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 |