Factors associated with inter-district variation of maternal mortality in Assam

Abstract

Background: Maternal mortality is an important indicator of the health and socioeconomic status of a nation. Assam has the highest maternal mortality ratio (MMR) in the country. Although maternal death is a biomedical event, the contributory factors are many. Objectives: The objectives of the study were to assess the role of demographic, socioeconomic, nutritional, health service availability, and utilization indicators in inter-district variation of maternal mortality in Assam. Materials and Methods: We conducted an analysis of maternal mortality using district-level secondary data of 27 districts of Assam. The dependent variable was the MMR, while independent variables were demographic, socioeconomic, nutritional, health service availability, and utilization indicators. Pearson correlation and linear regression analysis were done to assess the relationship between MMR and 14 indicators at the district level using SPSS version 20. Results: MMR decreased linearly with increase in proportion of rural population and accounted for 20% variability (P = 0.018). Proportion of households with access to safe drinking water had a significant negative linear association with MMR and accounted for 27% of variability (P = 0.005). MMR increased linearly with increase in proportion of pregnant women with anemia at the district level (P = 0.019). Community health centers (CHCs) per million populations were found to have a negative linear association with MMR and accounted for 15% of variability in MMR at the district level. Conclusions: Proportion of rural population, households with access to safe drinking water, pregnant women with anemia, and CHCs per million populations were associated with inter-district variation of maternal mortality in Assam.