Mortality after near-miss obstetric complications in Burkina Faso: medical, social and health-care factors/Mortalite suite aux complications obstetricales evitees de justesse au Burkina Faso: facteurs mediaux, sociaux et sanitaires/La mortalidad despues de complicaciones obstetricas graves en Burkina Faso: factores medicos, sociales y sanitarios)

Introduction International discussions about maternal health in low-income countries tend to focus on maternal deaths. However, there is increasing concern that these deaths are only the tip of the iceberg [...]
Objective To investigate mortality in women in Burkina Faso in the 4 years following a life-threatening near-miss obstetric complication and to identify the medical, social and health-care-related causes of death. Methods In total, 1014 women were recruited after hospital discharge and followed for up to 4 years: 337 had near-miss complications and 677 had uncomplicated pregnancies. Significant differences in mortality between the groups were assessed using Fisher's exact test. The medical causes of death were identified from medical records and verbal autopsy data; social and health-care-related factors associated with death were identified from interviews with the deceased women's relatives. Findings In the 4 years, 15 (5.3%) women died in the near-miss group and 5 (0.9%) died after uncomplicated pregnancies (P< 0.001). More than half the deaths after a near miss, but none after an uncomplicated delivery, were pregnancy-related. Indirect factors contributed to many of these deaths, particularly human immunodeficiency virus infection. Relatives' accounts suggested that the high cost and poor quality of health care, a lack of follow-up care and an unmet need for contraception contributed to the excess mortality in the near-miss group. Conclusion Women in Burkina Faso who initially survived a near-miss obstetric complication had an increased risk of all-cause and pregnancy-related death in the ensuing 4 years. The likelihood of survival over the longer term could be increased by offering a continuum of care that addresses the indirect and social causes of death and supplements the emergency intrapartum obstetric care provided by current safe motherhood programmes. Objectif Explorer la mortalite chez les femmes du Burkina Faso durant les 4 annees suivant une complication obstetricale fatale evitee de justesse ('near-miss') et identifier les causes medicales, sociales et sanitaires du deces. Methodes Au total, 1 014 femmes ont ete recrutees apres la sortie de l'hopital et suivies durant 4 ans: 337 ont vecu des 'near-miss' et 677 ont eu des grossesses sans complications. Des differences significatives de mortalite entre les groupes ont ete identifiees en utilisant le test exact de Fisher. Les causes medicales du deces ont ete identifiees a partir des dossiers medicaux et des donnees verbales d'autopsie; les facteurs sociaux et de soins de sante lies au deces ont ete constates a partir d'entretiens avec les proches des femmes decedees. Resultats Durant les 4 annees, 15 (5,3%) femmes sont mortes dans le groupe 'near-miss' et 5 (0,9%) sont decedees apres des grossesses sans complication (P Conclusion Les femmes au Burkina Faso qui ont initialement survecu a une complication obstetricale evitee de justesse presentaient un risque accru de deces pour toute cause ou lie a la grossesse les 4 annees suivantes. La probabilite de survie sur le long terme pourrait etre augmentee en offrant un continuum de soins qui s'attaque aux causes indirectes et sociales des deces et complemente les soins obstetricaux d'urgence fournis par les programmes actuels de maternite sans risque. Objetivo Investigar la mortalidad entre mujeres en Burkina Faso en los cuatro anos posteriores a una complication obstetrica potencialmente mortal e identificar las causas medicas, sociales y sanitarias relacionadas con el fallecimiento. Metodos Se realizo un seguimiento durante un maximo de cuatro anos a un total de 1014 mujeres inscritas despues de haber recibido el alta medica: De ellas, 337 habian sufrido complicaciones obstetricas graves y 677 habian disfrutado de embarazos sin complicaciones. Se empleo el test exacto de Fisher para evaluar las diferencias significativas en la mortalidad entre ambos grupos. Las causas medicas de la mortalidad se identificaron a traves de los historiales medicos y los datos de autopsias verbales. Las entrevistas con los familiares de las mujeres fallecidas permitieron identificar los factores sociales y sanitarios vinculados con el fallecimiento. Resultados Durante esos cuatro anos, fallecieron 1.5 (5,3%) mujeres del grupo con embarazos con complicaciones y cinco (0,9%) del grupo con embarazos sin complicaciones (P Conclusion Las mujeres en Burkina Faso que inicialmente sobrevivieron a una complicacion obstetrica grave presentaron un riesgo mayor de fallecer en los cuatro anos siguientes. La probabilidad de supervivencia a largo plazo podria aumentar si se ofreciera una asistencia continuada que abordara las causas indirectas y sociales de la mortalidad y que complementara la atencion obstetrica de emergencia durante el parto que proporcionan los programas actuales de maternidad sin riesgo.