Determinants of antenatal morbidity: a multivariate analysis

The aim of this paper was to investigate the potential risk factors for developing complications and their magnitude during the antenatal period.

The data used in this paper came from a prospective survey in rural areas of Bangladesh conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT) between November 1992 and December 1993. The differential patterns were analyzed for respondents' selected characteristics, and multivariate analysis was performed employing logistic regression and proportional hazards models for life-threatening and high-risk complications during pregnancy.

For life-threatening complications during pregnancy, several factors emerged as potential risk factors, such as number of the pregnancy, age at marriage, duration of pregnancy, economic status and history of anemia prior to the index pregnancy. The last two covariates were associated only in the proportional hazards. Potential risk factors for high-risk complications during pregnancy were level of education, age at marriage, wanted pregnancy, duration of pregnancy and economic status.

Health planners and policy makers in developing countries are trying to facilitate health services at the doorsteps of rural people. Our findings will help them understand the magnitude and underlying determinants of maternal morbidities and help their health planning process to reduce both life-threatening and high-risk complications during the antenatal period. Early age at marriage needs to be prevented through encouragement of girls' education as well as through increased social awareness programs. An effective quick referral mechanism should be developed to provide emergency services to high risk-groups. Finally, the importance of additional food supplements needs to be promoted during antenatal care visits as well as through mass media in order to reach people living in remote areas of rural Bangladesh.