Severe maternal outcomes in 36 West African hospitals from Benin, Burkina Faso and Niger

Background
Maternal mortality has been used as the major indicator of maternal health for more than thirty years, but approximately two decades ago, the exploration of women with maternal near-miss (MNM) became a complement indicator to the investigation of maternal deaths (MD). Our objective was to determine the frequencies and causes of severe maternal outcomes (SMO: MNM + MD) in regional and district hospitals in Benin, Burkina Faso and Niger.

Methods
Between 1st February 2008 and 31st October 2010, we conducted an SMO incidence study in 36 hospitals in the three countries.

Results
Overall, the incidence study found 77 women with MNM per 1,000 live births (LB) (54 in Benin, 81 in Burkina Faso and 108 in Niger), a maternal mortality ratio (MMR) of 1,775 per 100,000 LB (1,370 in Benin, 2,360 in Burkina Faso and 1,833 in Niger), an MNM to MD ratio of 4.32:1 (3.94 in Benin, 3.44 in Burkina Faso and 5.89 in Niger), and a mortality index [MI = MD / SMO] of 18.8% (20.3% in Benin, 22.5% in Burkina Faso and 14.5% in Niger). The majority of women with SMO (71.9%) were referred from another health facility. In the aggregate of maternal near miss of 1,788 cases, it was observed that 90.0% of women had a near miss complication on admission to a participating hospital.

Conclusions
At the time of our study the burden of severe maternal outcomes was high in Benin, Burkina Faso and Niger. We found that most women had a near miss complication on admission to a participating hospital, indicating the need to facilitate access to obstetric care for women with high risk pregnancies and complications.