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

Mattias Roost, Victor Conde Altamirano, Jerker Liljestrand, Birgitta Essen

Research output: Contribution to journalArticlepeer-review

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.
Original languageEnglish
Pages (from-to)335-342
JournalActa Obstetricia et Gynecologica Scandinavica
Volume89
Issue number3
DOIs
Publication statusPublished - 2010

Subject classification (UKÄ)

  • Obstetrics, Gynecology and Reproductive Medicine

Free keywords

  • Near-miss morbidity
  • antenatal care
  • socio-demographic differentials

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