Statistical methods for analysis of repeated measures on maternal morbidity

This paper applies statistical methods to identify factors associated with pregnancy-related complications in rural Bangladesh. The results are examined in order to identify the factors that can help formulate policy for reducing pregnancy-related morbidity.

Two statistical methods are used in this study to analyse the repeated-measures data on pregnancy-related complications in rural Bangladesh. One method is based on the application of linear logistic regression at each follow up, and the results are compared to identify the potential risk factors. Then the generalised estimating equation (GEE) approach is used, and the results based on each follow up are compared with those obtained from the application of the GEE approach. The maternal morbidity data collected by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies are used in this paper.

Economic status, visit for antenatal care, and histories of sexually transmitted disease, hypertension, heart disease and breathing problem are positively associated with the complications during pregnancy, while wanted pregnancy, household type, primary and secondary schooling, and five or more pregnancies are associated negatively with the response variable. Involvement with gainful employment shows a negative association by the first technique. The GEE approach failed to identify some important factors such as history of anaemia, previous pregnancy and gainful employment. However, duration of pregnancy appears to have an association with pregnancy complications, which was not found from the conditional model based on each follow up.

It appears that unwanted pregnancies need to be reduced through a well-organised and targeted family planning campaign for potential mothers of all ages in rural Bangladesh. Nutritional anaemia may cause various complications, and suggestions are given for reducing anaemia among pregnant women. In the rural areas of Bangladesh, first births usually occur at teenage. The first-birth pregnancy among teenagers can be a source of severe complications. There can be special programs to address the need for delay in the first pregnancy of those who marry at an early age.