National Institutes of Science and Technology Programme, Ministry of Science and Technology, and Council for Scientific and Technological Development Programme (CNPq), Brazil.
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.
This study examined the capacity of waist circumference (WC) to identify subjects with overweight (BMI ³ 25) and obesity (BMI ³ 30), in agreement with internationally recommended levels of action. Data were obtained from 791 women, 15-59 years old. After identifying overweight and obesity according to WC values, sensitivity and specificity were calculated to verify whether WC could be a good risk predictor for hypertension. Associations were tested by linear regression and logistic regression, controlling for confounding. WC cut-off points of 80cm and 88cm correctly identified 89.8% and 88.5% of women with overweight and obesity, respectively. Abdominal obesity (WC ³ 88cm) was statistically associated with hypertension in the multivariate analysis (OR = 2.88; 95% CI: 1.77-4.67). Hypertension was identified with a sensitivity of 63.8% and 42.8%, and with a specificity of 68.0% and 83.3%, for WC ³ 80 and ³ 88, respectively. The proposed cut-off points for abdominal obesity can potentially distinguish individuals at risk for future obesity, but has only moderate power to predict individuals with high blood pressure.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.