Abstract
Background: A maternal near-miss is a situation in which a woman was on the verge of death but survived a lifethreatening obstetric complication that happened during pregnancy, childbirth, or within 42 days after the pregnancy’s termination. Survivors of near-miss events share several features with mothers who have died and identifying
determinants of maternal near miss will aid in improving the capacity of the health system to reduce severe maternal
morbidity and mortality. Therefore, this study was designed to identify determinants of maternal near miss incidents
among women hospitalized to tertiary hospitals in Mogadishu, Somalia.
Methods: A facility-based unmatched case–control study was conducted in four tertiary hospitals in Mogadishu
from May 1 to July 31, 2021. A total of five hundred thirty-three (178 cases and 355 controls) study participants were
involved in the study. The discharge period, cases were recruited consecutively as they emerged, whereas controls
were chosen using systematic sampling approach based on every fifth interval of those delivered through normal
spontaneous vaginal delivery. Women who were hospitalized during pregnancy, delivery, or within 42 days of termination of pregnancy and met at least one of the maternal near-miss disease specific criteria were classified as cases,
while women who were admitted and gave birth by normal vaginal delivery and resealed from the hospital without
experiencing severe obstetric complications were considered controls. Participants were interviewed by well-trained
research assistants using pre-tested structured questionnaire and the medical records were reviewed to identify
maternal near-miss cases. Data were entered into and analyzed with SPSS 25.0. Logistic regression was used, and the
significance level was set at p value≤0.05.
Results: The most common maternal near-miss morbidities identified were severe anemia (32%), severe preeclampsia (19.6%), severe ante partum haemorrhage (15.0%), abortion complications (8.4%), eclampsia (6.1%), ICU
admission (5.6%), severe PPH (2.8%) and severe systemic infections (2.8%). The main factors associated with maternal
near-miss were rural residency [OR=2.685, 95%CI: (1.702–4.235)], age below 20 years [OR=2.728, 95%CI: (1.604–
4.5640)], unmarried [OR=2.18, 2.18, 95%CI (1.247–3.81)], lack of formal education [OR=2.829, 95%CI: (1.262–6.341)],
husband’s unemployment [OR=2.992, 95%CI: (1.886–4.745)], low family income [OR=3.333, 95%CI (1.055–10.530)],
first pregnancy before 18 years of age [OR=3.091, 95% CI: (2.044–4.674)], short birth interval [OR=5.922, 95%CI: