BMC Pregnancy and Childbirth
Volume 17, Issue 1, 2017

Afghan migrants face more suboptimal care than natives: A maternal near-miss audit study at university hospitals in Tehran, Iran (Article) (Open Access)

Mohammadi S.* , Saleh Gargari S. , Fallahian M. , Källestål C. , Ziaei S. , Essén B.
  • a Akademiska sjukhuset, Uppsala University, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala, SE-751 85, Sweden, Shahid Beheshti University of Medical Sciences, Infertility and Reproductive Health Research Center, Tehran, Iran
  • b Shahid Beheshti University of Medical Sciences, Infertility and Reproductive Health Research Center, Tehran, Iran
  • c Shahid Beheshti University of Medical Sciences, Infertility and Reproductive Health Research Center, Tehran, Iran
  • d Akademiska sjukhuset, Uppsala University, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala, SE-751 85, Sweden
  • e Akademiska sjukhuset, Uppsala University, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala, SE-751 85, Sweden
  • f Akademiska sjukhuset, Uppsala University, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala, SE-751 85, Sweden

Abstract

Background: Women from low-income settings have higher risk of maternal near miss (MNM) and suboptimal care than natives in high-income countries. Iran is the second largest host country for Afghan refugees in the world. Our aim was to investigate whether care quality for MNM differed between Iranians and Afghans and identify potential preventable attributes of MNM. Methods: An MNM audit study was conducted from 2012 to 2014 at three university hospitals in Tehran. Auditors evaluated the quality of care by reviewing the hospital records of 76 MNM cases (54 Iranians, 22 Afghans) and considering additional input from interviews with patients and professionals. Main outcomes were frequency of suboptimal care and the preventable attributes of MNM. Crude and adjusted odds ratios with confidence intervals for the independent predictors were examined. Results: Afghan MNM faced suboptimal care more frequently than Iranians after adjusting for educational level, family income, and insurance status. Above two-thirds (71%, 54/76) of MNM cases were potentially avoidable. Preventable factors were mostly provider-related (85%, 46/54), but patient- (31%, 17/54) and health system-related factors (26%, 14/54) were also important. Delayed recognition, misdiagnosis, inappropriate care plan, delays in care-seeking, and costly care services were the main potentially preventable attributes of MNM. Conclusions: Afghan mothers faced inequality in obstetric care. Suboptimal care was provided in a majority of preventable near-miss events. Improving obstetric practice and targeting migrants' specific needs during pregnancy may avert near-miss outcomes. © 2017 The Author(s).

Author Keywords

Quality of care Maternal near miss Iran Audit Preventability Afghan migrants

Index Keywords

management controlled clinical trial multicenter study prenatal care clinical trial insurance indigenous people university hospital pregnancy complication Pregnancy Complications human epidemiology trends Odds Ratio statistics and numerical data controlled study near miss (health care) Near Miss, Healthcare Management Audit ethnology Iran procedures Cross-Sectional Studies interview Confidence interval Young Adult cross-sectional study migrant Hospitals, University Humans female risk factor university Risk Factors medical record pregnancy Incidence organization and management adult migration Iranian (citizen) maternal mortality diagnostic error obstetric procedure family income Transients and Migrants maternal health service Maternal Health Services Afghan
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85013231175&doi=10.1186%2fs12884-017-1239-2&partnerID=40&md5=edefa0ca1d1c093a89faefe59186a300
DOI: 10.1186/s12884-017-1239-2
ISSN: 14712393
Cited by: 4
Original Language: English