Maternal mortality in the indigenous and non-indigenous population in Pará: contribution to the surveillance of deaths

Santos, Deivid Ramos dos; Nogueira, Laura Maria Vidal; Paiva, Bárbara Lopes; Rodrigues, Ivaneide Leal Ataide; Oliveira, Lívia Félix de; Caldas, Samantha Pereira

doi:10.1590/2177-9465-EAN-2017-0161

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RESEARCH • Esc. Anna Nery 21 (4) • 2017 • https://doi.org/10.1590/2177-9465-EAN-2017-0161 copy

Maternal mortality in the indigenous and non-indigenous population in Pará: contribution to the surveillance of deaths

Mortalidad materna en la población indígena y no indígena en Pará: contribución para el control de óbitos

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the occurrence of Maternal Mortality in general and in the indigenous population in the state of Pará.

Method:

A quantitative, analytical and retrospective study was performed, covering a historical series from 2005 to 2014. For the analysis of the results, non-parametric statistical tests, the Chi-square test and the G test were processed in the BioStat 5.0 software program.

Results:

A total of 884 maternal deaths were reported in the state of Pará, corresponding to a Mortality Rate of 60.7 per 100,000 live births for non-indigenous women and 135.8 per 100,000 live births for indigenous women. Oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and puerperium corresponded to 30.5% (n = 270).

Conclusion and Implications for the Practice:

Maternal mortality remains a serious public health problem in the state of Pará, clearly demonstrating that indigenous pregnant women require greater care, since they showed higher Maternal Mortality Rates when compared to non-indigenous women.

Keywords:
Maternal Mortality; Indigenous Population; Public Health Surveillance

Year	N	%	LB	MMR^* * p < 0.05 (χ2 test = 1277.6; p = 0.0001);	95%CI¹ 1 Confidence Interval for indigenous MMR.		N	%	LB	MMR^* * p < 0.05 (χ2 test = 1277.6; p = 0.0001);	95%CI² 2 Confidence Interval for non-indigenous MMR.		N	LB	N	%	LB	MMR^ p > 0.05 (χ2 test of adherence between MMRs = 296,606; p < 0.0001); (G test = 387.9024; p < 0.0001; G test (Williams) = 386.3852; p < 0.0001). Annual mean (non-indigenous: 86.5 deaths per year; indigenous: 1.3 deaths per year: total population: 88.4 deaths per year).	95%CI
	Indigenous						Non-indigenous						Ignored		Total population				95%CI
2005	1	7.7	791	126.4	124.7	128.1	86	10.0	144.469	59.5	58.3	60.7	1	280	88	10.0	145.540	60.5	124.7	128.10
2006	0	0.0	749	0	0.0	0.0	83	9.5	149.112	55.7	54.6	56.8	0	341	83	9.4	150.202	55.3	0.0	0.00
2007	1	7.7	795	125.8	124.2	127.4	82	9.4	149.045	55	53.9	56.1	0	307	83	9.4	150.147	55.3	124.2	127.43
2008	1	7.7	793	126.1	124.5	127.7	80	9.2	150.142	53.3	52.3	54.3	0	327	81	9.2	151.262	53.5	124.5	127.71
2009	1	7.7	798	125.3	123.7	126.9	73	8.4	141.997	51.4	50.4	52.4	0	345	74	8.4	143.140	51.7	123.7	126.87
2010	1	7.7	834	119.9	118.3	121.5	75	8.6	139.013	54	52.9	55.1	0	840	76	8.6	140.687	54	118.3	121.48
2011	0	0.0	1.124	0	0.0	0.0	87	10.0	139.839	62.2	61.0	63.4	0	1011	87	9.8	141.974	61.3	0.0	0.00
2012	3	23.1	1.205	249	246.5	251.5	84	10.0	135.616	61.9	60.7	63.1	3	1016	90	10.2	137.837	65.3	246.6	251.43
2013	3	23.1	1.206	248.8	246.0	251.6	110	12.9	136.792	80.4	78.8	82.0	2	1418	115	13.0	139.416	82.5	246.0	251.57
2014	2	15.4	1.280	156.3	154.2	158.4	105	12.1	139.733	75.1	73.6	76.6	0	2055	107	12.1	143.068	74.8	154.2	158.42
Total	13	100.0	9.575	135.8	134.0	137.6	865	100.0	1.425.758	60.7	59.5	61.9	6	7940	884	100.0	1.443.273	61.2	134.0	137.58

ICD-10 cause	N	%	SMMR¹ 1 p < 0.05 (χ2 test = 207.574; p < 0.0001);	N	%	SMMR² 2 p < 0.05 (χ2 test = 23.084; p = 0.0008);	N	N	%	SMMR³ 3 p < 0.05 (χ2 test = 23.688; p = 0.0006); (G test = 39.8016; p < 0.0001; G test (Williams) = 37.1242; p < 0.0002);	95%CI⁴ 4 Confidence Interval between MMRs.
ICD-10 cause	Indigenous			Non-indigenous			Ignored	Total Population			95%CI⁴ 4 Confidence Interval between MMRs.
Pregnancy that ends in an abortion	1	7.7	10.4	82	9.5	5.8	1	84	9.5	5.8	0.82	1.18
Oedema, proteinuria and hypertensive disorders during pregnancy, childbirth and the puerperium	7	53.8	73.1	261	30.2	18.3	2	270	30.5	18.7	6.15	7.85
Other maternal disorders predominantly related to pregnancy	0	0	0	22	2.5	1.5	0	22	2.5	1.5	0.00	0.00
Maternal care related to the fetus and amniotic cavity and possible delivery problems	1	7.7	10.4	58	6.7	4.1	1	60	6.8	4.2	0.85	1.15
Labor and childbirth complications	3	23.1	31.3	191	22.1	13.4	0	194	21.9	13.4	2.53	3.47
Complications predominantly related to the puerperium.	1	7.7	10.4	147	17	10.3	1	149	16.9	10.3	0.76	1.24
Other obstetric conditions not elsewhere classified	0	0	0	104	12	7.3	1	105	11.9	7.3	0.00	0.00
Total	13	100	135.8	865	100	60.7	6	884	100	61.2	10.90	15.10

Variables	Indigenous		Non-indigenous		Ignored		Total population		95%CI¹ 1 Confidence interval between proportions.
Variables	n	%	n	%	n	%	n	%	95%CI¹ 1 Confidence interval between proportions.
Place of occurrence
Hospital	12	92.3	794	91.8	6	100	812	91.9	10.09	13.91
Other than hospital	1	7.7	70	8.1	0	0	71	8.0	0.84	1.16
Ignored	0	0	1	0.1	0	0	1	0.1	0.00	0.00
Obstetric cause
Direct obstetric maternal death	13	100.0	746	86.2	4	66.7	762	86.2	11.07	14.93
Indirect obstetric maternal death	0	0	110	12.8	2	33.3	113	12.8	0.00	0.00
Unspecified obstetric maternal death	0	0	9	1.0	0	0	9	1.0	0.00	0.00
Investigated death
Investigated death with an informed death report file	7	53.8	360	41.6	3	50.0	370	41.9	6.02	7.98
Investigated death without a death report file	1	7.7	70	8.1	0	0	71	8.0	0.84	1.16
Death not investigated	4	30.8	352	40.7	2	33.3	358	40.5	3.26	4.74
Not applicable	1	7.7	83	9.6	1	16.7	85	9.6	0.82	1.18
Total	13	100.0	865	100.0	6	100	884	100.0	10.92	15.08

Health regions	N	%	LB	MMR^ p < 0.05 (χ2 test = 4557.105; p = 0.0001); p < 0.0001, applied to regions with MMR values > 0); p < 0.05 (χ2 test = 1810.930; p < 0.0001); p < 0.005 (χ2 test = 1410.905; p < 0.0001);	N	%	LB	MMR^* * p < 0.05 (χ2 test = 57.148; p < 0.0001);	N	LB	N	%	LB	%	95%CI¹ 1 Confidence Interval between MMRs.
Health regions	Indigenous				Non-indigenous				Ignored		Total Population				95%CI¹ 1 Confidence Interval between MMRs.
Metropolitan 1	0	0	261	0	184	21.3	348.652	52.8	1	879	185	20.9	349.792	52.9	0.00	0.00
Metropolitan 2	0	0	121	0	37	4.3	57.996	63.8	0	579	37	4.2	58.696	63.0	0.00	0.00
Metropolitan 3	0	0	394	0	90	10.4	147.438	61.0	0	545	90	10.2	148.377	60.7	0.00	0.00
Marajó 1	0	0	48	0	31	3.6	33.317	93.0	0	310	31	3.5	33.675	92.1	0.00	0.00
Marajó 2	0	0	44	0	58	6.7	63.390	91.5	0	1.012	58	6.6	64.446	90.0	0.00	0.00
Lago de Tucuruí	0	0	390	0	39	4.5	78.811	49.5	0	481	39	4.4	79.682	48.9	0.00	0.00
Carajás	1	7.7	596	167.8	109	12.6	156.778	69.5	1	446	111	12.6	157.820	70.3	0.80	1.20
Araguaia	3	23.1	1.221	245.7	36	4.2	73.923	48.7	0	458	39	4.4	75.602	51.6	2.80	3.20
Baixo Amazonas	0	0	1.127	0	82	9.5	150.286	54.6	3	1.194	85	9.6	152.607	55.7	0.00	0.00
Rio Caetes	0	0	91	0	70	8.1	95.686	73.2	0	376	70	7.9	96.153	72.8	0.00	0.00
Tapajós	3	23.1	3.857	77.8	22	2.5	38.200	57.6	0	101	25	2.8	42.158	59.3	2.84	3.16
Tocantins	1	7.1	81	1234.6	78	9.0	121.464	64.2	0	1.154	79	8.9	122.699	64.4	0.83	1.17
Xingu	5	38.5	1.344	372.0	28	3.2	59.787	46.8	1	404	34	3.8	61.535	55.3	4.77	5.23
Ignored	0	0	0	0	1	0.1	30	0	0	1	1	0.1	31	0	0.00	0.00
Total	13	100	9.575	135.8	865	100	1.425.758	60.7	6	7.940	884	100.0	1.443.273	61.2	10.92	15.08

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[1] Corresponding author: Bárbara Lopes Paiva. E-mail: barbaralopespaiva@gmail.com