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				𝑃^1
	Adequate		Nonadequate
	𝑛	(%)	𝑛	(%)
(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

¹𝑃 value adjusted for cluster effect.