Place-specific factors associated with adverse maternal and perinatal outcomes in Southern Mozambique: a retrospective cohort study

Prestige Tatenda Makanga, Charfudin Sacoor, Nadine Schuurman, Tang Lee, Faustino Carlos Vilanculo, Khatia Munguambe, Helena Boene, Ugochinyere Vivian Ukah, Marianne Vidler, Laura A Magee, Esperanca Sevene, Peter von Dadelszen, Tabassum Firoz, CLIP Working Group, Eusébio Macete, Anifa Vala, Felizarda Amose, Rosa Pires, Zefanias Nhamirre, Marta Macamo, Rogério Chiaú, Analisa Matavele, Ariel Nhancolo, Silvestre Cutana, Ernesto Mandlate, Salésio Macuacua, Cassimo Bique, Sibone Mocumbi, Emília Gonçálves, Sónia Maculuve, Ana Ilda Biz, Dulce Mulungo, Orvalho Augusto, Paulo Filimone, Vivalde Nobela, Corsino Tchavana, Cláudio Nkumbula, Jeffrey Bone, Dustin Dunsmuir, Sharla K Drebit, Chirag Kariya, Mai-Lei Woo Kinshella, Jing Li, Mansun Lui, Beth A Payne, Asif R Khowaja, Diane Sawchuck, Sumedha Sharma, Domena K Tu, Ugochi V Ukah, Prestige Tatenda Makanga, Charfudin Sacoor, Nadine Schuurman, Tang Lee, Faustino Carlos Vilanculo, Khatia Munguambe, Helena Boene, Ugochinyere Vivian Ukah, Marianne Vidler, Laura A Magee, Esperanca Sevene, Peter von Dadelszen, Tabassum Firoz, CLIP Working Group, Eusébio Macete, Anifa Vala, Felizarda Amose, Rosa Pires, Zefanias Nhamirre, Marta Macamo, Rogério Chiaú, Analisa Matavele, Ariel Nhancolo, Silvestre Cutana, Ernesto Mandlate, Salésio Macuacua, Cassimo Bique, Sibone Mocumbi, Emília Gonçálves, Sónia Maculuve, Ana Ilda Biz, Dulce Mulungo, Orvalho Augusto, Paulo Filimone, Vivalde Nobela, Corsino Tchavana, Cláudio Nkumbula, Jeffrey Bone, Dustin Dunsmuir, Sharla K Drebit, Chirag Kariya, Mai-Lei Woo Kinshella, Jing Li, Mansun Lui, Beth A Payne, Asif R Khowaja, Diane Sawchuck, Sumedha Sharma, Domena K Tu, Ugochi V Ukah

Abstract

Objectives: To identify and measure the place-specific determinants that are associated with adverse maternal and perinatal outcomes in the southern region of Mozambique.

Design: Retrospective cohort study. Choice of variables informed by literature and Delphi consensus.

Setting: Study conducted during the baseline phase of a community level intervention for pre-eclampsia that was led by community health workers.

Participants: A household census identified 50 493 households that were home to 80 483 women of reproductive age (age 12-49 years). Of these women, 14 617 had been pregnant in the 12 months prior to the census, of which 9172 (61.6%) had completed their pregnancies.

Primary and secondary outcome measures: A combined fetal, maternal and neonatal outcome was calculated for all women with completed pregnancies.

Results: A total of six variables were statistically significant (p≤0.05) in explaining the combined outcome. These included: geographic isolation, flood proneness, access to an improved latrine, average age of reproductive age woman, family support and fertility rates. The performance of the ordinary least squares model was an adjusted R2=0.69. Three of the variables (isolation, latrine score and family support) showed significant geographic variability in their effect on rates of adverse outcome. Accounting for this modest non-stationary effect through geographically weighted regression increased the adjusted R2 to 0.71.

Conclusions: The community exploration was successful in identifying context-specific determinants of maternal health. The results highlight the need for designing targeted interventions that address the place-specific social determinants of maternal health in the study area. The geographic process of identifying and measuring these determinants, therefore, has implications for multisectoral collaboration.

Trial registration number: NCT01911494.

Keywords: geostatistics; global health; health geography; maternal health; spatial epidemiology.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Design overview.
Figure 2
Figure 2
Geographic pattern for the rates of the combined adverse outcomes.
Figure 3
Figure 3
Geographic patterns in values for the model variables.
Figure 4
Figure 4
Age and fertility rates compared with adverse outcomes. The classic J shape graph for both.
Figure 5
Figure 5
Geographic variation of beta coefficients.

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