Abstract
This study analyzed the relationship between maternal mortality and variables related to the use of health services (especially residence–hospital traveled distances estimated through transit networks). Deaths were identified for Rio de Janeiro and adjacent cities, from 2000 to 2002, and were matched by age and socio-economic level to birth admissions without maternal deaths (1 case to 3 controls). The variables used were: type of hospital (general × specialized maternity services), number of hospital beds, nature of hospital ownership (public × private-associated), main admission diagnostic, residence–hospital distance, age, income, and education. Distances were estimated by a geographic information system, and were based on most probable itineraries through the urban transit networks. The probability of death was estimated by conditional logistic regression models. 226 maternal deaths were studied, and another 10 were excluded due to incompleteness of information. The ROC area for the final model was 0.89 [95 % CI (0.87–0.92)]. This model retained statistical significance for the variables admission diagnostic, type of hospital and residence–hospital distance. The death odds ratio for women who traveled 5–10 km (reference category: <5 km) was 3.84 [95 % CI (1.96–7.55)]. The traveled distance measured through transit networks was an important risk factor for death in the studied population.
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References
World Health Organization [WHO]. (2005). World Health Report 2005: Making every mother and child count. WHO. Available at: http://tinyurl.com/ojj8t6v. Accessed March 2013.
World Health Organization [WHO]. (2007). Maternal mortality in 2005. World Health Organization. Available at: http://tinyurl.com/3he3jsy. Accessed March 2013.
Ozumba, B. C., & Nwogu-Ikojo, E. E. (2008). Avoidable maternal mortality in Enugu, Nigeria. Public Health, 122(4), 354–360.
Rosero-Bixby, L. (2004). Spatial access to health care in Costa Rica and its equity: A GIS-based study. Social Science and Medicine, 58, 1271–1284.
Ravelli, A. C., Jager, K. J., de Groot, M. H., Erwich, J. J., Rijninks-van Driel, G. C., Tromp, M., et al. (2011). Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands. BJOG, 118(4), 457–465.
World Health Organization [WHO]. (1999). Women-friendly health services experiences in maternal care. World Health Organization, Available at: http://tinyurl.com/pvgk3y8. Accessed March 2013.
Costa, L. C., Nassi, C. D., Pinheiro, R. S., & Almeida, R. M. R. (2003). Accessibility of select hospitals and medical procedures by means of aerial and transit network-based measures. Health Services Management Research, 16, 136–140.
Costa, L. C., Almeida, R. M. R., & Pinheiro, R. S. (2007). Access by elderly patients with hip fractures to public hospitals. Public Health, 121, 525–528.
World Health Organization [WHO]. (2010). Trends in maternal mortality: 1990 to 2008: Estimates developed by WHO, UNICEF, UNFPA and The World Bank. World Health Organization. Available at: http://tinyurl.com/4mb9hdk. Accessed February 2013.
World Health Organization [WHO]. (2008). International statistical classification of diseases and related health problems-10th revision. World Health Organization. Available at: http://tinyurl.com/3wwsjj. Accessed August 2012.
DATASUS-Departamento de Informática do Sistema Único de Saúde do Brasil. (2009). Cadastro Nacional de Estabelecimentos de Saúde-CNES (in Portuguese). DATASUS. Available at: http://cnes.datasus.gov.br. Accessed February 2012.
Stekelenburg, J., Kyanamina, S., Mukelabai, M., Wolffers, I., & Van Roosmalen, J. (2004). Waiting too long: low use of maternal health services in Kalaboo, Zambia. Tropical Medicine & International Health, 9(3), 390–398.
Ramos, S., Karolinski, A., Romeroc, M., & Mercer, R. (2007). A comprehensive assessment of maternal deaths in Argentina: Translating multicentre collaborative research into action. Bulletin of the World Health Organization, 85, 615–622.
Hosmer, D., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York: Wiley.
Bittencourt, A. S., Camacho, L. A. B., & Leal, M. C. (2006). Hospital information systems and their application in public health (in Portuguese). Reports in Public Health/Cad Saúde Pública, 22(1), 19–30.
Simões, P. P., & Almeida, R. M. V. R. (2010). Geographic accessibility to obstetric care and maternal mortality in a large metropolitan area of Brazil. International Journal of Gynaecology and Obstetrics, 112(1), 25–29.
United Nations Development Program [UNDP]. (2011). Human Development Report. United Nations Development Program. Available at: http://tinyurl.com/pzptj2z. Accessed March 2013.
Valongueiro, A. S. (2007). Maternal mortality in Pernambuco, Brazil: What has changed in ten years? Reproductive Health Matters, 15(30), 134–144.
Gabrysch, S., & Campbell, O. M. R. (2009). Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy and Childbirth, 9(34), 1–18.
Gabrysch, S., Cousens, S., Cox, J., & Campbell, O. M. R. (2011). The Influence of distance and level of care on delivery place in rural Zambia: A study of linked national data in a geographic information system. Plos Medicine, 8(1), 1–12.
Rahlenbeck, S., & Hakizimana, C. (2002). Deliveries at a district hospital in Rwanda, 1997–2000. International Journal of Gynaecology and Obstetrics, 76, 325–328.
Macleod, J., & Rhode, R. (1998). Retrospective follow-up of maternal deaths and their associated risk factors in a rural district of Tanzania. Tropical Medicine & International Health, 3(2), 130–137.
Taguchi, N., Kawabata, M., Maekawa, M., Maruo, T., Aditiawarman, & Dewata, L. (2003). Influence of socio-economic background and antenatal care programmes on Maternal Mortality in Surabaya, Indonesia. Tropical Medicine & International Health, 8, 847–852.
Urassa, E., Lindmark, G., & Nystron, L. (1995). Maternal Mortality in Dar es Salaam, Tanzania. African Journal of Health Sciences, 2(1), 242–249.
Urassa, E., Massawe, S., Lindmark, G., & Nystron, L. (1997). Operational factors affecting maternal mortality in Tanzania. Health policy and planning, 12(1), 50–57.
Noor, A. M., Amin, A. A., Gething, P. W., Atkinson, P. M., & Hay, S. I. (2006). Modelling distances travelled to government health services in Kenya. Tropical Medicine & International Health, 11(2), 88–96.
Menezes, D. C. S., Leite, I. C., Schramm, J. M. A., & Leal, M. C. (2006). Evaluation of antenatal peregrination in a sample of postpartum women in Rio de Janeiro, Brazil, 1999/2001. Reports in Public Health/Cad Saúde Pública, 22(3), 553–559.
Ezugwu, E. C., Onah, H. E., Ezugwu, F. O., & Okafor, I. I. (2009). Maternal mortality in a transitional hospital in Enugu, Southeast Nigeria. African Journal of Reproductive Health, 13(4), 67–72.
Kale, P. L., & Costa, A. J. (2009). Maternal deaths in the city of Rio de Janeiro, Brazil, 2000–2003. Journal of Health, Population, and Nutrition, 27(6), 794–801.
Asamoah, B. O., Moussa, K. M., Stafström, M., & Musinguzi, G. (2011). Distribution of causes of maternal mortality among different socio-demographic groups in Ghana: A descriptive study. BMC Public Health, 11, 159.
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The authors declare no conflict of interests pertaining to the present manuscript.
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The present study was approved by an Internal Review Board (Ethics Committee) prior to its beginning (Universidade Federal Fluminense Medical School Ethics Committee).
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Simões, P.P., Almeida, R.M.V.R. Maternal Mortality and Accessibility to Health Services by Means of Transit-Network Estimated Traveled Distances. Matern Child Health J 18, 1506–1511 (2014). https://doi.org/10.1007/s10995-013-1391-x
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DOI: https://doi.org/10.1007/s10995-013-1391-x