Abstract
Purpose
To evaluate the association between ethnic differences and the occurrence of maternal near miss (MNM) in the Amazon and Northeast regions of Brazil.
Methods
This is a secondary analysis of a national cross-sectional study focused on the assessment of care to pregnancy, childbirth, and infants under 1 year of age. Ethnicity was classified as white, black or indigenous. Ethnic distribution by state and region, the proportion of severe maternal complications and related procedures, and the prevalence of MNM and its criteria were calculated for the ethnic groups. Risks for MNM were estimated per sociodemographic characteristics and healthcare received by ethnic group, using prevalence ratios adjusted by all predictors and by the sampling method.
Results
76% of the 16.783 women were black, 20% white and 3.5% indigenous. Around 36% reported any complication related to pregnancy and the most frequent were hemorrhage (27–31%), and infection (7.1–9.0%). The MNM ratio was higher among indigenous (53.1) and black (28.4) than in white women (25.7). For black women, the risks of MNM were lower for private prenatal care and hospital admission for conditions other than hypertension, while higher for cesarean section and peregrination. For indigenous, the risks of MNM were lower for private prenatal care, and higher for a longer time to reach the hospital. For white women, only the low number of prenatal visits increased the risk of MNM.
Conclusions
The occurrence of MNM was higher for indigenous and black than for white women.
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Acknowledgements
Our thanks to all people who participated in every phase of the study. The main study was financed by DECIT-MoH (the Department of Science and Technology from the Brazilian Ministry of Health). The current analysis was performed without any specific sponsorship.
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Protocol/project development: KGF, RTS, JGC. Data collection or management: MCL, ECM, LMS, JGC. Data analysis: ECM, KGF, JGC. Manuscript writing/editing: KGF, JGC, RTS. Commented, read and approved the final version: all the authors.
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Funding
The main study was financed by DECIT-MoH (the Department of Science and Technology from the Brazilian Ministry of Health—no Grant number). The current analysis was performed without any specific sponsorship.
Conflict of interest
The authors declare they have no conflict of interests at all.
Ethical approval
The Neonatal Call study was assessed and approved by the Research Ethics Committee of the Osvaldo Cruz Foundation (Rio de Janeiro, Brasil; FIOCRUZ, Letter of approval CEP/ENSP 56/10). Each woman signed an informed consent form after full explanation on the content of the study and before being enrolled. The study followed all ethical principles contained in the Declaration of Helsinki.
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Fernandes, K.G., Souza, R.T., Leal, M.C. et al. Ethnic differences in maternal near miss. Arch Gynecol Obstet 296, 1063–1070 (2017). https://doi.org/10.1007/s00404-017-4530-6
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DOI: https://doi.org/10.1007/s00404-017-4530-6