Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2017; 39(11): 587-595
DOI: 10.1055/s-0037-1606246
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Prevalence of Maternal Morbidity and Its Association with Socioeconomic Factors: A Population-based Survey of a City in Northeastern Brazil

Prevalência da morbidade materna e sua associação com fatores socioeconômicos: estudo de base populacional em uma capital do nordeste brasileiro
Tatyana Souza Rosendo
1   Departament of Collective Health, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
,
Angelo Giuseppe Roncalli
2   Departament of Odontology, Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
,
George Dantas de Azevedo
3   Escola Multicampi de Ciências Médicas do Rio Grande do Norte, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
› Author Affiliations
Further Information

Publication History

30 January 2017

21 June 2017

Publication Date:
23 August 2017 (online)

   Permissions and Reprints

Abstract

Purpose To identify the prevalence of maternal morbidity and its socioeconomic, demographic and health care associated factors in a city in Northeastern Brazil.

Methods A cross-sectional and population-based study was conducted, with a design based on multi-stage complex sampling. A validated questionnaire was applied to 848 women aged between 15 and 49 years identified in 8,227 households from 60 census tracts of Natal, the capital of the state of Rio Grande do Norte (RN), Brazil. The main outcome measure was maternal morbidity. The Poisson regression analysis, with 5% significance, was used for the analysis of the associated factors.

Results The prevalence of maternal morbidity was of 21.2%. A bivariate analysis showed the following variables associated with an increased number of obstetric complications: non-white race (prevalence ratio [PR] =1.23; 95% confidence interval [95%CI]: 1.04–1.46); lower socioeconomic status (PR = 1.33; 95%CI: 1.12–1.58); prenatal care performed in public services (PR = 1.42; 95%CI: 1.16–1.72): women that were not advised during prenatal care about where they should deliver (PR = 1.24; 95%CI: 1.05–1.46); delivery in public services (PR = 1.63; 95%CI: 1.30–2.03); need to search for more than one hospital for delivery (PR = 1.22; 95%CI: 1.03–1.45); and no companion at all times of delivery care (PR = 1.25, 95%CI: 1.05–1.48). The place where the delivery occurred (public or private) and the socioeconomic status remained significant in the final model.

Conclusion Women in a worse socioeconomic situation and whose delivery was performed in public services had a higher prevalence of maternal morbidity. Such an association reinforces the need to strengthen public policies to tackle health inequalities through actions focusing on these determinants.

Resumo

Objetivo Identificar a prevalência da morbidade materna e os fatores socioeconômicos, demográficos e de assistência à saúde associados a ela em uma capital do Nordeste brasileiro.

Métodos Estudo seccional, de base populacional, com desenho de amostras complexas. Aplicou-se um questionário validado para morbidade materna em 848 mulheres com idade entre 15 e 49 anos selecionadas em 8.227 domicílios distribuídos em 60 setores censitários de Natal, capital do Rio Grande do Norte, Brasil. O desfecho principal foi a morbidade materna. A análise multivariada foi feita por meio da regressão de Poisson, com 5% de significância.

Resultados A prevalência de morbidade materna foi de 21,2%. A análise bivariada encontrou associação entre o maior número de complicações obstétricas com: mulheres da raça preta/parda (razão de prevalência [RP] = 1,23; intervalo de confiança de 95% [IC95%]: 1,04–1,46); pior condição socioeconômica (RP = 1,33; IC95%: 1,12–1,58); pré-natal na rede pública (RP = 1,42; IC95%: 1,16 -1,72); mulheres que não foram informadas sobre o lugar da realização do parto durante o pré-natal (RP = 1,24; IC95%: 1,05–1,46); mulheres que realizaram o parto na rede pública (RP = 1,63; IC95%: 1,30–2,03); pacientes que percorreram mais de um hospital para realizar o parto (RP = 1,22; IC95%: 1,03–1,45); e aquelas que não tiveram acompanhante em todos os momentos da assistência ao parto – antes, durante e depois do parto (RP = 1,25; IC95% = 1,05–1,48). No modelo final da regressão, tanto o local do parto quanto a condição socioeconômica mantiveram a associação.

Conclusões A maior prevalência da morbidade materna esteve associada às piores condições socioeconômicas e à realização do parto na rede pública. Isso reforça a necessidade de fortalecimento de políticas públicas que reduzam as desigualdades em saúde.

Keywords

maternal mortality - morbidity - pregnancy complications - health surveys - health care disparities

Palavras-chave

mortalidade materna - morbidade - complicações na gravidez - estudos em saúde - desigualdades em saúde

Funding

The present study was funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), under process number 477496/2011–3


 

  • References

  • 1 World Health Organization. Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: WHO; 2008
    Google Scholar
  • 2 de Graaf JP, Steegers EA, Bonsel GJ. Inequalities in perinatal and maternal health. Curr Opin Obstet Gynecol 2013; 25 (02) 98-108
    CrossrefPubMedGoogle Scholar
  • 3 United Nations. [Internet]. The Millennium Development Goals Report 2013. New York: United Nations; 2013. [cited 2014 May 25]. Avaliable from: http://www.un.org/millenniumgoals/pdf/report-2013/mdg-report-2013-english.pdf
    Google Scholar
  • 4 Saucedo M, Deneux-Tharaux C, Bouvier-Colle MH. Understanding regional differences in maternal mortality: a national case-control study in France. BJOG 2012; 119 (05) 573-581
    CrossrefPubMedGoogle Scholar
  • 5 World Health Organization. Evaluating the quality care for severe pregnancy complications: the WHO near-miss approach for maternal health. Geneva: WHO; 2011
    Google Scholar
  • 6 Cecatti JG, Parpinelli MA. Maternal health in Brazil: priorities and challenges. Cad Saude Publica 2011; 27 (07) 1256
    CrossrefPubMedGoogle Scholar
  • 7 Souza JP. [Maternal mortality and development: the obstetric transition in Brazil]. Rev Bras Ginecol Obstet 2013; 35 (12) 533-535
    CrossrefPubMedGoogle Scholar
  • 8 Mantel GD, Buchmann E, Rees H, Pattinson RC. Severe acute maternal morbidity: a pilot study of a definition for a near-miss. Br J Obstet Gynaecol 1998; 105 (09) 985-990
    CrossrefPubMedGoogle Scholar
  • 9 Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control study. BMJ 2001; 322 (7294): 1089-1093 , discussion 1093–1094
    CrossrefPubMedGoogle Scholar
  • 10 Souza JP, Cecatti JG, Parpinelli MA, Serruya SJ, Amaral E. Appropriate criteria for identification of near-miss maternal morbidity in tertiary care facilities: a cross sectional study. BMC Pregnancy Childbirth 2007; 7: 20
    CrossrefPubMedGoogle Scholar
  • 11 Souza JP, Sousa MH, Parpinelli MA, Amaral E, Cecatti JG. Self-reported maternal morbidity and associated factors among Brazilian women. Rev Assoc Med Bras (1992) 2008; 54 (03) 249-255
    CrossrefPubMedGoogle Scholar
  • 12 Souza JP, Parpinelli MA, Amaral E, Cecatti JG. Population surveys using validated questionnaires provided useful information on the prevalence of maternal morbidities. J Clin Epidemiol 2008; 61 (02) 169-176
    CrossrefPubMedGoogle Scholar
  • 13 Souza JP, Cecatti JG, Parpinelli MA. , et al. Maternal morbidity and near miss in the community: findings from the 2006 Brazilian demographic health survey. BJOG 2010; 117 (13) 1586-1592
    CrossrefPubMedGoogle Scholar
  • 14 de Moraes AP, Barreto SM, Passos VMA, Golino PS, Costa JE, Vasconcelos MX. Severe maternal morbidity: a case-control study in Maranhao, Brazil. Reprod Health 2013; 10: 11
    CrossrefPubMedGoogle Scholar
  • 15 Souza JP, Cecatti JG, Pacagnella RC. , et al. Development and validation of a questionnaire to identify severe maternal morbidity in epidemiological surveys. Reprod Health 2010; 7: 16
    CrossrefPubMedGoogle Scholar
  • 16 Torres M, Moayedi S. Gynecologic and other infections in pregnancy. Emerg Med Clin North Am 2012; 30 (04) 869-884
    CrossrefPubMedGoogle Scholar
  • 17 Lwanga SK, Lemeshow S. Sample size determination in health studies: a practical manual. Geneva: WHO; 1991
    Google Scholar
  • 18 World Health Organization. The EPI coverage survey. Geneva: WHO; 1991
    Google Scholar
  • 19 United Nations Population Fund. Rich Mother, poor mother: the social determinants of maternal death. New York, UN: 2012
    Google Scholar
  • 20 Souza JP, Parpinelli MA, Amaral E, Cecatti JG. [Obstetric care and severe pregnancy complications in Latin America and the Caribbean: an analysis of information from demographic health surveys]. Rev Panam Salud Publica 2007; 21 (06) 396-401 Portuguese
    PubMedGoogle Scholar
  • 21 Cecatti JG, Souza RT, Pacagnella RC, Leal MC, Moura EC, Santos LM. Maternal near miss among women using the public health system in the Amazon and Northeast regions of Brazil. Rev Panam Salud Publica 2015; 37 (4-5): 232-238
    PubMedGoogle Scholar
  • 22 Amaral E, Souza JP, Surita F. , et al. A population-based surveillance study on severe acute maternal morbidity (near-miss) and adverse perinatal outcomes in Campinas, Brazil: the Vigimoma Project. BMC Pregnancy Childbirth 2011; 11: 9
    CrossrefPubMedGoogle Scholar
  • 23 Lotufo FA, Parpinelli MA, Haddad SM, Surita FG, Cecatti JG. Applying the new concept of maternal near-miss in an intensive care unit. Clinics (Sao Paulo) 2012; 67 (03) 225-230
    CrossrefPubMedGoogle Scholar
  • 24 Brown HL, Small M, Taylor YJ, Chireau M, Howard DL. Near miss maternal mortality in a multiethnic population. Ann Epidemiol 2011; 21 (02) 73-77
    CrossrefPubMedGoogle Scholar
  • 25 Creanga AA, Bateman BT, Kuklina EV, Callaghan WM. Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010. Am J Obstet Gynecol 2014; 210 (05) 435.e1-435.e8
    CrossrefPubMedGoogle Scholar
  • 26 Karlsen S, Say L, Souza JP. , et al. The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health. BMC Public Health 2011; 11: 606
    CrossrefPubMedGoogle Scholar
  • 27 Tunçalp Ö, Souza JP, Hindin MJ. , et al; WHO Multicountry Survey on Maternal and Newborn Health Research Network. Education and severe maternal outcomes in developing countries: a multicountry cross-sectional survey. BJOG 2014; 121 (Suppl. 01) 57-65
    CrossrefPubMedGoogle Scholar
  • 28 Ham P, Allen C. Adolescent health screening and counseling. Am Fam Physician 2012; 86 (12) 1109-1116
    PubMedGoogle Scholar
  • 29 Lamminpää R, Vehviläinen-Julkunen K, Gissler M, Heinonen S. Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997-2008. BMC Pregnancy Childbirth 2012; 12: 47
    CrossrefPubMedGoogle Scholar
  • 30 Oliveira Jr FC, Costa ML, Cecatti JG, Pinto e Silva JL, Surita FG. Maternal morbidity and near miss associated with maternal age: the innovative approach of the 2006 Brazilian demographic health survey. Clinics (Sao Paulo) 2013; 68 (07) 922-927
    CrossrefPubMedGoogle Scholar
  • 31 Oliveira Jr FC, Surita FG, Pinto E Silva JL. , et al; Brazilian Network for Surveillance of Severe Maternal Morbidity Study Group. Severe maternal morbidity and maternal near miss in the extremes of reproductive age: results from a national cross- sectional multicenter study. BMC Pregnancy Childbirth 2014; 14: 77
    CrossrefPubMedGoogle Scholar
  • 32 Galvão LPL, Alvim-Pereira F, de Mendonça CM. , et al. The prevalence of severe maternal morbidity and near miss and associated factors in Sergipe, Northeast Brazil. BMC Pregnancy Childbirth 2014; 14: 25
    CrossrefPubMedGoogle Scholar
  • 33 Adisasmita A, Deviany PE, Nandiaty F, Stanton C, Ronsmans C. Obstetric near miss and deaths in public and private hospitals in Indonesia. BMC Pregnancy Childbirth 2008; 8: 10
    CrossrefPubMedGoogle Scholar