Maternal Deaths in Mexico, 2010-2013: Disentangling the Effect of Individual and System Level Factors by a Multivariate Analysis of Health Information Systems Data

Session: Optimal Learning from Maternal Deaths and Near Misses: How Can We Facilitate Change?

Presentation: Hector Lamadrid-Figueroa, National Institute of Public Health
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Background: Analyses of the profile and factors associated to maternal deaths in Mexico has usually been mostly descriptive and more thorough multivariate approaches have been limited to particular settings. Being able to refine our knowledge on the profile and risk factors of maternal deaths will enable the devise of more effective interventions.

Methodology: We analyzed data on the 3,781 maternal deaths occurred in Mexico between 2010 and 2013 and registered in the Intentional Search and Reclassification of Maternal Deaths (BRIMM) dataset. The denominators for the calculation of Maternal Mortality Ratios were obtained from the System of Information on Births (SINAC). We estimated incidence rate ratios and 95% uncertainty intervals using Poisson regression models, including multiple adjustments for covariates. An additional analysis on the cause of death was performed using multinomial regression models.

Results: We found that the risk of death increases significantly during the night, showing peaks that coincide with shift changes, at 7 AM, 3 PM and 9 PM, as well as an additional peak at midnight. The risk of death in the Health Providing System for government workers (ISSSTE) was significantly larger than any other providers. The risk of death was significantly higher under 15 years of age after adjusting for parity. Hemorrhage was the main cause of death in the private sector as well as in deliveries tended by midwives, as opposed to hypertensive disorders and indirect deaths in the public sector.

Conclusions: Special attention should be given to institutional culture problems in health facilities, as there is evidence that suggests a lower quality of care at night and neglecting of patients in the time around shift changes. Interventions directed at ISSSTE health personnel and facilities should be a priority. Interventions on midwives capacity building and enabling environment, especially regarding identifying and even treating hemorrhage is crucial.