title: Maternal near miss among women using the public health system in the Amazon and Northeast regions of Brazil.
abstract: OBJECTIVE
  To assess the prevalence of pregnancy complications identified as maternal near miss (MNM) and associated factors among women using the public health care system in the Amazon and Northeast regions of Brazil.
  
  
  METHODS
  A secondary analysis of a population-based survey conducted in 2010 was performed focusing on women self-reporting maternal complications. The main outcome was MNM, pragmatically defined as intensive care unit admission, eclampsia, hysterectomy, or blood transfusion. In addition, the risk of MNM was estimated for certain sociodemographics and characteristics of care received. Poisson regression was performed, generating adjusted prevalence ratios (PRadj) with 95% confidence intervals (95%CI).
  
  
  RESULTS
  A total of 13 044 women (77%) who had given birth during the prior year using the public health system were interviewed. At least one complication was reported by 37.5%, with hemorrhage (28.4%) and infection (8.3%) being the most frequent. The overall MNM ratio was 31.5 per 1 000 live births, higher for the Amazon region than for the Northeast. Factors with a higher risk for developing MNM were: indigenous ethnicity (PRadj 2.77; 95% CI: 1.50-5.14), more than one hour to reach the hospital (PRadj 1.55; 95%CI: 1.06-2.25), being refused by a full hospital and having to find another one (PRadj 1.49; 95%CI: 1.03-2.16), cesarean section (PRadj 2.56; 95%CI: 1.90-3.44), and public prenatal care (PRadj 1.95; 95%CI: 1.06-3.61).
  
  
  CONCLUSIONS
  Users of public health system in the Amazon and Northeast regions of Brazil have high MNM rates. Some characteristics of the women and of the care they received represent inequalities associated with higher risk for MNM. Specific actions are required to improve maternal health programs in these expansive areas of the country.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, São Paulo, Brazil, cecatti@unicamp.br.
authors.forename: José G
authors.initials: JG
authors.lastname: Cecatti
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, São Paulo, Brazil, cecatti@unicamp.br.
authors.forename: Renato T
authors.initials: RT
authors.lastname: Souza
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, São Paulo, Brazil, cecatti@unicamp.br.
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Pacagnella
authors.affiliation: National School of Public Health, Osvaldo Cruz Foundation, Rio de Janeiro, Brazil.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Leal
authors.affiliation: National School of Public Health, Osvaldo Cruz Foundation, Rio de Janeiro, Brazil.
authors.forename: Erly C
authors.initials: EC
authors.lastname: Moura
authors.affiliation: Department of Public Health, School of Health Sciences, University of Brasília, Brasília, Brazil.
authors.forename: Leonor M P
authors.initials: LM
authors.lastname: Santos
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001938:Brazil; D003430:Cross-Sectional Studies; D004461:Eclampsia / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006470:Hemorrhage / Q000453:epidemiology; D006779:Hospitals, Public; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008427:Maternal Health Services; D008507:Medically Underserved Area; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D011295:Prenatal Care; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012306:Risk; D055815:Young Adult