Quality of Antenatal Care and Maternal Mortality in Madagascar: Analysis of Regional Disparities and  Non-Linear Modeling

Hery Sylvestre  Bemanana; Andriatompoina Felanarivo  Razafaindraibe; Sambatra  Rafamantanantsoa

doi:10.18502/jfrh.v19i3.20055

Hery Sylvestre Bemanana Sylababa Association, Antananarivo, Madagascar
Andriatompoina Felanarivo Razafaindraibe University of Toamasina, Toamasina, Madagascar
Sambatra Rafamantanantsoa Department of Obstetrics-Gynecology, Tanambao University Hospital Centre, University of Toliara, Toliara, Madagascar

DOI: https://doi.org/10.18502/jfrh.v19i3.20055

Keywords: Antenatal Care; Health Services Accessibility; Maternal Mortality; Madagascar; Public Health; Regression Analysis

Abstract

Objective: Maternal mortality remains a major public health challenge in Madagascar, with notable regional disparities. Antenatal care (ANC) plays a critical role in preventing maternal deaths, yet its coverage and quality vary significantly across regions. This study aims to assess the association between ANC quality and maternal mortality rate (MMR), focusing on regional disparities and exploring potential non-linear relationships.

Materials and methods: We conducted a retrospective ecological study using publicly available data from Madagascar’s 22 regions. ANC indicators included blood pressure monitoring, blood and urine tests, iron supplementation, and antiparasitic treatment. Linear regression and Generalised Additive Models (GAM) were used to examine associations and non-linear patterns. Statistical analyses were performed using R version 4.2.2, with a significance threshold of 5%.

Results: Considerable disparities were observed in ANC coverage across regions. Linear models revealed no significant association between ANC indicators and MMR (p > 0.05). However, GAM identified significant non-linear relationships for blood pressure monitoring (p < 0.0045) and blood testing (p < 0.0055), suggesting potential threshold effects.

Conclusion: Addressing maternal mortality in Madagascar requires enhancing both access to and the quality of ANC. Accounting for regional disparities and non-linear trends is essential in developing effective public health interventions.