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Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data

OBJECTIVE: To examine the risk factors for pregnancy-related death in India’s nine Empowered Action Group (EAG) states. DESIGN: Secondary data analysis of the Indian Annual Health Survey (2010–2013). SETTING: Nine states: Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Utta...

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Autores principales: Horwood, Geneviève, Opondo, Charles, Choudhury, Saswati Sanyal, Rani, Anjali, Nair, Manisha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440828/
https://www.ncbi.nlm.nih.gov/pubmed/32819952
http://dx.doi.org/10.1136/bmjopen-2020-038910
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author Horwood, Geneviève
Opondo, Charles
Choudhury, Saswati Sanyal
Rani, Anjali
Nair, Manisha
author_facet Horwood, Geneviève
Opondo, Charles
Choudhury, Saswati Sanyal
Rani, Anjali
Nair, Manisha
author_sort Horwood, Geneviève
collection PubMed
description OBJECTIVE: To examine the risk factors for pregnancy-related death in India’s nine Empowered Action Group (EAG) states. DESIGN: Secondary data analysis of the Indian Annual Health Survey (2010–2013). SETTING: Nine states: Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand. PARTICIPANTS: 1 989 396 pregnant women. METHODS: Maternal mortality ratio (MMR), overall and for each state, with 95% CI was calculated. Stepwise multivariable logistic regression was used to investigate the association of risk factors with maternal mortality. Area under the receiver-operating characteristic (AUROC) curve was used to assess the prediction of the model. OUTCOME MEASURES: MMR adjusted for survey design, adjusted OR (aOR)with 95% CI and C-statistic with 95% CI. RESULTS: MMR calculated for the nine states was 383/100 000 live births (95% CI 346 to 423 per 100 000). Age exhibited a U-shaped association with maternal mortality. Not having a health scheme and belonging to a scheduled caste or scheduled tribe group were significant risk factors for maternal death with aOR of 2.72 (95% CI 2.41 to 3.07), 1.10 (95% CI 1.02 to 1.18) and 1.43 (95% CI 1.31 to 1.56), respectively. Socioeconomic status and rural residence were not associated with maternal mortality after adjusting for access to a healthcare facility. Complications of pregnancy and medical comorbidities were the strongest risk factors for maternal death (aOR 50.2, 95% CI 44.5 to 56.6). Together, the risk factors identified accounted for 89% (95% CI 0.887 to 0.894) of the AUROC. CONCLUSIONS: Maternal mortality in India’s EAG states greatly exceeds the national average. The identified risk factors demonstrate the importance of improving the quality of pregnancy care. Notably, the study showed that the risk conferred by poor socioeconomic status could be mitigated by universal access to healthcare during pregnancy and childbirth.
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spelling pubmed-74408282020-08-28 Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data Horwood, Geneviève Opondo, Charles Choudhury, Saswati Sanyal Rani, Anjali Nair, Manisha BMJ Open Epidemiology OBJECTIVE: To examine the risk factors for pregnancy-related death in India’s nine Empowered Action Group (EAG) states. DESIGN: Secondary data analysis of the Indian Annual Health Survey (2010–2013). SETTING: Nine states: Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand. PARTICIPANTS: 1 989 396 pregnant women. METHODS: Maternal mortality ratio (MMR), overall and for each state, with 95% CI was calculated. Stepwise multivariable logistic regression was used to investigate the association of risk factors with maternal mortality. Area under the receiver-operating characteristic (AUROC) curve was used to assess the prediction of the model. OUTCOME MEASURES: MMR adjusted for survey design, adjusted OR (aOR)with 95% CI and C-statistic with 95% CI. RESULTS: MMR calculated for the nine states was 383/100 000 live births (95% CI 346 to 423 per 100 000). Age exhibited a U-shaped association with maternal mortality. Not having a health scheme and belonging to a scheduled caste or scheduled tribe group were significant risk factors for maternal death with aOR of 2.72 (95% CI 2.41 to 3.07), 1.10 (95% CI 1.02 to 1.18) and 1.43 (95% CI 1.31 to 1.56), respectively. Socioeconomic status and rural residence were not associated with maternal mortality after adjusting for access to a healthcare facility. Complications of pregnancy and medical comorbidities were the strongest risk factors for maternal death (aOR 50.2, 95% CI 44.5 to 56.6). Together, the risk factors identified accounted for 89% (95% CI 0.887 to 0.894) of the AUROC. CONCLUSIONS: Maternal mortality in India’s EAG states greatly exceeds the national average. The identified risk factors demonstrate the importance of improving the quality of pregnancy care. Notably, the study showed that the risk conferred by poor socioeconomic status could be mitigated by universal access to healthcare during pregnancy and childbirth. BMJ Publishing Group 2020-08-20 /pmc/articles/PMC7440828/ /pubmed/32819952 http://dx.doi.org/10.1136/bmjopen-2020-038910 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Epidemiology
Horwood, Geneviève
Opondo, Charles
Choudhury, Saswati Sanyal
Rani, Anjali
Nair, Manisha
Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data
title Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data
title_full Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data
title_fullStr Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data
title_full_unstemmed Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data
title_short Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data
title_sort risk factors for maternal mortality among 1.9 million women in nine empowered action group states in india: secondary analysis of annual health survey data
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440828/
https://www.ncbi.nlm.nih.gov/pubmed/32819952
http://dx.doi.org/10.1136/bmjopen-2020-038910
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