Abstract
Objective. To determine whether lack of routine antenatal care (ANC) is associated with near-miss morbidity upon arrival at hospital. Design. Case-referent study. Setting. Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government subsidized program. Sample. Women with severe maternal morbidity upon arrival at hospital (n = 297). Facility-matched referents with an uncomplicated childbirth at hospital (n = 297). Methods. Prospective inclusion of participants over a period of six months, using clinical and management-based criteria for near-miss. Multivariate logistic regression. Main outcome measures. Odds ratios (ORs) with 95% confidence intervals (CIs). Individual and joint effects of interacting variables. Results. Lack of ANC, lower education levels, and rural residence were interactively associated with near-miss upon arrival. Lack of ANC among women with limited education resulted in a four-fold greater risk for this condition. Such risk was considerably increased for women who lived in rural areas (OR 12.6; 95% CI 2.8–56.6). In addition, high maternal age and first time pregnancy were associated with near-miss upon arrival. Conclusions. This study identified subpopulations most likely to benefit from interventions designed to enable timely care-seeking for obstetric complications. ANC appears to facilitate utilization of emergency obstetric care, especially for women with socio-demographic disadvantages. Targeted initiatives to increase routine ANC may reduce severe maternal morbidity and mortality, both in urban and rural areas.
Acknowledgements
This study was supported by the Swedish International Development Agency/SAREC, the Faculty of Medicine at Lund University and Uppsala University, and the Research and Development Centre, Kronoberg County Council. The authors thank the directors and staff of those hospitals who participated in this project, and Carmen Cornejo at SEDES La Paz, Rose Mary Yupanqui at SERES El Alto, and Caroline de Hilari at Save the Children Bolivia for their assistance, Cecilia Jonsson, who participated in the data collection, and Anna Lindgren, who provided statistical support.
Disclosure of interest: The authors report no conflicts of interest. They alone are responsible for the content and writing of the paper.