title: Does antenatal care facilitate utilization of emergency obstetric care? A case-referent study of near-miss morbidity in Bolivia.
abstract: OBJECTIVE
  To determine whether lack of routine antenatal care (ANC) is associated with near-miss morbidity upon arrival at hospital.
  
  
  METHODS
  Case-referent study.
  
  
  METHODS
  Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government subsidized program.
  
  
  METHODS
  Women with severe maternal morbidity upon arrival at hospital (n = 297). Facility-matched referents with an uncomplicated childbirth at hospital (n = 297).
  
  
  METHODS
  Prospective inclusion of participants over a period of six months, using clinical and management-based criteria for near-miss. Multivariate logistic regression.
  
  
  METHODS
  Odds ratios (ORs) with 95% confidence intervals (CIs). Individual and joint effects of interacting variables.
  
  
  RESULTS
  Lack of ANC, lower education levels, and rural residence were interactively associated with near-miss upon arrival. Lack of ANC among women with limited education resulted in a four-fold greater risk for this condition. Such risk was considerably increased for women who lived in rural areas (OR 12.6; 95% CI 2.8-56.6). In addition, high maternal age and first time pregnancy were associated with near-miss upon arrival.
  
  
  CONCLUSIONS
  This study identified subpopulations most likely to benefit from interventions designed to enable timely care-seeking for obstetric complications. ANC appears to facilitate utilization of emergency obstetric care, especially for women with socio-demographic disadvantages. Targeted initiatives to increase routine ANC may reduce severe maternal morbidity and mortality, both in urban and rural areas.
authors.affiliation: Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden. Mattias.Roost@kbh.uu.se
authors.forename: Mattias
authors.initials: M
authors.lastname: Rööst
authors.forename: Víctor Conde
authors.initials: VC
authors.lastname: Altamirano
authors.forename: Jerker
authors.initials: J
authors.lastname: Liljestrand
authors.forename: Birgitta
authors.initials: B
authors.lastname: Essén
mesh_terms: D000328:Adult; D001838:Bolivia / Q000453:epidemiology; D016022:Case-Control Studies; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric