Indicators and Factors Associated with Severe Maternal Outcomes at a Tertiary Health Facility in North-Eastern Tanzania: A Crossectional Study

Background: Severe maternal outcome is a complementary indicator of maternal health services. In absence of the patient’s testimony, reviews of maternal deaths alone often fail to provide critical details from the victim’s perspective. Combining maternal near misses and maternal deaths as two indicators for maternal health inform of severe maternal outcomes is designed to bridge this gap. Methods: A crossectional study conducted between November 2021 and May 2022, included 287 women admitted with obstetric-related conditions. Sub-Saharan Africa (SSA) maternal near-miss tool was used to identify women with maternal near-miss. Descriptive statistics were used to evaluate obstetric characteristics and severe maternal outcome indicators. Factors associated with SMO were tested using chi-square and fishers exact test with a p-value <0.05 considered significant. Results: A total of 287 women were enrolled in this study, from whom 175(60.9%) had severe maternal outcomes (SMO) in form of 138(78.9%) maternal near-miss and 37(21.1%) maternal deaths with a total of 3,071 recorded live birth. A calculated severe maternal outcome ratio of 56.9 per 1000 live births, a maternal near-miss ratio of 44.9 per 1000 live births, a mortality index of 0.21, and the maternal mortality ratio of 1204 per 100,000 live births were obtained. Referral from other health facilities {OR 6.1, 95% CI [2.38 – 16.0]} p-value <0.001, delaying for more than 30min to receive intervention at our facility {OR 6.3, 95% CI [1.16 – 34.6]} p-value 0.03 and admission in intensive care units/ high dependent units {OR 33[7.24 – 159.5]} p-value <0.001 were factors highly associated with an SMO event. Conclusion: This is the first study of its kind across the northeastern zone of Tanzania. The above national average maternal mortality rate, a higher mortality index, a lower maternal near miss to maternal mortality ratio, and a high SMO ratio seen in this study indicates inadequacies in the health care system across different levels of care. Delay in receiving intervention for more than 30 minutes, referral from other health facilities, and admission to intensive care units are highly associated with a SMO event. SMO studies offer a better understanding of healthcare system challenges than studying maternal deaths alone.