Though we focus on maternal mortality and maternal death, in many settings, 'near misses' are equally important as both a public health concept and a human rights issue. The 'near miss' in obstetrics refers to a woman who was critically ill and would have died had it not been for care. Severe acute maternal morbidity (SAMM) in low-income countries.
Put another way, in looking at the health system, it is important to identify what factors led to death, and what factors helped narrowly avert death. In assessing the efficacy of a safe motherhood system, policymakers must look at the prevalence of near misses-- a decrease in the number of maternal deaths accompanied by an increase in severe acute maternal morbidity is of concern.
The rate of severe acute maternal mortality was found to be [.80% – 8.23% in studies that use disease-specific criteria while the range is 0.38% – 1.09% in the group that use organ-system based criteria and included unselected group of women] (http://www.reproductive-health-journal.com/content/1/1/3)
In a recent paper, Ronsmans and team studies a range of SAMM studies and noted that "is clearly illustrated in the studies that more SAMM cases are likely to die in resource-poor settings than in more developed country settings. For example, the studies conducted in Niger, Benin and Malaysia give the morbidity to mortality ratio as 11–12 [10,15,17] while this is 117–223 in studies conducted in Europe [11,18] in the category where disease-specific criteria are used. The same applies to the category of organ-system based criteria; morbidity: mortality ratio is 5–8 in South Africa [1,14,15] and 49 in Scotland . These findings suggest that an indicator that relates SAMM to maternal deaths could be a useful method in assessing the care SAMM cases receive."
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.
The Pumani bubbleCPAP was designed to meet this need for Malawi and is now widely available through Maternova. We had a few questions about post-research phases of the Pumani bubbleCPAP which we posed to Jocelyn Brown, inventor of the Pumani bubbleCPAP, and Molly McCabe, Director of Product Management.