Education and severe maternal outcomes in developing countries: a multicountry cross‐sectional survey

Abstract

Objective To assess the relationship between education and severe maternal outcomes among women delivering in healthcare facilities.Design Cross-sectional study.Setting Twenty-nine countries in Africa, Asia, Latin America, and the Middle East.Population Pregnant women admitted to 359 facilities during a period of 2-4 months of data collection between 2010 and 2011.Methods Data were obtained from hospital records. Stratification was based on the Human Development Index (HDI) values of the participating countries. Multivariable logistic regression analyses were conducted to assess the association between maternal morbidity and education, categorised in quartiles based on the years of formal education by country. Coverage of key interventions was assessed.Main outcome measures Severe maternal outcomes (near misses and death).Results A significant association between low education and severe maternal outcomes (adjusted odds ratio, aOR, 2.07; 95% confidence interval, 95% CI, 1.46-2.95), maternal near miss (aOR 1.80; 95% CI 1.25-2.57), and maternal death (aOR 5.62; 95% CI 3.45-9.16) was observed. This relationship persisted in countries with medium HDIs (aOR 2.36; 95% CI 1.33-4.17) and low HDIs (aOR 2.65; 95% CI 1.54-2.57). Less educated women also had increased odds of presenting to the hospital in a severe condition (i.e. with organ dysfunction on arrival or within 24 hours: aOR 2.06; 95% CI 1.36-3.10). The probability that a woman received magnesium sulphate for eclampsia or had a caesarean section significantly increased as education level increased (P < 0.05).Conclusions Women with lower levels of education are at greater risk for severe maternal outcomes, even after adjustment for key confounding factors. This is particularly true for women in countries that have poorer markers of social and economic development.

Can a simulation-based training program impact the use of evidence based routine practices at birth? Results of a hospital-based cluster randomized trial in Mexico

“…Some of these non-observable variables such as the mothers’ education or socio-economic level may influence health professionals’ provision of care. [32] However, since the intervention was randomized, we expect the distribution of these covariates to be balanced between intervention and control groups. Additionally any remaining time-invariant confounders that failed to be equally distributed between arms by means of the matching and the randomization, were likely controlled by the Difference-in-Differences approach, [27] leaving little room for bias.…”

Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

“…A lower educational level and lower HDI have been reported to be associated with maternal adverse outcome 16. Less educated women, for instance, have an increased risk of presenting to an emergency department in a severe condition 17. This may be related to several issues: women from emerging countries tend to have a later presentation to a medical centre, which is probably associated with limited knowledge and awareness of risks and lack of money, and also to factors like a less well-developed infrastructure, longer travel time and perhaps less availability of skilled medical staff.…”

Obstetric transition: the pathway towards ending preventable maternal deaths

“…In developed countries, the maternal mortality ratio (MMR) may be as low as 10 maternal deaths per 100 000 live births, compared to least developed countries where it may be as a high as 1000 maternal deaths or more per 100 000 live births . Wide disparities are also observed within countries and when the population is disaggregated by income or education quintiles . Thus, countries, regions within countries, and population groups within countries are often at different points on the path towards eliminating maternal mortality.…”