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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2017; 39(11): 587-595
DOI: 10.1055/s-0037-1606246
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Prevalence of Maternal Morbidity and Its Association with Socioeconomic Factors: A Population-based Survey of a City in Northeastern Brazil

Prevalência da morbidade materna e sua associação com fatores socioeconômicos: estudo de base populacional em uma capital do nordeste brasileiro
Tatyana Souza Rosendo
1   Departament of Collective Health, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
,
Angelo Giuseppe Roncalli
2   Departament of Odontology, Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
,
George Dantas de Azevedo
3   Escola Multicampi de Ciências Médicas do Rio Grande do Norte, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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Publikationsverlauf

30. Januar 2017

21. Juni 2017

Publikationsdatum:
23. August 2017 (online)

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Abstract

Purpose To identify the prevalence of maternal morbidity and its socioeconomic, demographic and health care associated factors in a city in Northeastern Brazil.

Methods A cross-sectional and population-based study was conducted, with a design based on multi-stage complex sampling. A validated questionnaire was applied to 848 women aged between 15 and 49 years identified in 8,227 households from 60 census tracts of Natal, the capital of the state of Rio Grande do Norte (RN), Brazil. The main outcome measure was maternal morbidity. The Poisson regression analysis, with 5% significance, was used for the analysis of the associated factors.

Results The prevalence of maternal morbidity was of 21.2%. A bivariate analysis showed the following variables associated with an increased number of obstetric complications: non-white race (prevalence ratio [PR] =1.23; 95% confidence interval [95%CI]: 1.04–1.46); lower socioeconomic status (PR = 1.33; 95%CI: 1.12–1.58); prenatal care performed in public services (PR = 1.42; 95%CI: 1.16–1.72): women that were not advised during prenatal care about where they should deliver (PR = 1.24; 95%CI: 1.05–1.46); delivery in public services (PR = 1.63; 95%CI: 1.30–2.03); need to search for more than one hospital for delivery (PR = 1.22; 95%CI: 1.03–1.45); and no companion at all times of delivery care (PR = 1.25, 95%CI: 1.05–1.48). The place where the delivery occurred (public or private) and the socioeconomic status remained significant in the final model.

Conclusion Women in a worse socioeconomic situation and whose delivery was performed in public services had a higher prevalence of maternal morbidity. Such an association reinforces the need to strengthen public policies to tackle health inequalities through actions focusing on these determinants.

Resumo

Objetivo Identificar a prevalência da morbidade materna e os fatores socioeconômicos, demográficos e de assistência à saúde associados a ela em uma capital do Nordeste brasileiro.

Métodos Estudo seccional, de base populacional, com desenho de amostras complexas. Aplicou-se um questionário validado para morbidade materna em 848 mulheres com idade entre 15 e 49 anos selecionadas em 8.227 domicílios distribuídos em 60 setores censitários de Natal, capital do Rio Grande do Norte, Brasil. O desfecho principal foi a morbidade materna. A análise multivariada foi feita por meio da regressão de Poisson, com 5% de significância.

Resultados A prevalência de morbidade materna foi de 21,2%. A análise bivariada encontrou associação entre o maior número de complicações obstétricas com: mulheres da raça preta/parda (razão de prevalência [RP] = 1,23; intervalo de confiança de 95% [IC95%]: 1,04–1,46); pior condição socioeconômica (RP = 1,33; IC95%: 1,12–1,58); pré-natal na rede pública (RP = 1,42; IC95%: 1,16 -1,72); mulheres que não foram informadas sobre o lugar da realização do parto durante o pré-natal (RP = 1,24; IC95%: 1,05–1,46); mulheres que realizaram o parto na rede pública (RP = 1,63; IC95%: 1,30–2,03); pacientes que percorreram mais de um hospital para realizar o parto (RP = 1,22; IC95%: 1,03–1,45); e aquelas que não tiveram acompanhante em todos os momentos da assistência ao parto – antes, durante e depois do parto (RP = 1,25; IC95% = 1,05–1,48). No modelo final da regressão, tanto o local do parto quanto a condição socioeconômica mantiveram a associação.

Conclusões A maior prevalência da morbidade materna esteve associada às piores condições socioeconômicas e à realização do parto na rede pública. Isso reforça a necessidade de fortalecimento de políticas públicas que reduzam as desigualdades em saúde.

Keywords

maternal mortality - morbidity - pregnancy complications - health surveys - health care disparities

Palavras-chave

mortalidade materna - morbidade - complicações na gravidez - estudos em saúde - desigualdades em saúde

Funding

The present study was funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), under process number 477496/2011–3


 

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