ArticlePloS one2014
The effect of health-facility admission and skilled birth attendant coverage on maternal survival in India: a case-control analysis.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 34 citations in OpenAlex.
- Time to death and its predictors among women with uterine rupture admitted to jimma town public hospitals, South West Ethiopia: retrospective cohort study.BMC pregnancy and childbirth · 2025Article
- Trends in the utilisation of skilled birth attendance among pregnant women in Benin, from 2001 to 2017-2018, and projections to 2030.BMC public health · 2023Article
- Article
- Measurement and mapping of maternal health service coverage through a novel composite index: a sub-national level analysis in India.BMC pregnancy and childbirth · 2022Article
- Rural-Urban Determinants of Receiving Skilled Birth Attendants among Women in Bangladesh: Evidence from National Survey 2017-18.International journal of clinical practice · 2022Article
- Measuring facility readiness to provide childbirth care: a comparison of indices using data from a health facility survey in Ethiopia.BMJ global health · 2021Article
- Optimal Profile Limits for Maternal Mortality Rates (MMR) Influenced by Haemorrhage and Unsafe Abortion in South Sudan.Journal of pregnancy · 2020Article
- Status of water, sanitation and hygiene services for childbirth and newborn care in eight countries in East Asia and the Pacific.Journal of global health · 2019Article
- Does facility birth reduce maternal and perinatal mortality in Brong Ahafo, Ghana? A secondary analysis using data on 119 244 pregnancies from two cluster-randomised controlled trials.The Lancet. Global health · 2019Article
- Optimal profile limits for maternal mortality rate (MMR) in South Sudan.BMC pregnancy and childbirth · 2018Article
- Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study.Journal of global health · 2018Article
- Evaluation of Communities of Practice performance developing implementation research to enhance maternal health decision-making in Mexico and Nicaragua.Implementation science : IS · 2018Article
- Regional inequity in complete antenatal services and public emergency obstetric care is associated with greater burden of maternal deaths: analysis from consecutive district level facility survey of Karnataka, India.International journal for equity in health · 2017Article
- Inequalities in the coverage of place of delivery and skilled birth attendance: analyses of cross-sectional surveys in 80 low and middle-income countries.Reproductive health · 2016Article
- Learning before leaping: integration of an adaptive study design process prior to initiation of BetterBirth, a large-scale randomized controlled trial in Uttar Pradesh, India.Implementation science : IS · 2015Article
- Facility Delivery, Postnatal Care and Neonatal Deaths in India: Nationally-Representative Case-Control Studies.PloS one · 2015Article
- Assessing Community Based Improved Maternal Neonatal Child Survival (IMNCS) Program in Rural Bangladesh.PloS one · 2015Article
- Effective strategies for reducing maternal mortality in Isfahan University of Medical Sciences, 2014.Iranian journal of nursing and midwifery researchArticle
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundResearch in areas of low skilled attendant coverage found that maternal mortality is paradoxically higher in women who seek obstetric care. We estimated the effect of health-facility admission on maternal survival, and how this effect varies with skilled attendant coverage across India. METHODS/
findingsUsing unmatched population-based case-control analysis of national datasets, we compared the effect of health-facility admission at any time (antenatal, intrapartum, postpartum) on maternal deaths (cases) to women reporting pregnancies (controls). Probability of maternal death decreased with increasing skilled attendant coverage, among both women who were and were not admitted to a health-facility, however, the risk of death among women who were admitted was higher (at 50% coverage, OR = 2.32, 95% confidence interval 1.85-2.92) than among those women who were not; while at higher levels of coverage, the effect of health-facility admission was attenuated. In a secondary analysis, the probability of maternal death decreased with increasing coverage among both women admitted for delivery or delivered at home but there was no effect of admission for delivery on mortality risk (50% coverage, OR = 1.0, 0.80-1.25), suggesting that poor quality of obstetric care may have attenuated the benefits of facility-based care. Subpopulation analysis of obstetric hemorrhage cases and report of 'excessive bleeding' in controls showed that the probability of maternal death decreased with increasing skilled attendant coverage; but the effect of health-facility admission was attenuated (at 50% coverage, OR = 1.47, 0.95-1.79), suggesting that some of the effect in the main model can be explained by women arriving at facility with complications underway. Finally, highest risk associated with health-facility admission was clustered in women with education ≤ 8 years.
conclusionsThe effect of health-facility admission did vary by skilled attendant coverage, and this effect appears to be driven partially by reverse causality; however, inequitable access to and possibly poor quality of healthcare for primary and emergency services appears to play a role in maternal survival as well.
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