Maternal morbidity: a longitudinal study of women’s health during and up to 22 months after pregnancy in Jamaica

ABSTRACT

Our study evaluated factors associated with ill-health in a population-based longitudinal study of women who delivered a singleton live-born baby in a 3-month period across Jamaica. Socio-demographics, perception of health, chronic illnesses, frequency and reasons for hospital admission were assessed. Relationships between ill-health and maternal characteristics were estimated using log-normal regression analysis. Of 9,742 women interviewed at birth, 1,311 were assessed at four stages, 27.7% of whom reported ill-health at least once. Hospitalization rates were 20.9% during pregnancy, 6.1% up to 12 months and 0.5% up to 22 months after childbirth. Ill-health, reported by 11% of women, was less likely with better education (RR=0.62, 95%; 0.42-0.84). Hospital admission was associated with higher socio-economic status (RR=1.33, 95% 1.04-1.70) and Caesarean section [CS] (RR=1.57, 95%; 1.21-2.04). One in three (33.7%) women reported chronic illnesses, and the likelihood increased with age, parity and delivery by elective CS (RR=1.44, 95%; 1.20-1.73). In multivariable analyses, ill-health was more likely with chronic illness (RR=2.06, 95%; CI: 1.71-2.48) and hospital admission from 12 to 22 months after childbirth (RR=1.54, 95% CI: 1.12-2.12). Ill-health during pregnancy and after childbirth represent a significant burden of disease and requires a standardised comprehensive approach to measuring and addressing this disease burden.

KEYWORDS:

• Indicators
• maternal morbidity
• pregnancy
• postnatal
• assessment

Author’s contributions

AMB, MSV and NvdB conceived the study. MM, JAR and NvdB conceived the design of the secondary analysis and inclusion of variables. MM coded variables in the database. JAR cleaned the data and JAR and SW performed data analysis. MM interpreted the data and wrote the manuscript. JAR, SW, AMB, NvdB and MSV edited the manuscript and have approved it for submission.

Acknowledgments

We are grateful to all the families who took part in this study, the staff in health centres and hospitals throughout Jamaica for their help during recruitment, and the JA KIDS team, of interviewers, computer and laboratory technicians, clerical and administrative workers, research scientists, volunteers and managers at the University of the West Indies (Mona). The Inter-American Development Bank (Grant ref: ATN/JF-12312-JA; ATN/OC-14535-JA) and the University of the West Indies, Mona Campus provided core support for JA KIDS. Secondary data analysis at the Centre for Maternal and Newborn Health in the UK was funded through a Global Health Grant (Project number OPP1033805) from Bill and Melinda Gates Foundation and World Health Organization (WHO). Additional support was provided by the World Bank, UNICEF, the CHASE Fund, the National Health Fund, Parenting Partners Caribbean, the University of Nevada - Las Vegas, the University of Texas Health Science Centre at Houston and Michigan State University and its Partners. This publication is the work of the authors listed who will serve as guarantors for the contents of this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

Ethical approval was granted by the University of the West Indies Ethics Committee (Mona) and the Ministry of Health’s Advisory Panel on Medico - Legal Affairs, Kingston, Jamaica.

Additional information

Funding

The JA Kids study was funded by a grant to the University of the West Indies from the Inter-American Development Bank (IDB) (Project number ATN/JF-12312-JA). Secondary data analysis at the Centre for Maternal and Newborn health in the UK was funded through a Global Health Grant (Project number OPP1033805) from the Bill and Melinda Gates Foundation and World Health Organization (WHO).