Research Article
Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study
Table 6
Distribution of cases of severe maternal morbidity according to occurrence of delays in obtaining obstetric care and level of performance of care.
| Type of delay, related to: | Level of performance | | Adequate | Nonadequate | | (%) | | (%) |
| (1) User factors | 567 | (10.0) | 286 | (10.5) | 0.89 | Delay in seeking health services | 303 | (5.4) | 139 | (5.1) | 0.92 | Refusal of treatment | 276 | (4.9) | 150 | (5.5) | 0.66 | Unsafe abortion | 48 | (0.9) | 3 | (0.1) | <0.001 | Total | 5.645 | | 2.735 | | | (2) Health service accessibility | 1.945 | (34.4) | 961 | (35.0) | 0.93 | Total | 5.647 | | 2.744 | | | Difficulty accessing antenatal care | 68 | (1.1) | 58 | (2.1) | 0.42 | Difficulties with transportation city/hospital | 54 | (0.9) | 63 | (2.2) | 0.06 | Total | 6.029 | | 2.819 | | | Absent/inadequate antenatal care | 1.909 | (33.8) | 783 | (28.6) | 0.19 | Geographic difficulty in accessing health service | 22 | (0.4) | 176 | (6.4) | <0.001 | Total | 5.645 | | 2.735 | | | (3) Quality of medical care | 1.046 | (17.3) | 1.263 | (42.6) | 0.01 | Total | 6.039 | | 2.962 | | | Absence of blood products | 20 | (0.3) | 37 | (1.3) | 0.01 | Lack of medication | 67 | (1.1) | 50 | (1.8) | 0.38 | Difficulty in communication between hospital and regulatory center | 250 | (4.1) | 529 | (18.8) | 0.004 | Lack of trained staff | 127 | (2.1) | 144 | (5.1) | 0.09 | Difficulty in monitoring | 180 | (3.0) | 229 | (8.1) | 0.18 | Total | 6.029 | | 2.819 | | | Delay in referral/transfer of the case | 143 | (2.4) | 149 | (5.2) | 0.07 | Delay in diagnosis | 327 | (5.4) | 160 | (5.6) | 0.96 | Delay in starting treatment | 416 | (6.9) | 186 | (6.5) | 0.93 | Improper management of the case | 589 | (9.7) | 629 | (21.8) | 0.13 | Total | 6.052 | | 2.879 | | | Any delay | 2.750 | (48.3) | 1.937 | (64.2) | 0.04 | Total | 5.698 | | 3.018 | | |
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value adjusted for cluster effect.
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