Maternal Mortality in Colombia in 2011: A Two Level Ecological Study
Open Access
- 18 March 2015
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 10 (3), e0118944
- https://doi.org/10.1371/journal.pone.0118944
Abstract
Maternal mortality reduction is a Millennium Development Goal. In Colombia, there is a large disparity in the maternal mortality ratio (MMR) between and into departments (states) and also between municipalities. We examined socioeconomics variables at the municipal and departmental levels which could be associated to the municipal maternal mortality in Colombia. A multilevel ecology study was carried out using different national data sources in Colombia. The outcome variable was the MMR at municipal level in 2011 with multidimensional poverty at municipal and department level as the principal independent variables and other measures of the social and economic characteristics at municipal and departmental level were also considered explicative variables (overall fertility municipal rate, percentage of local rural population, health insurance coverage, per capita territorial participation allocated to the health sector, transparency index and Gini coefficient). The association between MMR and socioeconomic contextual conditions at municipal and departmental level was assessed using a multilevel Poisson regression model. The MMR in the Colombian municipalities was associated significantly with the multidimensional poverty (relative ratio of MMR: 3.52; CI 95%: 1.09-11.38). This association was stronger in municipalities from departments with the highest poverty (relative ratio of MMR: 7.14; CI 95%: 2.01-25.35). Additionally, the MMR at municipal level was marginally associated with municipally health insurance coverage (relative ratio of MMR: 0.99; CI 95%: 0.98-1.00), and significantly with transparency index at departmental level (relative ratio of MMR: 0.98; CI 95%: 0.97-0.99). Poverty and transparency in a contextual level were associated with the increase of the municipal MMR in Colombia. The results of this study are useful evidence for informing the public policies discussion and formulation processes with a differential approach.This publication has 19 references indexed in Scilit:
- Women's Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007PLOS ONE, 2012
- Progress in health-related millennium development goals in the WHO South-East Asia RegionIndian Journal of Public Health, 2012
- Health system determinants of infant, child and maternal mortality: A cross-sectional study of UN member countriesGlobalization and Health, 2011
- Beneficios de combinar métodos para analizar causas de muertes maternas, Bucaramanga, ColombiaRevista Panamericana de Salud Pública, 2011
- Healthy lifestyle behaviour among Ghanaian adults in the phase of a health policy changeGlobalization and Health, 2011
- Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5The Lancet, 2010
- Huge poor–rich inequalities in maternity care: an international comparative study of maternity and child care in developing countriesBulletin of the World Health Organization, 2007
- DOES MORE TRANSPARENCY GO ALONG WITH BETTER GOVERNANCE?Economics & Politics, 2006
- Specification Tests in EconometricsEconometrica, 1978
- A new look at the statistical model identificationIEEE Transactions on Automatic Control, 1974