Quality of Antenatal Care and Maternal Mortality in Madagascar: Analysis of Regional Disparities and Non-Linear Modeling.

Journal of Family and Reproductive Health Pub Date : 2025-09-01 DOI:10.18502/jfrh.v19i3.20055

Hery Sylvestre Bemanana, Andriatompoina Felanarivo Razafaindraibe, Sambatra Rafamantanantsoa

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引用次数: 0

Abstract

Objective: Maternal mortality remains a major public health challenge in Madagascar, with notable regional disparities. Antenatal care (ANC) plays a critical role in preventing maternal deaths, yet its coverage and quality vary significantly across regions. This study aims to assess the association between ANC quality and maternal mortality rate (MMR), focusing on regional disparities and exploring potential non-linear relationships.

Materials and methods: We conducted a retrospective ecological study using publicly available data from Madagascar's 22 regions. ANC indicators included blood pressure monitoring, blood and urine tests, iron supplementation, and antiparasitic treatment. Linear regression and Generalised Additive Models (GAM) were used to examine associations and non-linear patterns. Statistical analyses were performed using R version 4.2.2, with a significance threshold of 5%.

Results: Considerable disparities were observed in ANC coverage across regions. Linear models revealed no significant association between ANC indicators and MMR (p > 0.05). However, GAM identified significant non-linear relationships for blood pressure monitoring (p < 0.0045) and blood testing (p < 0.0055), suggesting potential threshold effects.

Conclusion: Addressing maternal mortality in Madagascar requires enhancing both access to and the quality of ANC. Accounting for regional disparities and non-linear trends is essential in developing effective public health interventions.

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马达加斯加产前保健质量和孕产妇死亡率：区域差异分析和非线性建模。

目标：产妇死亡率仍然是马达加斯加面临的一项重大公共卫生挑战，区域差异显著。产前保健在预防孕产妇死亡方面发挥着关键作用，但其覆盖范围和质量在各区域差别很大。本研究旨在评估ANC质量与孕产妇死亡率（MMR）之间的关系，重点关注地区差异并探索潜在的非线性关系。材料和方法：我们利用马达加斯加22个地区的公开数据进行了回顾性生态学研究。ANC指标包括血压监测、血液和尿液检查、补铁和抗寄生虫治疗。使用线性回归和广义加性模型（GAM）来检查关联和非线性模式。采用R 4.2.2版本进行统计分析，显著性阈值为5%。结果：不同地区的ANC覆盖率存在相当大的差异。线性模型显示ANC指标与MMR之间无显著相关性（p < 0.05）。然而，GAM发现血压监测（p < 0.0045）和血液检测（p < 0.0055）之间存在显著的非线性关系，表明存在潜在的阈值效应。结论：解决马达加斯加的孕产妇死亡率问题需要提高ANC的获得和质量。考虑区域差异和非线性趋势对于制定有效的公共卫生干预措施至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Family and Reproductive Health

自引率

0.00%

发文量

审稿时长

5 weeks

期刊介绍： The Journal of Family & Reproductive Health (JFRH) is the quarterly official journal of Vali–e–Asr Reproductive Health Research Center. This journal features fulllength, peerreviewed papers reporting original research, clinical case histories, review articles, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology including genetics, endocrinology, andrology, embryology, gynecologic urology, fetomaternal medicine, oncology, infectious disease, public health, nutrition, surgery, menopause, family planning, infertility, psychiatry–psychology, demographic modeling, perinatalogy–neonatolgy ethics and social issues, and pharmacotherapy. A high scientific and editorial standard is maintained throughout the journal along with a regular rate of publication. All published articles will become the property of the JFRH. The editor and publisher accept no responsibility for the statements expressed by the authors here in. Also they do not guarantee, warrant or endorse any product or service advertised in the journal.