Temporal trends of maternal near miss in Brazil between 2000 and 2012

Abstract

Objectives: to identify the temporal trends and regional variations in maternal near miss in Brazil. Methods: ecological study of temporal trends. The units of analysis are in the States, the regions and Brazil, between 2000 and 2012, the dependent variable being the maternal near miss rate (MNMR), calculated from the records of the Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) (National Health Hospital Information System).Regression analysis using Joinpoint regression software, version 4.1.0. was applied to analyze morbidity trends. Results: the main result of this study was a finding on an increase rate trend in maternal near miss in Brazil, between 2000 and 2012. This trend behaves differently depending on the development level of the region studied, presenting a positively higher increase in less developed regions and states. Conclusions: there is an increasing trend in maternal near miss rates in Brazil. The SIH-SUS may be an important instrument in identifying and monitoring maternal morbidity. Furthermore, investments in more effective public policies are needed to reduce inequalities and improve human development, both of which have influenced the chain of events related to maternal health.

Temporal Trend of Near Miss and its Regional Variations in Brazil from 2010 to 2018

“…12 When taking into account the average rates of SAMM in Brazil during the period between 2010 and 2018, there is a risk rate of 5.89 near-miss cases per every 100 deliveries, which is higher than those of other studies that also used the HIS/SUS database. [2][3][4][5][6][7][8][9][10][11][12][13] In the population-based study of Sousa et al in 2008, 14 they analyzed different Brazilian capitals and macroregions and found a rate of 44.3/1,000 live births.…”

“…16 In a broad sense, even with the improvement of the indicators of maternal and child health care verified in several studies, socioeconomic and health-care differences are still prevalent in the North and the Northeast, which might explain the possible negative association between the highest risk rates and the lowest indexes of obstetric care verified in these regions. [9][10][11][12][13][14][15][16][17][18][19][20] Moreover, the North region presented a relative risk of hemorrhage two times higher and a 33% higher risk of of infection than the region with the lowest rates. This context suggests challenges in the access of pregnant women to health care units and specialized treatment, and fits the Three Delays Model of Thaddeus and Maine, 21 in which patients delay the search for assistance due to sociocultural reasons, are not able to access obstetric care, and when they manage to do it, they have to wait for a long time to receive treatment.…”

“…In other studies, ICU admissions also showed a direct relationship with the number of maternal near miss cases, as well as an association with a worse prognosis. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24…”