{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T06:01:57Z","timestamp":1778220117754,"version":"3.51.4"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T00:00:00Z","timestamp":1715558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>In the past few decades, several studies on the determinants and risk factors of severe maternal outcome (SMO) have been conducted in various developing countries. Even though the rate of maternal mortality in Eritrea is among the highest in the world, little is known regarding the determinants of SMO in the country. Thus, the aim of this study was to identify determinants of SMO among women admitted to Keren Provincial Referral Hospital.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A facility based unmatched case-control study was conducted in Keren Hospital. Women who encountered SMO event from January 2018 to December 2020 were identified retrospectively from medical records using the sub-Saharan Africa maternal near miss (MNM) data abstraction tool. For each case of SMO, two women with obstetric complication who failed to meet the sub-Saharan MNM criteria were included as controls. Bivariate and multivariate logistic regression analyses were employed using SPSS version-22 to identify factors associated with SMO.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In this study, 701 cases of SMO and 1,402 controls were included. The following factors were independently associated with SMO: not attending ANC follow up (AOR: 4.53; CI: 3.15\u20136.53), caesarean section in the current pregnancy (AOR: 3.75; CI: 2.69\u20135.24), referral from lower level facilities (AOR: 11.8; CI: 9.1\u201315.32), residing more than 30 kilometers away from the hospital (AOR: 2.97; CI: 2.29\u20133.85), history of anemia (AOR: 2.36; CI: 1.83\u20133.03), and previous caesarean section (AOR: 3.49; CI: 2.17\u20135.62).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In this study, lack of ANC follow up, caesarean section in the current pregnancy, referral from lower facilities, distance from nearest health facility, history of anaemia and previous caesarean section were associated with SMO. Thus, improved transportation facilities, robust referral protocol and equitable distribution of emergency facilities can play vital role in reducing SMO in the hospital.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0299663","type":"journal-article","created":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T17:29:24Z","timestamp":1715621364000},"page":"e0299663","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Determinants of severe maternal outcome in Keren hospital, Eritrea: An unmatched case-control study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8949-5158","authenticated-orcid":true,"given":"Henos Kiflom","family":"Zewde","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,5,13]]},"reference":[{"key":"pone.0299663.ref001","volume-title":"Transforming our world: the 2030 agenda for sustainable development.","author":"United Nations","year":"2015"},{"key":"pone.0299663.ref002","volume-title":"Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.","author":"World Health Organization","year":"2019"},{"key":"pone.0299663.ref003","volume-title":"Maternal mortality: evidence brief (No. WHO\/RHR\/19.20).","author":"World health organization","year":"2019"},{"key":"pone.0299663.ref004","volume-title":"Strategies towards ending preventable maternal mortality (EPMM).","author":"World Health Organization","year":"2015"},{"key":"pone.0299663.ref005","first-page":"243","article-title":"Preventable maternal mortality: Geographic\/rural-urban differences and associated factors from the population-based maternal mortality surveillance system in China.","volume":"11","author":"J Liang","year":"2011","journal-title":"BMC Pregnancy Childbirth"},{"issue":"6","key":"pone.0299663.ref006","doi-asserted-by":"crossref","first-page":"e0195711","DOI":"10.1371\/journal.pone.0195711","article-title":"preventability of maternal near miss and mortality in Rwanda: A case series from the University Teaching Hospital of Kigali (CHUK).","volume":"13","author":"C Benimana","year":"2018","journal-title":"PLoS ONE."},{"issue":"1","key":"pone.0299663.ref007","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s12905-018-0519-y","article-title":"Distant and proximate factors associated with maternal near-miss: a nested case-control study in selected public hospitals of Addis Ababa, Ethiopia.","volume":"18","author":"EF Liyew","year":"2018","journal-title":"BMC Women\u2019s Health"},{"key":"pone.0299663.ref008","doi-asserted-by":"crossref","first-page":"6029160","DOI":"10.1155\/2020\/6029160","article-title":"Factors Associated with Near Miss among Women Admitted in West Arsi Zone Public Hospitals, Ethiopia: Unmatched Case-Control Study.","volume":"2020","author":"FN Dessalegn","year":"2020","journal-title":"J pregnancy."},{"key":"pone.0299663.ref009","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s12978-016-0232-y","article-title":"Factors associated with maternal near miss in childbirth and the postpartum period: findings from the birth in Brazil National Survey, 2011\u20132012.","volume":"13","author":"Dias MAB Domingues RMSM","year":"2016","journal-title":"Reprod. 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