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Does antenatal care facilitate utilization of emergency obstetric care? A case-referent study of near-miss morbidity in Bolivia

Roost, Mattias; Altamirano, Victor Conde; Liljestrand, Jerker LU and Essen, Birgitta (2010) In Acta Obstetricia et Gynecologica Scandinavica 89(3). p.335-342
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... (More)
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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Near-miss morbidity, antenatal care, socio-demographic differentials
in
Acta Obstetricia et Gynecologica Scandinavica
volume
89
issue
3
pages
335 - 342
publisher
Wiley-Blackwell
external identifiers
  • wos:000275154100008
  • scopus:77749274260
ISSN
1600-0412
DOI
10.3109/00016340903511050
language
English
LU publication?
yes
id
0f0bd075-9bca-4f13-ba04-88795f2bb8c8 (old id 1589849)
date added to LUP
2010-04-19 14:38:09
date last changed
2018-05-29 11:05:36
@article{0f0bd075-9bca-4f13-ba04-88795f2bb8c8,
  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.},
  author       = {Roost, Mattias and Altamirano, Victor Conde and Liljestrand, Jerker and Essen, Birgitta},
  issn         = {1600-0412},
  keyword      = {Near-miss morbidity,antenatal care,socio-demographic differentials},
  language     = {eng},
  number       = {3},
  pages        = {335--342},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Obstetricia et Gynecologica Scandinavica},
  title        = {Does antenatal care facilitate utilization of emergency obstetric care? A case-referent study of near-miss morbidity in Bolivia},
  url          = {http://dx.doi.org/10.3109/00016340903511050},
  volume       = {89},
  year         = {2010},
}