Description of Maternal Morbidities Amongst 1000 Women During Pregnancy in Ambanja, Madagascar – Opportunities and Challenges of Using an mHealth System

Figures & data

Table 1 First-Visit Sociodemographic Characteristics of Pregnant Women Followed in Ambanja District – Madagascar Between January 13, 2015, and August 16, 2018

Variables
Mean age in years (±SD, median) (n=1007)	24.6 (±6.7, 24)
Age in categories, n (%) (n=1007)  <20 years  20–24 years  25–29 years  ≥30 years	281 (27.9) 275 (27.3) 204 (20.3) 247 (24.5)
Marital status, n (%)  Married  Single  Living with a family member	835 (82.3) 147 (14.5) 33 (3.2)
Education, n (%)  Primary school  Secondary school  University  Unknown	558 (55.0) 291 (28.7) 89 (8.8) 77 (7.6)
Place of residency, n (%)  Rural  Urban	257 (25.3) 758 (74.7)
Literacy, n (%) (n=1010)  Literate  Illiterate	70 (6.9) 940 (93.1)
No water at home, n (%) (n=1014)	928 (91.5)
Professional categories, n (%)  Housewife  Working in the fields  Teacher  Student  Sales/business  Other or unknown	585 (57.6) 183 (18.0) 33 (3.3) 25 (2.5) 106 (10.4) 83 (8.2)
Substance abuse (OH, tobacco or drug), n (%) (n=1009)	24 (2.4)
Domestic violence, n (%) (n=1011)	62 (6.1)
Female genital mutilation reported, n (%) (n=1012)	2 (0.2)
Had tuberculosis, n (%)	12 (1.2)

Table 2 Obstetric Details of Pregnant Women from Their First Visit

Variables
Trimester of pregnancy at first visit, n (%)  1st trimester  2nd trimester  3rd trimester	122 (12.0) 585 (57.7) 307 (30.3)
Gestity, n (%)  1  2  ≥3	311 (30.6) 302 (29.8) 402 (39.6)
Parity, n (%)  0  1  2  ≥3	310 (30.7) 297 (29.4) 182 (18.0) 221 (21.9)
Mode of delivery of previous child, n (%)  Spontaneous  Caesarean	567 (91.5) 53 (8.5)
At least one miscarriage, n (%)	55 (5.4)

Table 3 Screening of Pregnant Women at Their First Visit

Variables
Syphilis status, n (%)  Positive  Negative  Indeterminate/Not done	25 (2.5) 709 (69.9) 281 (27.7)
HIV status, n (%) Positive Negative Indeterminate/Not done	12 (1.2) 881 (86.8) 122 (12.0)
Malaria status, n (%)  Positive  Negative  Indeterminate/Not done	22 (2.2) 756 (74.5) 237 (23.4)
Received treatment against worms, n (%) (n=1013)	350 (34.6)
Mean systolic blood pressure in mmHg (±SD, median) (n=999)	108.4 (±12.0, 107)
Mean diastolic blood pressure in mmHg (±SD, median) (n=998)	67.8 (±10.4, 67)
High blood pressure (defined by SBP≥140 and/or DBP≥90), n (%)	41 (4.0)
Severe high blood pressure (defined by SBP≥160 and/or DBP≥110), n (%)	4 (0.4)
Mean heart rate in BPM (±SD, median) (n=999)	92.5 (±12.6, 92)
Mean glucose in mg/dL (±SD, median) (n=786)	85.9 (±16.8, 85.0)
Presence of gestational diabetes (defined by fasting glucose≥126 mg/dL) (n=786)	17 (2.2)
Mean haemoglobin in g/dL (±SD, median) (n=849)	10.3 (±1.4, 10.3)
Anemia, n (%)(n=849)  <11 g/dL  Mild anemia (10–11 g/dL)  Moderate anemia (7-<10 g/dL)  Severe anemia <7 g/dL	581 (68.4) 269 (46.3) 305 (52.5) 7 (1.2)
Received treatment for anemia, n (%)  No  Yes  Unknown	626 (61.8) 381 (37.6) 6 (0.6)
Morbidity, n (%)  At least one comorbidity among anemia, HBP, syphilis, HIV, malaria or gestational diabetes (n=798)  At least two comorbidities (n=675)	632 (79.2) 293 (43.4)

Figure 1 Percentage of anemic women, showing mild, moderate and severe anemia with 95% CIs (n=849). A total of 68.4% of women were anemic (the majority presented with moderate anemia).

Table 4 Risk Factors for Anemia During Pregnancy (No Anemia versus Mild, Moderate or Severe Anemia) (Univariable Analyses and Multivariable Model)

Variables	Univariate Analyses (n=849)			Multivariate Analysis (n=833)
	Odds Ratio1	95% CI	>p-value	Odds Ratio1	95% CI	p-value
Age in years	0.99	0.97–1.02	0.545	-	-	-
Age in categories			0.539			0.585
<20 years	1.00	-	-	1.00	-	-
20–24 years	0.98	0.66–1.44	0.904	1.12	0.73–1.73	0.609
25–29 years	1.15	0.75–1.77	0.531	1.3	0.78–2.16	0.317
≥30 years	0.83	0.55–1.24	0.355	0.97	0.57–1.64	0.898
Marital status			0.02			0.049
Married	1.00	-	-	1.00	-	-
Single	1.68	1.08–2.60	0.02	1.68	1.05–2.70	0.032
Living with a family member	2.34	0.88–6.23	0.09	2.05	0.74–5.66	0.165
Education			0.812	-	-	-
University	1.00	-	-
Primary school	1.06	0.63–1.76	0.834
Secondary school	0.95	0.55–1.63	0.844
Place of residency, n (%)			0.468			0.677
Rural	1.00	-		1.00	-
Urban	0.88	0.63–1.24		1.08	0.74–1.59
Illiteracy	1.41	0.77–2.59	0.263	1.5	0.78–2.89	0.223
No water at home	0.86	0.51–1.44	0.561	0.78	0.45–1.35	0.368
Professional categories			0.696	-	-	-
Housewife	1.00	-	-
Working in the fields	0.92	0.62–1.37	0.673
Teacher	0.63	0.29–1.36	0.238
Student	0.78	0.33–1.80	0.553
Sales/business	1.03	0.62–1.71	0.901
Other or unknown	0.72	0.43–1.22	0.222
Female genital mutilation	0.46	0.03–7.32	0.579	-	-	-
Had tuberculosis	0.69	0.19–2.47	0.569	-	-	-
HIV status			0.408	-	-	-
Negative	1	-	-
Positive	0.46	0.11–1.87	0.281
Indeterminate/ND	1.19	0.75–1.88	0.451
Syphilis status			0.292			0.392
Negative	1.00	-	-	1.00	-	-
Positive	0.86	0.34–2.17	0.748	1.09	0.40–2.95	0.864
Indeterminate/ND	0.77	0.56–1.07	0.118	0.79	0.55–1.12	0.181
Malaria status			0.39			0.446
Negative	1.00	-	-	1.00	-	-
Positive	2.34	0.67–8.20	0.182	2.27	0.63–8.13	0.207
Indeterminate/ND	0.96	0.68–1.35	0.815	0.99	0.69–1.41	0.941
Comorbidity (other than anemia)	0.79	0.49–1.27	0.327	-	-	-
Treated against worms	1.05	0.76–1.47	0.76	-	-	-

Note: 1, All analyses were adjusted for the trimester of pregnancy.