Distant and proximate factors associated with maternal near-miss: a nested case-control study in selected public hospitals of Addis Ababa, Ethiopia

Background: Ethiopia is one of the sub-Saharan Africa countries with the highest maternal mortality. Maternal near-misses are more common than deaths and statistically stronger for a comprehensive analysis of the determinants. The study aimed to identify the factors associated with maternal near-miss in selected public hospitals of Addis Ababa, Ethiopia. Methods: We conducted a nested case-control study in five selected public hospitals of Addis Ababa, Ethiopia from May 1, 2015 to April 30, 2016. Participants were interviewed by well-trained data collectors using pre-tested questionnaire. Medical records were also reviewed to gather relevant information. World Health Organization criteria were used to identify maternal near-miss cases. A total of three controls matched for age and study area was selected for each maternal near-miss case. Bivariate and multivariable conditional logistic regressions were performed using Stata version 13.0. Results: A total of 216 maternal near-miss cases and 648 controls were included in the study. The main factors associated with maternal near-miss were: history of chronic hypertension (AOR = 10.80,95% CI; 5.16-22.60), rural residency (AOR = 10.60,95% CI; 4.59-24.46), history of stillbirth (AOR = 6.03,95% CI; 2.09-17.41), no antenatal care attendance (AOR = 5.58,95% CI; 1.94-16.07) and history of anemia (AOR = 5.26,95% CI; 2.89-9.57). Conclusions: There is a need for appropriate interventions in order to improve the identified factors. The factors can be modified through a better access to medical and maternity care, scaling up of antenatal care in rural areas, improve in infrastructure to fulfill referral chain from primary level to secondary and tertiary health care levels, and health education to pregnant women.