Ann L. Montgomery|Shaza A Fadel|Rajesh Kumar|Susan J. Bondy|Rahim Moineddin|Prabhat Jha
The Effect of Health-Facility Admission and Skilled Birth Attendant Coverage on Maternal Survival in India: A Case-Control Analysis
St. Michael's Hospital|Centre for Global Health Research|St. Michael's Hospital|Centre for Global Health Research|Post Graduate Institute of Medical Education and Research|Public Health Ontario|University of Toronto|Institute for Clinical Evaluative Sciences|University of Toronto|Public Health Ontario|University of Toronto|St. Michael's Hospital|Centre for Global Health Research
research areas low skilled attendant coverage found maternal mortality paradoxically higher women seek obstetric care estimated effect healthfacility admission maternal survival effect varies skilled attendant coverage across indiausing unmatched populationbased casecontrol analysis national datasets compared effect healthfacility admission time antenatal intrapartum postpartum maternal deaths cases women reporting pregnancies controls probability maternal death decreased increasing skilled attendant coverage among women admitted healthfacility however risk death among women admitted higher 50 coverage 232 95 confidence interval 185292 among women higher levels coverage effect healthfacility admission attenuated secondary analysis probability maternal death decreased increasing coverage among women admitted delivery delivered home effect admission delivery mortality risk 50 coverage 10 080125 suggesting poor quality obstetric care may attenuated benefits facilitybased care subpopulation analysis obstetric hemorrhage cases report excessive bleeding controls showed probability maternal death decreased increasing skilled attendant coverage effect healthfacility admission attenuated 50 coverage 147 095179 suggesting effect main model explained women arriving facility complications underway finally highest risk associated healthfacility admission clustered women education 8 yearsthe effect healthfacility admission vary skilled attendant coverage effect appears driven partially reverse causality however inequitable access possibly poor quality healthcare primary emergency services appears play role maternal survival well