Validity of Modified Early Obstetric Warning System (Meows) In Low Resource Setting: A Case of St. Francis Hospital Nsambya, Kampala, Uganda

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DOI: 10.21522/TIJCR.2014.05.01.Art006

Authors : Omona Kizito, Okello B Otuu, Zaake Daniel, Sekweyama Peter


Introduction: Globally every day, about 830 women die due to complications of pregnancy and child birth. Of these deaths, 99% occur in low-resource settings, and most could be prevented. Use of Modified Early Obstetric Warning System (MEOWS) would be appropriate. MEOWS is a monitoring chart intended to identify mothers at risk and initiate the right action, at right time by the appropriately skilled clinicians, at a time when treatment might make a difference to reduce maternal mortality and morbidity.

Objectives: To determine the sensitivity, specificity and predictive values of Modified Early Obstetric Warning System (MEOWS) in correctly identifying women at risk of developing obstetric morbidity in St. Francis Hospital_Nsambya between January and February, 2016

Methods: The study was a prospective cohort study conducted at St. Francis Hospital Nsambya, maternity ward, from January to February 2016. MEOWS monitoring tool was used alongside with questionnaires.

Result: 502 respondent mothers were enrolled in the study. 160patients (31.9%) triggered and of which: 11.5% of them had obstetric morbidity which included postpartum haemorrhage-35.5%, preeclampsia-26.3%, suspected infection-22.4%, third degree perineum tear-5.3%, anaesthetic complications-4% and prolong hospital stay-7%. MEOWS was 81.7% sensitive (95% CI 80-94%), 76.3% specific (95% CI 74-81%), with a positive predictive value 36.3% (95% CI 31-44%) and negative predictive value of 96.2% (95% CI 94-99%).

Conclusion: MEOWS chart is even effective for use in low resource setting, like Uganda.

Keywords: Modified Early Obstetric Warning System (MEOWS). Sensitivity. Validity. Predictive values. Maternal Morbidity. Maternal Mortality.


[1]. Ahrens, T. S. O. K. (2006). Comparison of Three New Generation Pulse Oximeters in a Medical Intensive Care Unit. Crit Care Med. 2006, 34: A85.

[2]. Buderer, N. M. (1996). Statistical methodology: Incorporating the prevalence of disease into sample size calculation for sensitivity and specificity. Acad Emerg Med 1996, 3:895–900.

[3]. Cioffi, J. (2000a) Nurses’ experiences of making decisions to call emergency assistance to their patients. Journal of Advanced Nursing, 32: 108–114.

[4]. ICF International Inc. (2012). Uganda Demographic and Health Survey 2011. Kampala: UBOS.

[5]. Isaacs, R. A., Wee, M. Y. K., Bick, D. E., Sheppard, Z. A., Thomas, S., Hundley, V., Smith, G. B., Van.

[6]. Teijlingen, E. and Thomas, P. W. (2014). A national survey of obstetric early warning systems in the United Kingdom: five years on. Journal of the Association of the Anaesthetists of Great Britain and Ireland, 69 (7).

[7]. Lewis, G. (ed). (2007). the confidential Enquiry into Maternal and Child Health (CEMACH) Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer - 2003- 2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH.

[8]. Mangum, B.W. (1995). “Reproducibility of the Temperature of the Ice Point in Routine Measurements,” NIST Tech. Note 1411.

[9]. Marc, V. D. V., Helen, S. and Lauren, A. P. (2013). Maternal Critical Care: A Multidisciplinary Approach. New York: Cambridge University Press.

[10].  Melanie, F. C. (2014). A modified early obstetric warning system. British Journal of Midwifery, 22 (12).

[11].  Ministry of Health [MOH]. (2010). Statistical Abstract 2010. Kampala: Author Say, L., Chou, D., Gemmill, A., Tunçalp Ö., Moller, A. B., Daniels, J. D. (2014). Global Causes of Maternal Death: A WHO Systematic Analysis. Lancet Global Health, 2 (6): 323-333.

[12].  Singh, S., McGlennan, A., England, A. and Simons, R. (2012). A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anaesthesia, 67(1), 12–18. doi:10.1111/j.1365-2044.2011.06896.x.

[13].  Uganda Bureau of Statistic [UBOS]. (2012). Uganda Demographic and Health Survey 2011. Kampala: Author.

[14].  United Nations [UN]. (2015). Global Strategy for Women's, Children's and Adolescents' Health, 2016-2030. New York: Author.

[15].  World Health Organization [WHO]. (2005). World Health Report. Geneva: Author.