Table 3

Effectiveness of the NMCR cycle on morbidity and on process outcomes

AuthorsMorbidity 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 managementSignificant 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 standardsImproved 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.