Table 3.
Effectiveness of the NMCR cycle on morbidity and on process outcomes
| Authors | Morbidity and other health outcomes (incidence) | Standards of care (improved standards) | Other process outcomes |
| Lumala et al, 201713 | – | Eclampsia and pre-eclampsia: 7/10 standards PPH: 3/4 standards |
– |
| Mgaya et al, 201714 | SAMM: 9.0% vs 8.8% (p=0.98). Uterine rupture: 1/260 vs 0/250 (p=0.49) Perinatal severe morbidities and deaths and fresh stillbirths: 16% vs 8.8% (p=0.01) |
Obstructed labour: 6/10 standards on diagnosis, 6/10 standards on case management | Significant reduction of time needed from decision to perform a caesarean section to delivery (mean difference: 30 min, p<0.001) |
| Kayiga et al, 201615 | Uterine rupture: 8/180 vs 2/180 (p=0.04) Maternal sepsis: 10/180 vs 2/180 (p=0.02) Postspinal headache: 0/180 vs 13/180 (p<0.001) Baby admitted to intensive care: 27/180 vs 31/180 (p=0.61) |
Obstructed labour: 2/6 standards, 4/13 measures of standards | – |
| Mohd Azri et al, 201516 | Eclampsia: 42/44818 vs 9/10784 (p>0.05) Recurrent eclamptic fits: 8/42 vs 1/9 (p>0.05) Newborn babies with Apgar score (<7) at 5 min after birth: 8/42 vs 3/9 (p>0.05) Birth weight less than 2500 g 22/42 vs 5/9 (p>0.05) |
Improved adherence to 2/2 audit criteria that where substandard in the first phase (all other 10 criteria were already according to standards at baseline) | – |
| Gebrehiwot and Tewolde, 201417 | – | – | Reducing waiting time |
| Baltag et al, 201218 | – | – | Improved medical records Improved attitude towards patients |
| Kidanto et al 201219 | – | Eclampsia and pre-eclampsia: 10/16 standards | Improved records keeping |
| Sukhanberdiyev et al, 201120 and Hodorogea, 201021 |
Improved patient satisfaction (NR) | – | Improved case management and monitoring (eg, weighing of blood losses and documenting systematically) |
| Van den Akker et al, 201122 | SAMM: 33/2295 vs 49/5291 (p=0.08) Major PPH: 17/2295 vs 15/5291 (p=0.006) Uterine rupture: 14/2295 vs 4/5291 (p=0.03) Severe pre-eclampsia: 6/2295 vs 16/5291 (p=0.3) Maternal infections: 10/2295 vs 14/5291 (p=0.6) |
– | Improved patients monitoring |
| Bailey et al, 201023 | – | Eclampsia: 12/18 standards Infections: 11/23 standards Obstructed labour: 1/1 standards PPH: 3/3 standards |
– |
| Van den Akker et al, 200924 | Uterine rupture: 16/833 vs 19/3099 (OR 0.32; 95% CI 0.16 to 0.63) | – | – |
| Hunyinbo et al, 200825 | SAMM: 8/31 standards | – | |
| Kongnyuy et al, 200826 | – | – | Significant increase in the met need for EmOC (15.2% for 2005, 17.0% for 2006 and 18.8% for 2007, p value for trend<0.001). |
| Kongnyuy et al, 200827 | – | SAMM: 4/7 standards (other criteria were already according to standards at baseline) |
– |
| Weeks et al, 200528 | Eclampsia: 5/43 vs 5/43 (p>0.05) | Severe pre-eclampsia: 5/9 standards | – |
| Wagaarachchi et al, 200129 | – | SAMM: 8/31 standards | – |
EmOC, Emergency Obstetric Care; NMCR, near-miss case review; NR, not further specified; PPH, postpartum haemorrhage; SAMM, severe acute maternal morbidity.