Maternal Mortality and Accessibility to Health Services by Means of Transit-Network Estimated Traveled Distances
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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.
KeywordsMaternal mortality Accessibility Traveled distances Logistic regression
Conflict of interest
The authors declare no conflict of interests pertaining to the present manuscript.
The present study was approved by an Internal Review Board (Ethics Committee) prior to its beginning (Universidade Federal Fluminense Medical School Ethics Committee).
- 1.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.
- 2.World Health Organization [WHO]. (2007). Maternal mortality in 2005. World Health Organization. Available at: http://tinyurl.com/3he3jsy. Accessed March 2013.
- 6.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.
- 9.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.
- 10.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.
- 11.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.
- 15.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.Google Scholar
- 17.United Nations Development Program [UNDP]. (2011). Human Development Report. United Nations Development Program. Available at: http://tinyurl.com/pzptj2z. Accessed March 2013.
- 19.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.Google Scholar
- 27.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.Google Scholar