Maternal near-misses at a provincial hospital in Papua New Guinea: A prospective observational study

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Study Justification:
– Maternal near-miss indices can provide valuable insights into factors associated with maternal morbidity and mortality.
– Papua New Guinea (PNG) has one of the highest maternal mortality rates in the world.
– Previous studies on near-miss indices in PNG have focused on tertiary-level hospitals, but provincial hospitals serve the majority of underprivileged women.
Study Highlights:
– The study was conducted at Modilon Hospital in Madang Province, PNG.
– 6019 live births were recorded during the audit period.
– 163 women presented with life-threatening conditions, including 153 near-misses and 10 maternal deaths.
– The maternal near-miss ratio was 25.4/1000 live births.
– The maternal mortality ratio (MMR) was 166/100,000 live births.
– The maternal death to near-miss ratio was 1:15.3.
– The severe maternal outcome ratio was 27.1/1000 live births.
– The total mortality index was 6.8%.
– Sociodemographic factors such as age, parity, education, employment, rural residence, referral source, booking status, history of stillbirths, and anemia were associated with near-miss cases.
Recommendations for Lay Reader and Policy Maker:
– Urgent action is needed to address the high maternal mortality and near-miss rates in PNG.
– Women’s rights, education, and social status should be improved to empower underprivileged women.
– Health reforms with increased financial and political support are necessary.
– Access to family planning, supervised deliveries, and skilled emergency obstetric care should be ensured for rural women in PNG.
Key Role Players:
– Government health departments
– Non-governmental organizations (NGOs) working in maternal health
– Local healthcare providers and hospitals
– Community leaders and advocates for women’s rights
Cost Items for Planning Recommendations:
– Funding for education programs targeting women’s rights and empowerment
– Investment in healthcare infrastructure and equipment
– Training and capacity building for healthcare providers
– Outreach programs to reach rural communities
– Support for family planning services
– Financial incentives for skilled birth attendants
– Monitoring and evaluation systems to track progress and outcomes

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study provides specific data on the near-miss ratio, maternal mortality index, and associated maternal indices for Modilon Hospital in Madang Province of Papua New Guinea. However, the abstract does not provide details on the study design, sample size, or methodology used. To improve the strength of the evidence, the abstract should include more information on these aspects, as well as any limitations of the study. Additionally, it would be helpful to provide more context on the significance of the findings and how they contribute to the existing knowledge on maternal morbidity and mortality in Papua New Guinea.

Background: Maternal near-miss indices are World Health Organisation (WHO) recognised indicators that may improve our understanding of factors associated with maternal morbidity and mortality. In Papua New Guinea (PNG) where maternal mortality is among the highest in the world, only one study has documented near-miss indices in a tertiary-level hospital, but none from provincial hospitals where the majority of under-privileged women access healthcare services. Aims: To determine the near-miss ratio, maternal mortality index (MMI), and associated maternal indices for Modilon Hospital in Madang Province of PNG. Methods: All women attending Modilon Hospital who met the WHO maternal near-miss definition and/or a WHO-modified (PNG-specific) near-miss definition, were prospectively enrolled. Results: There were 6019 live births during the audit period; 163 women presented with life-threatening conditions (153 near-misses and 10 maternal deaths). The maternal near-miss ratio was 25.4/1000 live births and the maternal mortality ratio (MMR) was 166/100 000 live births, with a maternal death to near-miss ratio of 1:15.3. The severe maternal outcome ratio was 27.1/1000 live births and the total mortality index was 6.8%. Higher proportions of near-miss women were aged ≥30 years, nulliparous, illiterate, from rural communities, lacked formal employment, referred from peripheral health facilities, unbooked, had history of still births and were anaemic. Conclusion: Sociodemographic factors such as women’s rights, education level and status in society, in addition to appropriate health reforms with greater financial and political support are urgently needed to ensure underprivileged women in rural PNG have access to family planning, supervised deliveries and skilled emergency obstetric care.

Innovation 1: Mobile Family Planning Clinics
Develop mobile family planning clinics that can travel to rural communities, providing education and resources for family planning methods. This will ensure that women in remote areas have access to information and contraceptives, empowering them to make informed decisions about their reproductive health.

Innovation 2: Telemedicine for Antenatal Care
Implement telemedicine programs that connect pregnant women in rural communities with skilled healthcare providers. Through video consultations, women can receive regular check-ups, screenings, and education on pregnancy-related issues without the need for travel.

Innovation 3: Maternal Health Hotline
Establish a maternal health hotline that women can call for immediate assistance and guidance during pregnancy and childbirth. Trained healthcare professionals can provide advice, assess the situation, and coordinate emergency obstetric care if needed.

Innovation 4: Community Health Workers
Train and deploy community health workers in rural areas to provide education and support for maternal health. These workers can conduct awareness campaigns, provide basic antenatal care, and refer women to healthcare facilities when necessary.

Innovation 5: Drone Delivery of Medical Supplies
Utilize drones to deliver essential medical supplies, such as blood products and emergency medications, to remote healthcare facilities. This will ensure that provincial hospitals have the necessary resources to provide timely and appropriate emergency obstetric care.

Innovation 6: Midwifery Training Programs
Establish midwifery training programs in rural areas to increase the number of skilled healthcare providers. By training local women as midwives, communities can have access to culturally sensitive and knowledgeable maternal healthcare professionals.

Innovation 7: Gender Equality Programs
Implement gender equality programs that address sociocultural barriers and promote women’s rights. These programs can focus on ending early marriage, preventing gender-based violence, and empowering women to make decisions about their reproductive health.

By implementing these innovations, access to maternal health services in Papua New Guinea can be improved, leading to a reduction in maternal morbidity and mortality rates.
AI Innovations Description
Based on the study titled “Maternal near-misses at a provincial hospital in Papua New Guinea: A prospective observational study,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Improve access to family planning: Implement programs that provide education and resources for family planning methods to ensure that women have control over their reproductive health and can make informed decisions about when to have children.

2. Strengthen antenatal care services: Enhance antenatal care services in rural communities by training and deploying skilled healthcare providers to provide regular check-ups, screenings, and education on pregnancy-related issues.

3. Enhance emergency obstetric care: Establish well-equipped and staffed emergency obstetric care facilities in provincial hospitals to ensure that women experiencing complications during childbirth can receive timely and appropriate medical interventions.

4. Increase awareness and education: Conduct awareness campaigns to educate women and communities about the importance of seeking skilled care during pregnancy and childbirth, as well as the potential risks and warning signs of complications.

5. Improve transportation infrastructure: Develop and maintain reliable transportation systems, such as roads and ambulances, to facilitate the timely transfer of pregnant women from rural areas to healthcare facilities in case of emergencies.

6. Strengthen healthcare workforce: Increase the number of skilled healthcare providers, particularly midwives and obstetricians, in rural areas through training programs and incentives to attract and retain professionals in underserved regions.

7. Address sociodemographic factors: Advocate for women’s rights, promote gender equality, and address sociocultural barriers that may prevent women from accessing maternal healthcare services, such as early marriage, gender-based violence, and discrimination.

By implementing these recommendations, it is possible to improve access to maternal health services in Papua New Guinea and reduce maternal morbidity and mortality rates.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Data collection: Gather baseline data on the current state of maternal health access in Papua New Guinea, including maternal mortality rates, near-miss ratios, and sociodemographic factors that affect access.

2. Define indicators: Identify key indicators to measure the impact of each recommendation, such as the percentage increase in contraceptive use, the number of skilled healthcare providers deployed to rural areas, or the reduction in travel time to healthcare facilities.

3. Establish a control group: Select a control group of similar characteristics to compare the outcomes with the intervention group. This group should not receive the recommended interventions.

4. Intervention implementation: Implement the recommended interventions in the intervention group, such as family planning programs, antenatal care services, emergency obstetric care facilities, awareness campaigns, transportation infrastructure improvements, healthcare workforce strengthening, and sociodemographic interventions.

5. Data analysis: Collect data on the indicators from both the intervention and control groups over a specified period of time. Analyze the data to compare the outcomes between the two groups.

6. Measure impact: Calculate the changes in the selected indicators between the intervention and control groups. This will help determine the impact of the recommendations on improving access to maternal health.

7. Interpret results: Analyze the results to understand the effectiveness of each recommendation and identify any challenges or limitations encountered during the implementation.

8. Refine and adjust: Based on the findings, refine and adjust the interventions as necessary to optimize their impact on improving access to maternal health.

9. Repeat and validate: Repeat the simulation over multiple iterations to validate the results and ensure consistency.

By following this methodology, researchers and policymakers can gain insights into the potential impact of the recommendations on improving access to maternal health in Papua New Guinea. This information can then be used to guide the implementation of effective interventions and policies to address the identified challenges.

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