Does antenatal care facilitate utilization of emergency obstetric care? A case-referent study of near-miss morbidity in Bolivia
Source: Acta Obstetricia et Gynecologica Scandinavica, Volume 89, Number 3, March 2010 , pp. 335-342(8)
Publisher: Informa Healthcare
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.
Document Type: Research Article
Affiliations: 1: 1Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden 2: 2La Paz Hospital, La Paz, Bolivia 3: 3Faculty of Medicine, Lund University, Lund, Sweden
Publication date: 2010-03-01