Impact of Training on Awareness and Knowledge of Service Providers About Maternal Near-Miss Events in Maharashtra, India

  • Ragini KulkarniEmail author
  • Sanjay Chauhan
  • Anushree Patil
  • Poonam Shivkumar
  • Surekha Tayade
  • Namrata Dohate
  • Archana Patil
  • Aniruddh Deshpande
  • Madhusudan Karnataki
Original Article



To improve the awareness and knowledge regarding Maternal Near Miss (MNM) among health service providers in the selected districts and women’s hospitals in Maharashtra, India.


A one-day training programme on MNM was conducted at four Family Welfare Training Centres in the state of Maharashtra, India, for the health service providers, viz. gynaecologists, pathologists, anaesthesiologists, medical officers, staff nurses, other paramedical workers of the selected 29 districts/women’s hospitals in Maharashtra. A total of 147 participants participated in the training programme. The participants filled a questionnaire before (pretest) and after the training (post-test) with the same set of questions pertaining to knowledge on the basic and operational aspects of MNM.


There was a significant improvement in the level of knowledge (post-test responses vs pretest responses) about the correct definition and classification of MNM, as per the instructions in the MNM-R guidelines by the Government of India. The service providers informed regarding the challenges in the implementation of the MNM-R guidelines at their hospitals such as shortage of manpower in terms of specialists and need of quality assurance.


The training programme improved the knowledge of the service providers about MNM, which would help them to implement the MNM-R guidelines effectively at their hospitals. This training effectively upgraded the knowledge level, and therefore, such trainings should be organized for all obstetricians, high-dependency unit (HDU) personnel and critical care teams.


Maternal near miss Training Pretest Post-test India 



We acknowledge the Ministry of Health and Family Welfare, Government of India and Government of Maharashtra, for providing funding support for the study through the Program Implementation Plan of the state. The authors acknowledge the encouragement received from ICMR (NIRRH/RA/713 /12–2018).

Compliance with Ethical Standards

Conflict of interest:


Ethical Approval

Ethical approval (expedited review) was taken from the institutional ethics committee.

Informed Consent

Waiver of informed consent was requested as the responses of the participants were completely anonymized.

Supplementary material

13224_2019_1259_MOESM1_ESM.pdf (132 kb)
Supplementary file1 (PDF 132 kb)


  1. 1.
    National Institution for Transforming India, Government of India. Accessed 23 Sept 2018
  2. 2.
    Geller SE, Rosenberg D, Cox SM. The continuum of maternal morbidity and mortality: factors associated with severity. Am J Obstet Gynecol. 2004;191:39–944.CrossRefGoogle Scholar
  3. 3.
    Evaluating the quality of care for severe pregnancy complications. The WHO near-miss approach for maternal health. World Health Organization; 2011. pp. 1–34Google Scholar
  4. 4.
    Oladapo OT, Sule-odu AO, Olatunj AO, et al. “Near miss” Obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study. Reprod Health J. 2005;2(9):1–9.Google Scholar
  5. 5.
    Souza JP, Cecatti JG, Parpineli MA, et al. Appropriate criteria for identification of near miss maternal morbidity in tertiary care facilities: a cross-sectional study. BMC Pregnancy Childbirth. 2007;7(20):1–8.Google Scholar
  6. 6.
    Operational Guidelines on Maternal Near Miss Review, Ministry of Health and Family Welfare. Government of India; 2014Google Scholar
  7. 7.
    Kumar R, Floor S, Tewari A. Burdwan district in West Bengal. Indian J Public Heal. 2018;62:235–43.CrossRefGoogle Scholar
  8. 8.
    Kalhan M, Singh S, Punia A, et al. Maternal near-miss audit: Lessons to be learnt. Int J Appl Basic Med Res. 2017;7:85–7.CrossRefGoogle Scholar
  9. 9.
    Chhabra P. Maternal near miss: an indicator for maternal health and maternal care. Indian J Community Med. 2014;39:132–7.CrossRefGoogle Scholar
  10. 10.
    Lazzerini M, Richardson S, Ciardelli V, et al. Effectiveness of the facility-based maternal near-miss case reviews in improving maternal and newborn quality of care in low-income and middle-income countries: a systematic review. BMJ Open. 2018;8:e019787.CrossRefGoogle Scholar
  11. 11.
    Liyew EF, Yalew AW, Afework MF, et al. Incidence and causes of maternal near-miss in selected hospitals of Addis Ababa. Ethiopia. PLoS ONE. 2017;12:e0179013.CrossRefGoogle Scholar
  12. 12.
    De Pinho Maria, Da Silva J, Fonseca SC, Augusto M, Dias B, Izzo AS, Teixeira GP, et al. 7 REVIEW Concepts, prevalence and characteristics of severe maternal morbidity and near miss in Brazil: a systematic review. Rev Bras Saúde Mater Infant. 2018;18(1):7–35. Scholar
  13. 13.
    Manjunatha G 2018 A study of maternal near miss at a district teaching hospital: a retrospective observational study. Int J Reprod Contracept Obs Gynecol. 7(4):1421–6. 10.18203/2320–1770.ijrcog20181328Google Scholar
  14. 14.
    Marwah G 2017 Maternal near miss review: a brief appraisal. Int J Reprod Contracept Obs Gynecol 6(5):1703–6. 10.18203/2320–1770.ijrcog20171928Google Scholar
  15. 15.
    Maswime S, Buchmann E. A systematic review of maternal near miss and mortality due to postpartum haemorrhage. Int J Gynaecol Obstet. 2017;137:1–7.CrossRefGoogle Scholar
  16. 16.
    O’Malley EG, Popivanov P, Fergus A, et al. Maternal near miss: What lies beneath? Eur J Obstet Gynecol Reprod Biol. 2016;199:116–20.CrossRefGoogle Scholar
  17. 17.
    Tura AK, Stekelenburg J, Scherjon SA, et al. Adaptation of the WHO maternal near miss tool for use in sub-Saharan Africa: an international Delphi study. BMC Pregnancy Childbirth. 2017;17:445.CrossRefGoogle Scholar
  18. 18.
    Ps R, Verma S, Rai L, et al. “Near miss” obstetric events and maternal deaths in a tertiary care hospital: an audit. J Pregnancy. 2013.
  19. 19.
    Firdawek E, Worku A. Maternal near miss and still birth in developing countries: a systematic review with meta-analysis. J Pregnancy Child Health. 2015;2:209. Scholar
  20. 20.
    David E, Machungo F, Zanconato G, et al. Maternal near miss and maternal deaths in Mozambique: a cross-sectional, region-wide study of 635 consecutive cases assisted in health facilities of Maputo province. BMC Pregnancy Childbirth. 2014;14:401.CrossRefGoogle Scholar
  21. 21.
    Bhutta ZA, Lassi ZS, Mansoor N. Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from developing countries. Accessed 11 Jan 2018

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2019

Authors and Affiliations

  • Ragini Kulkarni
    • 1
    Email author
  • Sanjay Chauhan
    • 1
  • Anushree Patil
    • 2
  • Poonam Shivkumar
    • 3
  • Surekha Tayade
    • 3
  • Namrata Dohate
    • 1
  • Archana Patil
    • 4
  • Aniruddh Deshpande
    • 4
  • Madhusudan Karnataki
    • 4
  1. 1.Department of Operational Research, National Institute for Research in Reproductive Health (NIRRH)Indian Council of Medical Research (ICMR)MumbaiIndia
  2. 2.Department of Clinical Research, National Institute for Research in Reproductive Health (NIRRH)Indian Council of Medical Research (ICMR)MumbaiIndia
  3. 3.Department of Obstetrics and GynecologyMahatma Gandhi Institute of Medical SciencesWardhaIndia
  4. 4.State Family Welfare BureauPuneIndia

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