Maternal Mortality in Colombia in 2011: A Two Level Ecological Study

Abstract

OBJECTIVE: Maternal mortality reduction is a Millennium Development Goal. In Colombia, there is a large disparity in the maternal mortality ratio (MMR) between into departments (states) also between municipalities. We examined socioeconomics variables at the municipal departmental levels which could be associated to the municipal maternal mortality in Colombia. METHODS: A multilevel ecology study was carried out using different national data sources in Colombia. The outcome variable was the MMR at municipal level in 2011 with multidimensional poverty at municipal department level as the principal independent variables other measures of the social economic characteristics at municipal departmental level were also considered explicative variables (overall fertility municipal rate, percentage of local rural population, health insurance coverage, per capita territorial participation allocated to the health sector, transparency index Gini coefficient). The association between MMR socioeconomic contextual conditions at municipal departmental level was assessed using a multilevel Poisson regression model. RESULTS: The MMR in the Colombian municipalities was associated significantly with the multidimensional poverty (relative ratio of MMR: 3.52; CI 95%: 1.09 11.38). This association was stronger in municipalities from departments with the highest poverty (relative ratio of MMR: 7.14; CI 95%: 2.01 25.35). Additionally, the MMR at municipal level was marginally associated with municipally health insurance coverage (relative ratio of MMR: 0.99; CI 95%: 0.98 1.00), significantly with transparency index at departmental level (relative ratio of MMR: 0.98; CI 95%: 0.97 0.99). CONCLUSION: Poverty transparency in a contextual level were associated with the increase of the municipal MMR in Colombia. The results of this study are useful evidence for informing the public policies discussion formulation processes with a differential approach.