's	978-94-034-1777-6
Elektronische ISBN's	978-94-034-1776-9
Status	Published - 2019

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Title and contentsFinal publisher's version, 3,2 MB
Chapter 1Final publisher's version, 15,6 MB
Chapter 2Final publisher's version, 18,4 MB
Chapter 3Final publisher's version, 19,9 MB
Chapter 4Final publisher's version, 18,4 MB
Chapter 5Final publisher's version, 14,9 MB
Chapter 6Final publisher's version, 11,4 MB
Chapter 7Final publisher's version, 15,5 MB
Chapter 8 Final publisher's version, 31,1 MB
Complete thesisFinal publisher's version, 146 MB
PropositionsFinal publisher's version, 1,05 MB

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title = "Safe Motherhood: Severe maternal morbidity and mortality in eastern Ethiopia",

abstract = "The objective of this thesis was to assess the frequency of and factors associated with severe maternal morbidity and mortality in eastern Ethiopia. It included studies reviewing applicability of the World Health Organization (WHO) criteria for identifying severe maternal morbidity, and suggest adaptations to increase its applicability in sub-Saharan Africa. Moreover, it contains findings about the performance of the adapted tool in eastern Ethiopia. With the global reduction in number of maternal deaths, the need to study woman who with severe complications during pregnancy and childbirth has emerged. Such studies suffered from lack of uniform identification criteria until the publication of the 2009 WHO MNM tool. Unfortunately, these criteria were difficult for use in several low-resource settings and a need to adapt the criteria to the local context emerged. From a consultation of experts in the field, a new tool was suggested. The adapted tool functioned well in identifying cases of severe morbidity and deaths in two hospitals in eastern Ethiopia. The tool also captured significant number of cases not identified by the WHO criteria. In addition, proportion of stillbirth and early neonatal deaths was high among woman in the WHO group. This implies that strategies for improving maternal and child health should use the adapted criteria. In addition to studying the magnitude of severe maternal morbidity and deaths, it is important to thoroughly evaluate care provided to these women if meaningful improvement in quality of care is to be achieved.",

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AB - The objective of this thesis was to assess the frequency of and factors associated with severe maternal morbidity and mortality in eastern Ethiopia. It included studies reviewing applicability of the World Health Organization (WHO) criteria for identifying severe maternal morbidity, and suggest adaptations to increase its applicability in sub-Saharan Africa. Moreover, it contains findings about the performance of the adapted tool in eastern Ethiopia. With the global reduction in number of maternal deaths, the need to study woman who with severe complications during pregnancy and childbirth has emerged. Such studies suffered from lack of uniform identification criteria until the publication of the 2009 WHO MNM tool. Unfortunately, these criteria were difficult for use in several low-resource settings and a need to adapt the criteria to the local context emerged. From a consultation of experts in the field, a new tool was suggested. The adapted tool functioned well in identifying cases of severe morbidity and deaths in two hospitals in eastern Ethiopia. The tool also captured significant number of cases not identified by the WHO criteria. In addition, proportion of stillbirth and early neonatal deaths was high among woman in the WHO group. This implies that strategies for improving maternal and child health should use the adapted criteria. In addition to studying the magnitude of severe maternal morbidity and deaths, it is important to thoroughly evaluate care provided to these women if meaningful improvement in quality of care is to be achieved.

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