Background
Methods
Context of parent trial
Definitions of morbidity categories
Category | Obstetric complication | Near miss |
---|---|---|
Live Births or stillbirths - Complications during delivery
| ||
Postpartum hemorrhage
| Report of profuse bleeding OR Retained placenta | Report of nearly dying + Profuse bleeding |
Sensitivity: 63-84%, Specificity: 89-97% | ||
Eclampsia
| Convulsions (excluding epilepsy) and NO high fever | Report of nearly dying + Convulsions (excluding epilepsy) and NO high fever |
Sensitivity: 73-99%, Specificity: 86-99% | ||
Sepsis
| High fever + foul-smelling vaginal discharge OR high fever + lower abdominal pain | Report of nearly dying + High fever |
Sensitivity: 69-74%, Specificity: 95-98% | ||
Obstructed Labor
| (Report of baby stuck + use of saline drip with injection) OR (report of baby stuck + injection only) OR labor pains >24 hours | Report of nearly dying + (Report of baby stuck + use of saline drip with injection) OR (report of baby stuck + injection only) OR labor pains >24 hours |
Sensitivity: 56-70%, Specificity: 99-100% | ||
Induced abortions or miscarriages
| ||
Category
|
Obstetric complication
|
Near miss
|
Hemorrhage
| Report of vaginal bleeding (other than spotting) heavier than a normal period in 72 hours following pregnancy outcome | Report of nearly dying + Profuse bleeding |
Sepsis
| High fever + foul-smelling vaginal discharge OR high fever + lower abdominal pain in 7 days after pregnancy outcome | Report of nearly dying + High fever |
Definitions of independent variables
Data analysis
Results
Characteristics of study sample
Characteristics | Non-complicated pregnancy | Obstetric complication | Near miss | Total |
---|---|---|---|---|
n = 30,830 | n = 10,380 | n = 1,004 | n = 42,214 | |
% | % | % | % (n) | |
Biological factors
| ||||
Women’s age***
| ||||
<18 years | 13.3 | 19.5 | 15.3 | 15.2 (6,417) |
18-35 years | 80.9 | 70.5 | 80.3 | 78.6 (33,180) |
>35 years | 5.7 | 9.9 | 7.1 | 6.0 (2,592) |
Parity***
| ||||
Nulliparity | 24.6 | 34.2 | 34.4 | 27.2 (11,479) |
1-2 births | 49.8 | 36.7 | 36.8 | 46.3 (19,556) |
>2 births | 25.5 | 29.0 | 28.8 | 26.4 (11,172) |
Obstetric history***
| ||||
No previous stillbirth or miscarriage | 77.3 | 71.9 | 74.3 | 77.4 (36,197) |
Stillbirth or miscarriage | 22.7 | 28.0 | 25.6 | 22.5 (6,007) |
Mid-upper arm circumference*
| ||||
< 21.5 cm | 33.4 | 37.6 | 34.7 | 33.8 (14,226) |
≥ 21.5 cm | 66.4 | 62.3 | 65.2 | 65.8 (27,819) |
Socioeconomic factors
| ||||
Household wealth index
| ||||
Lowest quartile | 25.3 | 25.5 | 25.7 | 25.7 (10,836) |
2nd quartile | 25.6 | 25.5 | 24.8 | 25.3 (10,662) |
3rd quartile | 24.7 | 25.3 | 24.3 | 24.8 (10,473) |
Highest quartile | 24.3 | 23.5 | 25.2 | 24.1 (10,186) |
Women’s literacy*
| ||||
Illiterate | 45.2 | 39.8 | 44.5 | 43.2 (18,241) |
Literate | 54.7 | 60.0 | 55.5 | 56.7 (23,913) |
Psychosocial factors
| ||||
Couples’ pregnancy wantedness ranking***
| ||||
Both partners wanted pregnancy | 43.0 | 20.1 | 36.7 | 39.2 (16,616) |
Only one partner wanted pregnancy | 11.1 | 17.4 | 12.0 | 10.8 (4,512) |
Neither partner wanted pregnancy | 45.1 | 61.9 | 50.6 | 49.3 (20,805) |
Characteristics | % (n) |
---|---|
Place of delivery (among 27,241 women with live births or stillbirths)
| |
Home | 86% (23,427) |
Health facility | 14% (3,814) |
Skilled attendance at birth
a
(among 27,241 women with live births or stillbirths)
| |
Doctor, nurse, or family welfare visitor | 15% (4,086) |
Relatives, family, or neighbors only | 45% (12,389) |
Untrained TBA | 29% (7,900) |
Trained TBA | 17% (4,710) |
Antenatal care visits
b
(among 26,283 women with live births)
| |
At least one visit | 27% (7,096) |
No visits | 73% (19,187) |
Bivariate and multivariable analyses
Obstetric complications (n = 10,217) | Near misses (n = 993) | |||
---|---|---|---|---|
Independent variables | Relative risk ratio (RRR) | 95% confidence interval | Relative risk ratio (RRR) | 95% confidence interval |
Biological factors
| ||||
Age 18–35 years (ref)
| ||||
Age < 18 years | 1.28*** | (1.11, 1.47) | 1.21 | (0.97, 1.47) |
Age >35 years | 1.24*** | (1.10, 1.39) | 1.25 | (0.98, 1.53) |
Parity 1–2 (ref)
| ||||
Nulliparity | 1.36*** | (1.15, 1.58) | 1.29*** | (1.11, 1.46) |
Parity > 2 | 1.13 | (0.99, 1.27) | 1.16 | (0.98, 1.31) |
No previous stillbirth or miscarriage (ref)
| ||||
Adverse obstetric history | 1.17*** | (1.05, 1.30) | 1.15 | (0.97, 1.32) |
MUAC ≥ 21.5 cm (ref)
| ||||
MUAC < 21.5 cm | 1.14* | (1.02, 1.26) | 1.04 | (0.91, 1.17) |
Socioeconomic factors
| ||||
Wealth index – Lowest quartile (ref)
| ||||
Wealth index - 2nd quartile | 1.00 | (0.87, 1.13) | 0.99 | (0.89, 1.10) |
Wealth index - 3rd quartile | 1.03 | (0.90, 1.16) | 0.99 | (0.90, 1.09) |
Wealth index - Highest quartile | 0.99 | (0.89, 1.10) | 1.02 | (0.89, 1.14) |
Maternal illiteracy (ref)
| ||||
Maternal literacy | 1.08* | (1.01, 1.14) | 0.99 | (0.81, 1.17) |
Psychosocial factors
| ||||
Both partners wanted pregnancy (ref)
| ||||
Only one partner wanted pregnancy | 1.12** | (1.05, 1.20) | 1.05 | (0.88, 1.23) |
Neither partner wanted pregnancy | 1.41*** | (1.30, 1.52) | 1.07 | (0.89, 1.23) |
Obstetric complications (n = 10,217) | Near misses (n = 993) | |||
---|---|---|---|---|
Independent variables | Relative risk ratio (RRR) | 95% confidence interval | Relative risk ratio (RRR) | 95% confidence interval |
Biological factors
| ||||
Age 18–35 years (ref)
| ||||
Age <18 years | 1.26*** | (1.14, 1.39) | 1.16 | (0.98, 1.34) |
Age >35 years | 1.23*** | (1.09, 1.38) | 1.14 | (0.94, 1.35) |
Parity 1–2 (ref)
| ||||
Nulliparity | 1.16** | (1.02, 1.29) | 1.20** | (1.06, 1.34) |
Parity > 2 | 1.10 | (0.99, 1.22) | 1.11 | (0.96, 1.25) |
No previous stillbirth or miscarriage (ref)
| ||||
Adverse obstetric history | 1.15*** | (1.07, 1.22) | 1.13 | (0.98, 1.29) |
MUAC ≥ 21.5 cm (ref)
| ||||
MUAC < 21.5 cm | 1.07 | (0.99, 1.14) | 1.00 | (0.89, 1.11) |
Socioeconomic factors
| ||||
Wealth index – Lowest quartile (ref)
| ||||
Wealth index - 2nd quartile | 1.00 | (0.90, 1.11) | 1.00 | (0.91, 1.10) |
Wealth index - 3rd quartile | 1.01 | (0.89, 1.12) | 1.01 | (0.90, 1.13) |
Wealth index - Highest quartile | 1.00 | (0.92, 1.09) | 1.01 | (0.89, 1.12) |
Maternal illiteracy (ref)
| ||||
Maternal literacy | 1.01 | (0.92, 1.12) | 1.00 | (0.90, 1.11) |
Psychosocial factors
| ||||
Both partners wanted pregnancy (ref)
| ||||
Only one partner wanted pregnancy | 1.07 | (0.98, 1.16) | 1.01 | (0.87, 1.16) |
Neither partner wanted pregnancy | 1.33*** | (1.20, 1.46) | 1.03 | (0.87, 1.19) |
Sub-analyses
Reported obstetric complications or near misses | ||||
---|---|---|---|---|
Independent variables | Eclampsia | Hemorrhage | Sepsis | Obstructed labor |
(n = 324) | (n = 4,945) | (n = 3,120) | (n = 2,847) | |
Odds ratio | Odds ratio | Odds ratio | Odds ratio | |
Biological factors
| ||||
Age 18–35 years (ref)
| ||||
Age <18 years | 1.35*** | 1.20*** | 1.18*** | 1.27*** |
Age >35 years | 1.34*** | 1.27*** | 1.19* | 1.21*** |
Parity 1–2 (ref)
| ||||
Nulliparity | 1.13** | 1.10** | 1.14** | 1.30*** |
Parity >2 | 1.12 | 1.09 | 1.05 | 1.10 |
No previous stillbirth or miscarriage (ref)
| ||||
Adverse obstetric history | 1.18*** | 1.06** | 1.12** | 1.14*** |
MUAC ≥ 21.5 cm (ref)
| ||||
MUAC < 21.5 cm | 1.04 | 1.12* | 1.16* | 1.05 |
Socioeconomic factors
| ||||
Wealth index – Lowest quartile (ref)
| ||||
Wealth index - 2nd quartile | 1.00 | 1.01 | 1.02 | 1.00 |
Wealth index - 3rd quartile | 1.01 | 1.02 | 1.00 | 1.00 |
Wealth index - Highest quartile | 1.00 | 1.03 | 1.05 | 1.02 |
Maternal illiteracy (ref)
| ||||
Maternal literacy | 1.01 | 1.01 | 1.04 | 1.03 |
Psychosocial factors
| ||||
Both partners wanted pregnancy (ref)
| ||||
Only one partner wanted pregnancy | 1.02 | 1.06 | 1.08 | 1.07 |
Neither partner wanted pregnancy | 1.02 | 1.40*** | 1.37*** | 1.28*** |
Independent variables | Live births (n = 25,687) |
---|---|
Biological factors
| |
Age 18–35 years (ref)
| |
Age <18 years | 1.16*** |
Age >35 years | 1.20*** |
Parity 1–2 (ref)
| |
Nulliparity | 1.19*** |
Parity > 2 | 1.12 |
No previous stillbirth or miscarriage (ref)
| |
Adverse obstetric history | 1.14*** |
MUAC ≥ 21.5 cm (ref)
| |
MUAC < 21.5 cm | 1.08 |
Socioeconomic factors
| |
Wealth index – Lowest quartile (ref)
| |
Wealth index - 2nd quartile | 1.00 |
Wealth index - 3rd quartile | 1.01 |
Wealth index - Highest quartile | 1.00 |
Maternal illiteracy (ref)
| |
Maternal literacy | 1.04 |
Psychosocial factors
| |
Both partners wanted pregnancy (ref)
| |
Only one partner wanted pregnancy | 1.00 |
Neither partner wanted pregnancy | 1.16*** |
Care during pregnancy
| |
Did not attend any antenatal visits (ref)
| |
Attended at least one antenatal visit | 0.88** |
Independent variables | Live births or stillbirths (n = 26,903) |
---|---|
Biological factors
| |
Age 18–35 years (ref)
| |
Age <18 years | 1.19*** |
Age >35 years | 1.25*** |
Parity 1–2 (ref)
| |
Nulliparity | 1.12** |
Parity > 2 | 1.10 |
No previous stillbirth or miscarriage (ref)
| |
Adverse obstetric history | 1.17*** |
MUAC ≥ 21.5 cm (ref)
| |
MUAC < 21.5 cm | 1.05 |
Socioeconomic factors
| |
Wealth index – Lowest quartile (ref)
| |
Wealth index - 2nd quartile | 1.02 |
Wealth index - 3rd quartile | 0.99 |
Wealth index - Highest quartile | 1.00 |
Maternal illiteracy (ref)
| |
Maternal literacy | 1.06 |
Psychosocial factors
| |
Both partners wanted pregnancy (ref)
| |
Only one partner wanted pregnancy | 1.03 |
Neither partner wanted pregnancy | 1.19*** |
Place of delivery
| |
Home (ref)
| |
Health facility | 0.90* |