Proportion and Associated Factors of Maternal Near Miss among Northwest Ethiopian women following Armed conflict: A Cross sectional study
This 2025 cross-sectional study at the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia found that maternal near miss occurs in 14.3% of admitted women following armed conflict, with significant associations identified for primiparity, lack of antenatal care, and delays in seeking or receiving care.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine pregnancy as a long, winding road trip. Usually, the car (the healthcare system) has a full tank of gas, the map is clear, and the driver (the mother) knows exactly where to go if the engine starts sputtering. But in this story, the road trip happened during a time when the bridges were out, the roads were blocked by conflict, and the map was torn.
This research paper takes a look at what happened to 420 mothers who had to make that trip to the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia in 2025. They were studying something called "Maternal Near Miss." Think of this not as a crash, but as a terrifying moment where the car almost flipped over, but the driver managed to steer it back to safety just in time. These are women who faced life-threatening complications during pregnancy or birth but survived, either because the medical team caught them in time or just by sheer luck.
The Big Numbers
The researchers found that 14.3% of the mothers they studied experienced one of these "near miss" scares. That's roughly 1 out of every 7 women. To put this in perspective, for every single mother who actually died, there were 20 women who came incredibly close to dying but survived. The paper calculates a "Maternal Mortality Index" of 3%, which is like saying that out of every 100 women who faced a severe crisis, 3 didn't make it.
The Three Delays: The Traffic Jams
The study uses a concept called the "Three Delays Model" to explain why these near misses happen. Imagine trying to get to the hospital, but you hit three different traffic jams:
- Delay 1: The family doesn't decide to go to the hospital fast enough.
- Delay 2: They can't get there because the roads are blocked or there's no ambulance.
- Delay 3: They arrive at the hospital, but the doctors or medicine aren't ready.
In this study, the second delay was a major issue. The paper notes that among the women who made the decision to seek care on their own (rather than being referred), 15% faced a delay in that decision. Among those specific women who experienced a decision delay, the most common reason was a lack of transportation due to the armed conflict and "command post" situations, reported by 62% of them. Furthermore, looking at how women arrived at the hospital overall, 80.3% of all participants did not arrive by ambulance; they had to find their own way. The study found that if a woman faced any of these three delays, she was 11 times more likely to have a near-miss experience compared to someone who didn't face any delays.
Who Was Most at Risk?
The paper looked at who was most likely to end up in this scary situation.
- First-time moms: Women who were having their first baby (primiparous) were 4.17 times more likely to have a near miss than women who had given birth before. It's like a new driver who hasn't learned the tricks of the road yet; they are more likely to panic when things go wrong.
- Skipping the check-ups: Women who didn't go for Antenatal Care (ANC) check-ups were 4.29 times more likely to have a near miss. Think of ANC as the regular maintenance check for the car. If you skip the oil changes and tire rotations, you're much more likely to break down on the highway.
- Rural vs. Urban: Interestingly, while living in a rural area seemed risky at first glance, the study found that once you accounted for other factors, it wasn't a statistically significant predictor on its own. The real danger was the lack of care and the delays, not just the address.
What the Paper Says It's NOT
The researchers were careful to rule out some things. They explicitly stated that they excluded women whose near-miss complications were caused by random accidents or incidental causes (like a car crash unrelated to pregnancy). They also didn't find that having a previous C-section was a major factor in this specific group, even though other studies sometimes suggest it might be.
The Takeaway
The authors suggest that the high number of near misses (14.3%) is a sign that the healthcare system is under heavy pressure. They note that this number is actually very similar to what was found at the same hospital six years earlier, before the recent conflict. This suggests that the progress Ethiopia had made in saving mothers might have been stalled or undone by the war. The conflict didn't just stop the roads; it stopped the flow of information, the availability of ambulances, and the ability of families to make quick decisions.
The paper concludes that to fix this, we need to get the "traffic" moving again. This means making sure every woman gets her regular check-ups (ANC), ensuring that ambulances can actually drive to the hospital without hitting roadblocks, and giving special attention to first-time moms who might need a little extra guidance. The data shows that when the road is clear and the car is checked, the near misses drop. When the road is blocked by war, the near misses stay high.
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