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Table 4 Applicability of the WHO MNM criteria and suggested adaptations

From: Applicability of the WHO maternal near miss tool in sub-Saharan Africa: a systematic review

Study

Hospital type

Reported challenges or removed criteria

Adaptations made

Ayele, 2014, Ethiopia

District

Not all WHO near miss criteria were available

Reported as possible limitation only. No adaptation made or suggested

Litorp, 2014, Tanzania

Tertiary and secondary

Due to limited resources, some laboratory- and management-based criteria were not applicable (not specified)

None. But it was reported as a limitation for possible under-estimation especially at the regional hospital

Nelissen, 2013, Tanzania

District

Removed: PaO2/FiO2 < 200 mmHg; creatinine > 300 μmol/l or > 3.5 mg/dl; bilirubin > 100 μmol.l or > 6.0 mg/dl; pH < 7.1; lactate > 5 mEq/ml; loss of consciousness and ketoacids in urine; use of continuous vasoactive drugs; dialysis for acute renal failure

Included additionally eclampsia, uterine rupture, sepsis or severe systemic infection, admission to intensive care unit, reducing threshold of blood for transfusion from > 5 units to > 1 (Haydom Hospital criteria)

Rulisa, 2015, Rwanda

Tertiary

In most cases, it was impossible to meet the full WHO criteria because most of the laboratory tests used to define those events, were not performed at the hospital

Patients were include if they had severe maternal complications (not specified) or admitted to intensive care unit

Tuncalp 2013, Ghana

Tertiary

Although laboratory testing was available, often the markers were not requested on time or at all owing to the urgency of the management of these women.

No adaptation was made

Herklots 2017, Zanzibar

Tertiary

Some of the markers were not applicable to the setting especially laboratory criteria

Lowered threshold of blood transfusion from > 5 units to > 5 units transfused or ordered but not entirely given

Kalisa, 2016, Rwanda

District

Reported as not available: PaO2 /FiO2 < 200 mmHg; pH < 7.1; lactate > 5 mEq/ml; ketoacids in urine; dialysis for acute renal failure

Additionally included: eclampsia, uterine rupture, sepsis or severe systemic infection; admission to intensive care unit (Ruhengeri hospital criteria)

Sayinzoga, 2017, Rwanda

District

The WHO criteria adapted in the Haydom study was used

Used Haydom Hospital criteria