Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-12-04T13:24:28Z No. of bitstreams: 1 Fernanda Rocha de Aguiar_.pdf: 1937778 bytes, checksum: 1fc90c40d2895375df76738cdc391205 (MD5) / Made available in DSpace on 2018-12-04T13:24:28Z (GMT). No. of bitstreams: 1 Fernanda Rocha de Aguiar_.pdf: 1937778 bytes, checksum: 1fc90c40d2895375df76738cdc391205 (MD5) Previous issue date: 2018-08-27 / UNISINOS - Universidade do Vale do Rio dos Sinos / Este trabalho objetiva analisar os possíveis cenários da indústria postal brasileira, em um horizonte até 2028, a partir dos efeitos econômicos, sociais, políticos, tecnológicos e legais decorrentes das transformações desse mercado. É fato que as empresas estão usando canais digitais para emitir contas, declarações e faturas. As pessoas agora usam redes sociais e smartphones para se comunicar com familiares e amigos. Além disso, os consumidores estão mudando gradativamente de lojas físicas para compras online. Ou seja, ambos, a substituição de correspondências físicas por mídias e o comércio eletrônico, estão em alta e resultam em desafios e oportunidades para a indústria postal, além de impulsionarem os esforços para diversificar e aumentar a eficiência e a inovação. Essas considerações motivaram o desenvolvimento de uma pesquisa qualitativa, de natureza exploratória, utilizando o método da análise de cenários a partir de informações fornecidas por especialistas do correio brasileiro, bem como atores do ambiente contextual em que a empresa está inserida. A coleta de dados foi realizada por meio de entrevistas semiestruturadas, em que as informações foram apuradas mediante Análise de Conteúdo. Como resultado, foram construídos quatro cenários baseados em incertezas e tendências da indústria postal brasileira, de forma a indicar de que maneira a distribuição domiciliária pode ser adequada a essas perspectivas. Da análise dos cenários, validada por especialistas, ressalta-se que o correio brasileiro precisa de estratégias que possam preparar a organização para atravessar as diferentes situações que foram desenhadas, especialmente com a necessidade de diversificação do seu modelo de negócio, incluindo remodelagem de produtos, flexibilidade em suas atividades e inovação de suas plataformas. Do contrário, a empresa poderá se direcionar para a realidade da precarização dos serviços, que representa a baixa qualidade e a falta de eficiência operacional, forçando as premissas de privatização ou quebra de monopólio para o correio brasileiro. / This paper aims to analyze the possible scenarios of the Brazilian postal industry in a horizon up to 2028, from the economic, social, political, technological and legal effects resulting from the transformations of this market. It is a fact that companies are using digital channels to issue accounts, statements and invoices. People now use social networks and smartphones to communicate with family and friends. In addition, consumers are gradually shifting from physical stores to shopping online. In other words, both the substitution of physical correspondence by means of e-commerce and e-commerce are on the rise and result in challenges and opportunities for the postal industry, as well as boosting efforts to diversify and increase efficiency and innovation. These considerations motivated the development of a qualitative research of an exploratory nature using the Scenario Analysis method from information provided by Brazilian mail specialists as well as actors from the contextual environment in which the company is inserted. The research was performed through semi-structured interviews in which the information was cleared through Content Analysis. As a result, four scenarios were built based on the uncertainties and trends of the Brazilian postal industry in order to indicate how home delivery may be appropriate to these perspectives. From the analysis of the scenarios, validated by specialists, it is emphasized that Brazilian postal industry needs strategies that can prepare the organization to cross the different situations that were designed, especially with the need to diversify its business model, including product remodeling, flexibility in their activities and innovation of their platforms. Otherwise, the company could be directed to the reality of the precariousness of the services that represents the poor quality and lack of operational efficiency, forcing the premises of privatization or end of the postal monopoly for Brazilian postal service.

During the past decades, there have been an acceleration of customers’ needs of customized products. This have pressured many companies in offering customized products in order to reach customer satisfaction and keep growing and expanding their market share. Nowadays the competitive pressure between companies with the same product segment is increasing and the market requirements are changing rapidly. To handle this competition, many manufacturing companies are focusing on mass customized production. However, mass customization has been a topic of interest for many researchers. The focus has been in studying and understanding the complexity and the constrains that a company encounter when dealing with mass customized production in mostly the automotive industry. One of the constrains that have been less highlighted by researchers were the effects that mass customized production has on the output variation of production lines. Therefore, the purpose of this thesis is to investigate how to minimize output variations in mass customized production within assembly lines. To do that the researchers focused on studying the output variation in whitegoods industry instead of the automotive industry that captures most of the existing research. The study includes two main research questions. The first question was to identify the factors that affect the output variation in mass customized production. While the second question was to identify applicable solutions that can be used to stabilize the output. To ensure the reliability and validity of the research findings, the researchers used multiple case study combined with literature reviews. To answer the research questions several data collection techniques were used in the multiple case study conducted on two lines. Those data collection techniques were participating observations, document reviews, a semi-structured interview and many conversations with the affected persons. The findings from the case study for research question one showed consistency with the theories described in the theoretical background. This was evident because similar problems when it comes to output variations were defined in the theories. One problem was about the simplification of assembly line balancing problem that was evident in both case studies. This was an effect of the missing product family classification which created a high output variation because of the use of only one line balancing for all product variants. Another problem identified included functionality problems of machines because of performing wrong assembly or the use of the wrong component. There was as well the problem of missing or delayed components which was an effect of the lack of structure in the material picking and the deliveries performed for both lines. A combination of those factors created the experienced output variation on both lines. To deal with those problems and minimize the output variation, a solution approach was defined in the second research question. This approach was created together with the case company with the help of the theoretical background and it presents several steps to follow when attacking and resolving similar problems as presented above. The most important conclusion of this thesis is that, when dealing with output variation in mass customized production where people are performing the assembly, it is essential to provide the right conditions for them to ensure that they have the right knowledge base to perform the requested assembly.

This thesis investigates the utilisation of maternal health care in Zambia, where despite being a signatory to the Safe Motherhood Initiative and Millennium Development Goals, which are aimed at improving maternal health, indicators of maternal health continue to perform poorly. The need to understand crucial factors in improving maternal health motivated the current research, especially since there is a dearth of literature in this area in Zambia. The thesis focuses on two aspects of maternal health care: antenatal care (ANC) and facility-based deliveries, to answer two broad questions. Firstly, what factors determine the use of ANC in Zambia? Secondly, to what extent has the abolition of user fees affected facility-based deliveries? An assessment of the factors, which explain the utilisation of ANC in Zambia, using three sets of comparable datasets reveals that, while there are differences in the factors explaining the decision to use ANC and the frequency of visits over time, the decision to seek ANC and the frequency of use is low among the poor and less educated, and there are marked regional differences in utilisation. The most appropriate econometric specification for antenatal visits, according to different performance indicators, was the two-part model, which differs from recent research favouring more complex methodologies. The analysis is further extended through the inclusion of supply-side factors and the examination of individual and community level factors associated with inadequate and non-use of ANC, following the adoption of the focused ANC approach in Zambia. To incorporate the supply side factors, the 2007 Zambia Demographic and Health Survey was linked to administrative and health facility census data using geo-referenced data. To assess the factors associated with (1) the inadequate use of ANC (defined as three or less visits), and (2) the non-use of ANC in the first trimester of pregnancy, we specify two multilevel logistic models. At the individual level, the woman’s employment status, quality of ANC received and the husband’s educational attainment are negatively associated, while parity, the household childcare burden and wealth are positively associated with inadequate utilisation of ANC. Both individual and community level characteristics influence inadequate use and non-use of ANC in the first trimester; however, community level factors are relatively stronger in rural areas. Although ANC is an important facet of maternal care, it occurs before delivery, but does not necessarily provide much information with respect to delivery decisions. Therefore, the thesis investigates delivery decisions, as well, in particular, the effect of user fee removal in rural areas of Zambia on facility-based deliveries. To account for regional differences, we employ a Seemingly Unrelated Regression model incorporating an Interrupted Time Series design. The analysis uses quarterly longitudinal data covering 2003q1-2008q4. When unobserved heterogeneity, spatial dependence and quantitative supply-side factors are controlled for, user fee removal is found to immediately increase aggregate facility-based deliveries, although the national trend was unaffected. Drug availability and the presence of traditional birth attendants also influence facility-based deliveries at the national level, such that, in the short-term, strengthening and improving community-based interventions could increase facility-based deliveries. However, there is significant variation and spatial dependence masked in the aggregate analysis. The results highlight the importance of service quality in promoting facility-based deliveries, and also suggest that social and cultural factors, especially in rural areas, influence the use of health facilities for delivery. These factors are not easily addressed, through an adjustment to the cost of delivery in health facilities. Additionally, we analyse the effect of user fee abolition on the location of childbirth, focussing on deliveries that occur in public health facilities using household survey data. To elicit the causal relationship, we exploit the relative change in fees across health districts within a difference-in-differences framework. Surprisingly, although reductions in home deliveries were observed, as expected, reductions in public health facility-based deliveries were also uncovered, along with increases in deliveries at private health facilities. However, these findings were statistically insignificant; suggesting that the abolition of user fees had little, if any, impact on the choice of location for childbirth. The statistically insignificant, but unexpected, causal effects further suggest that the removal of user fees have unintended consequences, possibly the transference of facility costs to the client, which would deter the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in outcomes; instead, other efforts, such as improving service quality, could have a greater impact. / Thesis (PhD)--University of Pretoria, 2013. / gm2014 / Economics / unrestricted

This thesis conducts a study on a data set from the Swedish and Danish postal service Postnord, comparing an artificial neural network (ANN) and a gradient boosting machine (GBM) for predicting delays in package deliveries. The models are evaluated based on F1-score for the important class which represents the data points that are delayed and needed to be identified. The GBM is already implemented and tuned using grid search by Postnord, the ANN is tuned using sequential model based optimization with the tree Parzen estimator function. Furthermore, it is trained using dynamic resampling to handle the imbalanced data set. Even with several measures implemented to handle the class imbalance, the ANN performs poorly when tested on unseen data, unlike the GBM. The GBM has high precision (84%) and decent recall (24%), which produces a F1-score of 0.38. The ANN has high recall (62%) but extremely low precision (5%) which gives a F1-score of 0.08, indicating that it is biased to predict sample as delayed when it is in time. The GBM has a natural handling of class imbalance unlike the ANN, and even with measures taken to improve the ANN and its handling of class imbalance, GBM performs better.

Offentligt upphandlade tjänster omsätter omkring 800 miljarder SEK per år och står för omkring 20% av Sveriges BNP. Offentlig upphandling av tjänster står för omkring 43% av alla offentligt upphandlade affärer vilket gör upphandling av tjänster en vanligare typ av affär än upphandling av produkter. Trots detta har det akademiska intresset för vad som driver värde inom offentligt upphandlade affärer varit lågt, och intresset för offentligt upphandlade tjänster ännu lägre. För att förstå vad som driver värde under kontraktsperioden i en offentligt upphandlad tjänsteaffär har Trafikförvaltningen i Stockholm valts som fallföretag. Trafikförvaltningen är den organisation som upphandlar och förvaltar kollektivtrafiken i Stockholm och kollektivtrafiken i Stockholm har cirka två miljoner påstigande varje dag. Studiens syfte är därför att undersöka vilka faktorer som driver kundvärde under komplexa tjänsteleveranser och att definiera vad är värdedrivande på respektive faktor. För att åstadkomma detta genomfördes en litteraturstudie för att ta reda på vilka faktorer som vanligtvis är värdedrivande under affärer mellan företag, affärer mellan företag och statliga organisationer och under tjänsteleveranser. Detta resulterade i en analysmodell som därefter prövades explorativt genom 14 djupintervjuer med affärsförvaltare och affärsområdesansvariga på Trafikförvaltningen och en representant från Skånetrafiken respektive Västtrafik. Utifrån denna fallstudie kan det konstateras att följande faktorer definitivt är värdedrivare under B2G-tjänsteleveranser: Faktorn tjänstekvalitet, vilket innebär en hög kvalitet och prestanda, en hög kravuppfyllelse över tid och att tjänsten levereras så att kunden får tid att ägna sig åt sin kärnverksamhet. Faktorn tjänstehantering, vilket innebär ett ordentligt och förebyggande underhåll, en välfungerande fakturahantering och en välfungerande rapport- och dokumentationshantering. Faktorn leveransnoggrannhet, vilket innebär att leverera med exakthet och att leverantören gör allt i sin makt för att leverera tjänsten så exakt som möjligt. Faktorn möjligheter att växa, vilket innebär att leverantören levererar sin tjänst på ett sådant sätt att kunden kan växa i marknadsandel och antal slutkunder. Faktorn utvecklingsmöjligheter, vilket innebär kontinuerliga förbättringar av verksamheten och att leverantören aktivt arbetar för att utveckla processer och rutiner. Faktorn organisatoriska förmågor, vilket innebär att leverantörens samarbete med andra aktörer ska fungera på ett professionellt och ansvarstagande vis, att leverantören har en stor kunskap- och avtalsförståelse, ett helhetsperspektiv - inte bara ett ekonomiskt perspektiv, tar ett arbetsgivaransvar samt har avtalsstöd när förhandlingar uppstår. Faktorn intressentrelationer, vilket innebär en hög kundnöjdhet (slutkunderna) och att leverantören aktivt jobbar för att öka denna, att leverantören levererar tjänsten utan att skada kundens varumärke och anseende samt att leverantören skapar socialt värde genom att värde skapas för allmänheten. Faktorn leverantörsrelation, vilket innebär att leverantören ska ha en god personlig interaktion, en hög lyhördhet och god samtalston, skapar tillit och förtroende, är lösningsorienterade i förhandlingar samt inte har ett opportunistiskt beteende. Sist men inte minst, faktorn interaktion, vilket innebär ett professionellt och affärsmässigt bemötande, en hög tillgänglighet, transparens och respektfullhet samt förstår den offentliga förvaltningens roll i affären.

Mozambique is in the process of setting up maternity waiting homes (MWHs) in an attempt to improve access of women living in remote areas. It is expected that MWHs will increase institutional deliveries and consequently, decrease maternal mortality caused by the delay in reaching obstetric care. However, no evidence for this assumption has been found in the literature. The objective of this research was, using Geographical Information Systems (GIS), to assess the impact of MWHs in increasing institutional deliveries coverage. GIS technology is a valuable methodology to analyse access, especially in contexts where official records are weak. An ecological study, using a sample of 28 health facilities, was conducted in six districts in northern Mozambique. The findings suggest that MWHs could contribute to increasing institutional deliveries coverage in a range of 4% to 2 %. However, they do not appear to increase access of women living in remote areas. / M.A. (Public Health)

Bakgrund: Den agila projektmodellen har under de senaste två decennierna vuxit fram som en utmanare till den traditionella vattenfallsmodellen. En av de stora skillnaderna mellan projektmodellerna är att i det agila arbetssättet involveras kunden kontinuerligt. Frågan är vad som då händer med överlämningen av den sista versionen av produkten, när utvecklingen är färdig? Samtidigt har bankbranschen på senare år utmanats av nya aktörer vilka profilerar sig som just digitala och IT-inriktade, och både dessa moderna banker såväl som de traditionella storbankerna har anammat det agila arbetssättet för att kunna konkurrera om kundernas uppmärksamhet. Dessa banker arbetar inte agilt till lika hög grad, och frågan är om överlämningen påverkas av det? Syfte: Syftet med studien är att öka förståelsen för hur överlämningen av det slutliga projektresultatet i agila projekt ser ut på svenska banker. Vidare ska studien undersöka om den skiljer sig mellan banker med olika agil mognad samt vilka konsekvenser som kan uppkomma i samband med överlämningen. Genomförande: Studien är genomförd som en flerfallstudie där två fall - storbanker och nischbanker, undersöks. Vidare har en fenomenologisk ansats och ett kvalitativt angreppssätt använts. Empirin har samlats in genom ett målstyrt urval varpå semistrukturerade intervjuer har genomförts med tio projektledare. Slutsats: Studien resulterar i slutsatsen att en överlämning av en slutlig produkt i agila projekt inte genomförs på ett formellt sätt, till skillnad från vad teorin tidigare har antytt. I synnerhet lämnar aldrig ansvaret för produkten någonsin det team som har utvecklat den. Vidare visar studien att storbanker arbetar med en lägre grad av agil mognad än vad nischbanker gör, men att detta inte påverkar hur överlämningen ser ut. Slutligen bidrar studien till insikter om konsekvenser kring att överlämningen inte existerar på ett formellt sätt. Detta leder till en reflektion kring att organisationer behöver anpassa sin agila projektmetodik till sin egen kontext. Projektledare generellt bör dessutom fundera över hur organisationens arbetssätt påverkar organisationen i stort samt vara medveten om de konsekvenser som dyker upp vid förändringar i arbetssättet. / Background: During the last two decades, the agile project methodology has grown as a competitor to the more traditional waterfall methodology. One of the biggest differences is, with an agile methodology the customer is involved throughout the project. But what happens in the final handover, when the development is finished? At the same time, the Swedish banking industry has been challenged by new actors whom profile themselves as digital focused and IT centred. Both types of banks have developed an agile way of working to be able to compete about the customers. However, the two types of banks does not work agile with the same maturity, and we wonder if the handover is affected by that? Purpose: The purpose of the study is to increase the understanding of what the handover of the final product in agile projects at Swedish banks looks like. Further, the study will examine if the handover differ between banks with different agile maturity, and which consequences that may arise in connection to the handover. Completion: The study was conducted as a multiple-case study in which two cases - traditional banks and specialised banks were examined. Further, a phenomenological and a qualitative approach has been used. The empirical data has been conducted through a targeted selection, where semi-structured interviews have been held with ten project leaders. Conclusion: The study concludes that the handover of the final product in agile projects does not exist in the formal way previous research has suggested. Specifically, the responsibility of the product does never leave the team developing it. Further, the study show traditional banks work with a lower degree of agile maturity in comparison to specialised banks. However, this does not affect the characteristics of the handover. Finally, the study contributes to insights about the consequences of the handover not being as formal. This contributes to a discussion about the need for organisations to be able to adapt their agile methodology to their own context. In general, project leaders also should reflect upon how their way of working affect the organisation as a whole, as well as being aware of the consequences that appears when changing the organisation’s way of working.

Mozambique is in the process of setting up maternity waiting homes (MWHs) in an attempt to improve access of women living in remote areas. It is expected that MWHs will increase institutional deliveries and consequently, decrease maternal mortality caused by the delay in reaching obstetric care. However, no evidence for this assumption has been found in the literature. The objective of this research was, using Geographical Information Systems (GIS), to assess the impact of MWHs in increasing institutional deliveries coverage. GIS technology is a valuable methodology to analyse access, especially in contexts where official records are weak. An ecological study, using a sample of 28 health facilities, was conducted in six districts in northern Mozambique. The findings suggest that MWHs could contribute to increasing institutional deliveries coverage in a range of 4% to 2 %. However, they do not appear to increase access of women living in remote areas. / M.A. (Public Health)

Background: The interest in obstetrical complications that culminate with maternal death and the urgent need for improvement in these indexes led to the development of the concept of maternal near miss. From a normal situation, the patients are in a continuum that can evolve with the development of moderate and severe situations of health. Severe acute maternal morbidity (SAMM) (situation less severe) and near miss (NM) (situation more severe) are two degrees of situation immediately before maternal death. The main advantage of studying these cases is higher frequency when comparing with maternal deaths cases and that the determining factors are the same. This study aims to determine the ocurrence of SAMM and NM situations in two maternities of reference of the state of Sergipe, determine the prevalence of the event and describe the risk factors associated. Casuistic and methods: A cross sectional study with double controls was conducted in patients who were pregnant sometime and were hospitalized in two reference maternities of Sergipe state. The patients answered a survey about issues relevant to the subject. For categorical variables was used Fisher s exact test. For normal continuous variables was applied the Student t test and for the not normal, the U-Mann-Whitey test. Odds ratio and confidence interval were used whenever possible. Multivariate analysis was performed and p <0,05. Results: There were 16,243 live birth deliveries, and occurred 1102 SAMM, 77 NM and 17 maternal deaths cases. The prevalence of SAMM + NM founded were, respectively, 7.6 cases/1000 LB, the mortality index was 18% (4.5 cases for each death) The main causes of SAMM and NM were respectively: 67.5% by hypertensive causes and 87.1% by necessity of invasive procedures. High age, low income, absence of prenatal, high rates of cesarean section, previous abortion and low weight of the baby at birth with unfavorable perinatal prognosis were statistically significant for the study group. Multivariate analysis showed that the number of eligibility criteria for NM was related with the severity of the situation. Conclusions: The situations of SAMM and NM in the two maternities studied reached significant values. Study NM can be the most efficiently way of conducting internal audits for the improving of the quality of services. Protocols based on adverse situations like these, where the detection can be made on the exact point of failure, can recommend conducts and interventions able to save lives. / Introdução: O interesse por complicações em obstetrícia que culminassem com morte materna e a necessidade urgente da melhora desses índices resultou no desenvolvimento do conceito de near miss materno. A partir de uma situação normal, a paciente insere-se em um continuum que pode evoluir com o desenvolvimento de situações de gravidade moderada e intensa. Morbidade materna grave (MMG) e near miss (NM) são duas denominações dadas às situações imediatamente anteriores ao óbito materno. A grande vantagem em se estudar esses casos é justamente a sua frequência superior em relação aos casos de morte materna (MM) e que os fatores determinantes são os mesmos. Este estudo tem por objetivos: determinar a ocorrência de situações de MMG e NM em duas maternidades de referência do estado de Sergipe, determinar a prevalência do evento nesses locais e descrever os fatores de risco associados. Casuística e métodos: Foi realizado estudo do tipo transversal com duplo controle em pacientes que em algum momento estiveram gestantes e permaneceram internadas em situações de risco nas duas maternidades de referência do Estado de Sergipe no período de um ano. As pacientes responderam a um questionário que continham questões sobre o assunto. Para a análise estatística das variáveis categóricas foi utilizado o teste exato de Fisher. Para as variáveis contínuas normais e para tabelas 2x2 foi aplicado o teste t de Student e para tabelas maiores o teste do qui-quadrado. Para as tabelas não-normais foi aplicado o teste de U-Mann-Whitey. Cálculo do Odds ratio e intervalo de confiança foram utilizados sempre que possível. Neste estudo foi realizada análise multivariada e o valor de p< 0,05 foi considerado. Resultados: Dos 16.243 partos, ocorreram 1102 casos de MMG, 77 casos de NM e 17 MM. A prevalência de MMG + NM foi de 72,6 casos /1000 NV, o índice de mortalidade foi de 18% (4,5 casos para cada morte). As principais causas de MMG e NM foram respectivamente: 67,5% por causas hipertensivas e 87,1% devido à necessidade de realização de procedimentos invasivos. Idade elevada, baixa renda, a não realização de pré natal, maior índice de parto cesáreo, antecedentes obstétricos de aborto anterior e cesárea anterior, baixo peso do RN ao nascer com prognóstico perinatal desfavorável mostraram-se estatisticamente significantes para o grupo estudado. A análise multivariada demonstrou que a quantidade de critérios de elegibilidade de NM esteve relacionada à gravidade do quadro. Conclusões: As situações de NM + MMG nas duas maternidades estudadas atingiram valores expressivos. Estudar NM pode ser o modo mais eficiente de realização de auditorias internas na busca da melhora da qualidade dos serviços. Protocolos baseados em situações adversas como estas, onde pode ser feita a detecção exata do ponto de falha, podem recomendar condutas e intervenções possivelmente capazes de salvar vidas.

Background: The interest in obstetrical complications that culminate with maternal death and the urgent need for improvement in these indexes led to the development of the concept of maternal near miss. From a normal situation, the patients are in a continuum that can evolve with the development of moderate and severe situations of health. Severe acute maternal morbidity (SAMM) (situation less severe) and near miss (NM) (situation more severe) are two degrees of situation immediately before maternal death. The main advantage of studying these cases is higher frequency when comparing with maternal deaths cases and that the determining factors are the same. This study aims to determine the ocurrence of SAMM and NM situations in two maternities of reference of the state of Sergipe, determine the prevalence of the event and describe the risk factors associated. Casuistic and methods: A cross sectional study with double controls was conducted in patients who were pregnant sometime and were hospitalized in two reference maternities of Sergipe state. The patients answered a survey about issues relevant to the subject. For categorical variables was used Fisher s exact test. For normal continuous variables was applied the Student t test and for the not normal, the U-Mann-Whitey test. Odds ratio and confidence interval were used whenever possible. Multivariate analysis was performed and p <0,05. Results: There were 16,243 live birth deliveries, and occurred 1102 SAMM, 77 NM and 17 maternal deaths cases. The prevalence of SAMM + NM founded were, respectively, 7.6 cases/1000 LB, the mortality index was 18% (4.5 cases for each death) The main causes of SAMM and NM were respectively: 67.5% by hypertensive causes and 87.1% by necessity of invasive procedures. High age, low income, absence of prenatal, high rates of cesarean section, previous abortion and low weight of the baby at birth with unfavorable perinatal prognosis were statistically significant for the study group. Multivariate analysis showed that the number of eligibility criteria for NM was related with the severity of the situation. Conclusions: The situations of SAMM and NM in the two maternities studied reached significant values. Study NM can be the most efficiently way of conducting internal audits for the improving of the quality of services. Protocols based on adverse situations like these, where the detection can be made on the exact point of failure, can recommend conducts and interventions able to save lives. / Introdução: O interesse por complicações em obstetrícia que culminassem com morte materna e a necessidade urgente da melhora desses índices resultou no desenvolvimento do conceito de near miss materno. A partir de uma situação normal, a paciente insere-se em um continuum que pode evoluir com o desenvolvimento de situações de gravidade moderada e intensa. Morbidade materna grave (MMG) e near miss (NM) são duas denominações dadas às situações imediatamente anteriores ao óbito materno. A grande vantagem em se estudar esses casos é justamente a sua frequência superior em relação aos casos de morte materna (MM) e que os fatores determinantes são os mesmos. Este estudo tem por objetivos: determinar a ocorrência de situações de MMG e NM em duas maternidades de referência do estado de Sergipe, determinar a prevalência do evento nesses locais e descrever os fatores de risco associados. Casuística e métodos: Foi realizado estudo do tipo transversal com duplo controle em pacientes que em algum momento estiveram gestantes e permaneceram internadas em situações de risco nas duas maternidades de referência do Estado de Sergipe no período de um ano. As pacientes responderam a um questionário que continham questões sobre o assunto. Para a análise estatística das variáveis categóricas foi utilizado o teste exato de Fisher. Para as variáveis contínuas normais e para tabelas 2x2 foi aplicado o teste t de Student e para tabelas maiores o teste do qui-quadrado. Para as tabelas não-normais foi aplicado o teste de U-Mann-Whitey. Cálculo do Odds ratio e intervalo de confiança foram utilizados sempre que possível. Neste estudo foi realizada análise multivariada e o valor de p< 0,05 foi considerado. Resultados: Dos 16.243 partos, ocorreram 1102 casos de MMG, 77 casos de NM e 17 MM. A prevalência de MMG + NM foi de 72,6 casos /1000 NV, o índice de mortalidade foi de 18% (4,5 casos para cada morte). As principais causas de MMG e NM foram respectivamente: 67,5% por causas hipertensivas e 87,1% devido à necessidade de realização de procedimentos invasivos. Idade elevada, baixa renda, a não realização de pré natal, maior índice de parto cesáreo, antecedentes obstétricos de aborto anterior e cesárea anterior, baixo peso do RN ao nascer com prognóstico perinatal desfavorável mostraram-se estatisticamente significantes para o grupo estudado. A análise multivariada demonstrou que a quantidade de critérios de elegibilidade de NM esteve relacionada à gravidade do quadro. Conclusões: As situações de NM + MMG nas duas maternidades estudadas atingiram valores expressivos. Estudar NM pode ser o modo mais eficiente de realização de auditorias internas na busca da melhora da qualidade dos serviços. Protocolos baseados em situações adversas como estas, onde pode ser feita a detecção exata do ponto de falha, podem recomendar condutas e intervenções possivelmente capazes de salvar vidas.