PT  - JOURNAL ARTICLE
AU  - Prestige Tatenda Makanga
AU  - Charfudin Sacoor
AU  - Nadine Schuurman
AU  - Tang Lee
AU  - Faustino Carlos Vilanculo
AU  - Khatia Munguambe
AU  - Helena Boene
AU  - Ugochinyere Vivian Ukah
AU  - Marianne Vidler
AU  - Laura A Magee
AU  - Esperanca Sevene
AU  - Peter von Dadelszen
AU  - Tabassum Firoz
ED  - ,
TI  - Place-specific factors associated with adverse maternal and perinatal outcomes in Southern Mozambique: a retrospective cohort study
AID  - 10.1136/bmjopen-2018-024042
DP  - 2019 Feb 01
TA  - BMJ Open
PG  - e024042
VI  - 9
IP  - 2
4099  - http://bmjopen.bmj.com/content/9/2/e024042.short
4100  - http://bmjopen.bmj.com/content/9/2/e024042.full
SO  - BMJ Open2019 Feb 01; 9
AB  - Objectives To identify and measure the place-specific determinants that are associated with adverse maternal and perinatal outcomes in the southern region of Mozambique.Design Retrospective cohort study. Choice of variables informed by literature and Delphi consensus.Setting Study conducted during the baseline phase of a community level intervention for pre-eclampsia that was led by community health workers.Participants A household census identified 50 493 households that were home to 80 483 women of reproductive age (age 12–49 years). Of these women, 14 617 had been pregnant in the 12 months prior to the census, of which 9172 (61.6%) had completed their pregnancies.Primary and secondary outcome measures A combined fetal, maternal and neonatal outcome was calculated for all women with completed pregnancies.Results A total of six variables were statistically significant (p≤0.05) in explaining the combined outcome. These included: geographic isolation, flood proneness, access to an improved latrine, average age of reproductive age woman, family support and fertility rates. The performance of the ordinary least squares model was an adjusted R2=0.69. Three of the variables (isolation, latrine score and family support) showed significant geographic variability in their effect on rates of adverse outcome. Accounting for this modest non-stationary effect through geographically weighted regression increased the adjusted R2 to 0.71.Conclusions The community exploration was successful in identifying context-specific determinants of maternal health. The results highlight the need for designing targeted interventions that address the place-specific social determinants of maternal health in the study area. The geographic process of identifying and measuring these determinants, therefore, has implications for multisectoral collaboration.Trial registration number NCT01911494.