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

Rosendo, Tatyana Souza; Roncalli, Angelo Giuseppe; Azevedo, George Dantas de

doi:10.1055/s-0037-1606246

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev. Bras. Ginecol. Obstet. 39 (11) • Nov 2017 • https://doi.org/10.1055/s-0037-1606246 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
maternal mortality; morbidity; pregnancy complications; health surveys; health care disparities

Variables		n*	%**	95%CI**
Age	≤ 34 years old	671	78.7	75.5–81.6
	≥ 35 years old	174	21.3	18.4–24.5
	Total	845	100.0
Race (skin color)	White	286	34.7	30.1–39.7
	Non-white	525	65.3	60.3–69.9
	Total	811	100.0
Marital status	Married/stable relationship	539	68.7	61.8–74.9
	Single/divorced	241	31.3	25.1–38.2
	Total	780	100.0
Socioeconomic Status	High	343	51.7	44.0–59.3
	Low	342	48.3	40.7–56.0
	Total	685	100.0
Type of health service where prenatal care was performed	Private	242	30.6	24.6–37.4
	Public	587	69.4	62.6–65.4
	Total	829	100.0
Type of health service where delivery was performed	Private	162	24.1	18.3–31.0
	Public	559	75.9	69.0–81.7
	Total	721	100.0
Type of delivery	Normal	409	48.0	42.8–53.2
	Cesarean	428	52.0	46.8–57.2
	Total	837	100.0

Complications (clinical conditions or interventions)		n*	%**	95%CI**
Clinical conditions	Hemorrhage	85	10.7	8.4–13.4
	Urinary tract infection	91	10.7	8.7–13.0
	Septicemia	44	5.2	3.8–7.1
	Icterus	37	4.5	3.1–6.3
	Pre-eclampsia/eclampsia	34	4.3	2.9–6.2
	Chronic hypertension	26	2.8	1.6–4.8
	Abortion	11	1.6	0.9–2.7
	Eclampsia	10	1.3	0.7–2.3
	Gestational diabetes	6	0.8	0.3–1.8
Interventions	Hospitalization for > 1 week	44	5.4	3.9–7.4
	Transfer between hospitals	35	4.2	2.9–6.0
	ICU hospitalization	16	1.8	1.1–3.1
	Blood transfusion	10	1.2	0.6–2.3
	Laparotomy	11	1.1	0.5–2.2
	Mechanical ventilation	7	0.9	0.4–2.4
	Hysterectomy	2	0.2	0.1–0.9
At least one of these complications		176	21.2	18.3–24.5

	Number of maternal complications
Variable	n	Mean	SD	PR	95%CI	p
Socioeconomic and demographic characteristics
Age
≤ 34 years old	131	2.70	1.49	1
≥ 35 years old	42	2.50	1.33	0.93	0.77–1.11	0.409
Total	173	2.65	1.45
Race (skin color)
White	62	2.32	1.25	1
Non-white	103	2.86	1.49	1.23	1.04–1.46	0.014
Total	165	2.66	1.42
Marital status
Married/stable relationship	113	2.58	1.50	1
Single/divorced	52	2.88	1.37	1.12	0.95–1.32	0.181
Total	165	2.67	1.46
House crowding
≤ 2 dwellers per room	104	2.51	1.43	1
≥ 3 dwellers per room	67	2.90	1.46	1.15	0.98–1.36	0.084
Total	171	2.66	1.45
Occupation
Employed	76	2.78	1.48	1
Unemployed	98	2.57	1.42	0.93	0.79–1.09	0.352
Total	174	2.66	1.45
Socioeconomic status
High	72	2.32	1.24	1
Low	71	3.08	1.57	1.33	1.12–1.58	0.001
Total	143	2.70	1.46
Maternal assistance
Prenatal care
Yes	164	2.70	1.46	1
No	10	2.10	1.20	0.78	0.55–1.10	0.157
Total	174	2.66	1.45
Number of prenatal appointments
≥ 6 appointments	127	2.68	1.53	1
≤ 5 appointments	24	3.00	1.25	1.12	0.93–1.36	0.242
Total	151	2.73	1.49
Time of 1st prenatal appointment
Up to the 3rd month	139	2.65	1.49	1
From the 4th month	21	3.05	1.20	1.15	0.95–1.39	0.145
Total	160	2.70	1.46
Type of health service where prenatal care was performed
Private	49	2.08	1.30	1
Public	113	2.95	1.44	1.42	1.16–1.72	< 0.001
Total	162	2.69	1.46
Basic exams recommended the by Ministry of Health
Performed all exams	146	2.74	1.50	1
Did not perform all exams	13	2.15	0.90	0.79	0.62–0.99	0.045
Total	159	2.69	1.47
Instructions about where the delivery would be performed
Yes	101	2.47	1.34	1
No	63	3.06	1.57	1.24	1.05–1.46	0.010
Total	164	2.70	1.46
Delivery performed in the same place where the patient was instructed to go
Yes	86	2.47	1.38	1
No	15	2.47	1.12	1.00	0.778–1.28	0.996
Total	101	2.47	1.34
Type of health service where the delivery was performed
Private	35	1.80	1.13	1
Public	125	2.93	1.43	1.63	1.30–2.03	< 0.001
Total	160	2.68	1.44
Delivery performed in the first hospital
Yes	135	2.54	1.43	1
No	38	3.11	1.45	1.22	1.03–1.45	0.024
Total	173	2.66	1.45
Type of delivery
Normal	52	2.92	1.53	1
Cesarean	111	2.57	1.41	0.88	0.74–1.05	0.143
Total	163	2.68	1.45
Companion before the delivery
Yes	149	2.60	1.42	1
No	21	3.05	1.66	1.17	0.92–1.50	0.198
Total	170	2.65	1.45
Companion during the delivery
Yes	82	2.38	1.40	1
No	78	2.83	1.38	1.19	1.01–1.41	0.039
Total	160	2.60	1.41
Companion after the delivery
Yes	136	2.54	1.43	1
No	28	2.89	1.42	1.14	0.93–1.39	0.213
Total	164	2.60	1.43
Companion full time
Yes	76	2.28	1.31	1
No	80	2.84	1.44	1.25	1.05–1.48	0.011
Total	156	2.56	1.40
Days of hospitalization
≤ 7 days	137	2.39	1.30	1
≥ 7 days	35	3.80	1.49	1.59	1.36–1.86	< 0.001
Total	172	2.67	1.45

	Number of maternal complications
	Non-Adjusted		Adjusted
Condition	PR (95%CI)	p	PR (95%CI)	p
Age	0.93 (0.77–1.11)	0.409	1.03 (0.87–1.23)	0.713
Race (non-white)	1.23 (1.04–1.46)	0.014	1.19 (0.99–1.44)	0.054
Low socioeconomic status	1.33 (1.12–1.58)	0.001	1.23 (1.03–1.46)	0.019
Delivery performed in public service	1.63 (1.30–2.03)	< 0.001	1.51 (1.21–1.87)	< 0.001

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[1] Address for correspondence Tatyana Souza Rosendo, MD, Departamento de Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Av. Senador Salgado Filho, 3.000-Lagoa Nova, 59078-970 Natal, RN, Brasil (e-mail: tatyana.ufrn@hotmail.com).