Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Midlands, Zimbabwe.
Department of Geography, Simon Fraser University, Vancouver, British Columbia, Canada.
BMJ Open. 2019 Feb 19;9(2):e024042. doi: 10.1136/bmjopen-2018-024042.
To identify and measure the place-specific determinants that are associated with adverse maternal and perinatal outcomes in the southern region of Mozambique.
Retrospective cohort study. Choice of variables informed by literature and Delphi consensus.
Study conducted during the baseline phase of a community level intervention for pre-eclampsia that was led by community health workers.
A household census identified 50 493 households that were home to 80 483 women of reproductive age (age 12-49 years). Of these women, 14 617 had been pregnant in the 12 months prior to the census, of which 9172 (61.6%) had completed their pregnancies.
A combined fetal, maternal and neonatal outcome was calculated for all women with completed pregnancies.
A total of six variables were statistically significant (p≤0.05) in explaining the combined outcome. These included: geographic isolation, flood proneness, access to an improved latrine, average age of reproductive age woman, family support and fertility rates. The performance of the ordinary least squares model was an adjusted R=0.69. Three of the variables (isolation, latrine score and family support) showed significant geographic variability in their effect on rates of adverse outcome. Accounting for this modest non-stationary effect through geographically weighted regression increased the adjusted R to 0.71.
The community exploration was successful in identifying context-specific determinants of maternal health. The results highlight the need for designing targeted interventions that address the place-specific social determinants of maternal health in the study area. The geographic process of identifying and measuring these determinants, therefore, has implications for multisectoral collaboration.
NCT01911494.
确定并衡量莫桑比克南部地区与不良母婴和围产儿结局相关的特定地点决定因素。
回顾性队列研究。变量的选择依据文献和德尔菲共识。
在由社区卫生工作者领导的子痫前期社区层面干预的基线阶段进行的研究。
家庭普查确定了 50493 户家庭，这些家庭共居住着 80483 名育龄妇女（12-49 岁）。在这些妇女中，有 14617 人在普查前 12 个月怀孕，其中 9172 人（61.6%）完成了妊娠。
对所有完成妊娠的妇女计算了综合胎儿、产妇和新生儿结局。
共有 6 个变量在解释综合结局方面具有统计学意义（p≤0.05）。这些变量包括：地理隔离、易受洪水影响、可使用改良厕所、育龄妇女平均年龄、家庭支持和生育率。普通最小二乘模型的性能为调整 R=0.69。其中 3 个变量（隔离、厕所评分和家庭支持）对不良结局发生率的影响具有显著的地理变异性。通过地理加权回归来解释这种适度的非平稳效应，将调整 R 提高到 0.71。
社区探索成功地确定了与产妇健康相关的特定地点决定因素。结果强调了需要设计针对该研究区域产妇健康特定地点社会决定因素的有针对性的干预措施。因此，确定和衡量这些决定因素的地理过程对多部门合作具有影响。
NCT01911494。
Zotero 插件
