Introduction Worldwide, 99% of deaths of women in their reproductive ages are due to childbirth and pregnancy complications. Maternal mortality is the subject of the fifth United Nations’ millennium development goal: the aim is to reduce the maternal mortality ratio by three quarters from 1990 to 2015. Although much research has been conducted in recent years, knowing the spatial pattern of maternal mortality in developing countries will help target scarce resources and intervention programs to high risk areas for the greatest impact, since nationwide interventions are costly. Objective This study assessed the spatial patterns and trends of, and causes and risk factors associated with, maternal mortality in the Ifakara Health and Demographic Surveillance Site (IHDSS) in Tanzania, from 2006 to 2010, with a view to providing information that may help reduce maternal mortality in this country. Method A secondary data analysis of a longitudinal study using data from the IHDSS was conducted. Inverse distance weighted (IDW) method of interpolation in ArcGIS was used to assess spatial patterns. Cox proportional hazards regression was used to identify and quantify risk factors associated with maternal mortality. Results A total of 36 792 women aged 15 to 49 were included in the study of which 77 died due to childbirth or pregnancy related complications. The overall maternal mortality rate for the five years was 0.79 per 1000 person years. The trend declined from 90.42 per 1000 person years in 2006 to 57.42 per person years in 2010. There were marked geographical differences in maternal mortality patterns with high levels of mortality occurring in areas with close proximity to health facilities in some instances. The main causes of maternal death were eclampsia (23%), haemorrhage (22%) and abortion-related complications (10%). Maternal age, marital status and socioeconomic status were found to be risk factors. There was a reduced risk of 82% (HR: 0.18, 95% CI: 0.05-0.74) and 78% (HR: 0.22, 95% CI: 0.05 – 0.92) for women aged 20-29 and 30-39 years, respectively, compared with those younger than 20 years. While being married had a protective effect of 94% (HR: 0.06, 95% CI: 0.01 - 0.51) compared to being single, women who were widowed had an increased risk of 813% (HR: 9.13, 95% CI: (1.017 – 81.942). Higher socioeconomic status had a protective effect on maternal mortality: women who were in the poorer and least poor socioeconomic groups were 70% (HR: 0.30, 95% CI: 0.11 – 0.81) and 75% (HR: 0.25, 95% CI: 0.06 - 1.09) less likely to die from maternal causes, respectively, compared to those in the poorest category. Conclusion There has been a decline in maternal mortality in rural southern Tanzania, with geographical differences in patterns of death. Eclampsia, haemorrhage and abortion-related complication are the three leading causes of maternal death in rural southern Tanzania, with risk factors being maternal age less than 20 years, marital status (single, widowed), and lower socioeconomic status. Keywords: maternal mortality, risk factors, spatial pattern, maternal mortality rate, verbal autopsy

Submitted by admin tede (tede@pucgoias.edu.br) on 2017-08-18T14:18:52Z No. of bitstreams: 1 ALESSANDRA ARANTES DA SILVA CAMPOS.pdf: 415649 bytes, checksum: ab4b35efcca04c630226e9335856e2fe (MD5) / Made available in DSpace on 2017-08-18T14:18:52Z (GMT). No. of bitstreams: 1 ALESSANDRA ARANTES DA SILVA CAMPOS.pdf: 415649 bytes, checksum: ab4b35efcca04c630226e9335856e2fe (MD5) Previous issue date: 2017-06-26 / Cardiovascular diseases are among the leading causes of death in the world and in Brazil. Women of childbearing age have been affected by these events in increasingly significant numbers, since it modifies the expected pattern of deaths in this age group. This dissertation aimed to outline the epidemiological profile of cardiovascular disease mortality in women of childbearing age, in the state of Goiás, from 2000 to 2014. It is a retrospective study with a quantitative approach. The data corresponding to the deaths of women of childbearing age, from 10 to 49 years, for cardiovascular diseases (Chapter IX of ICD-10), in the state of Goiás, were digitally accessed at the Mortality Information Service (SIM) in the period of 2000 To 2014. Cardiovascular diseases ranked third in the number of deaths in the study group. The most prevalent diseases that led to women of childbearing age were, respectively, cerebrovascular diseases, ischemic heart diseases and other forms of heart disease. Mortality declined in the group of women between the ages of 20 and 49, with a more pronounced decline in the age group of 40 to 49 years. In relation to marital status, there was a decrease in the number of deaths of married and widowed women and an increase among women in a stable union. In terms of schooling, there was a decrease in the number of deaths among women with uninformed or ignored education and without any education, whereas among women with four years or more of education there was an increase in the number of deaths. There was an increase in the number of deaths among women of brown color and fall among white women. In the majority of cases, women died, especially in the hospital environment, with deaths occurring at home in the second place. It is concluded that, over the years, women of childbearing age have presented better responses regarding the modification of risk factors for cardiovascular diseases, as well as adherence to guiding principles for the reduction of these risk factors. Although health and education policies have followed this trend, they still lack epidemiological evidence for their better targeting and implementation. / As doenças cardiovasculares estão entre as principais causas de óbito no mundo e no Brasil. As mulheres em idade fértil têm sido acometidas por esses eventos em números cada vez mais expressivos, dado que modifica o padrão esperado dos óbitos nesta faixa etária. A presente dissertação teve por objetivo delinear o perfil epidemiológico da mortalidade por doenças cardiovasculares em mulheres em idade fértil, no estado de Goiás, no período de 2000 a 2014. Trata-se de um estudo retrospectivo com abordagem quantitativa. Foram acessados digitalmente no Serviço de Informação de Mortalidade (SIM) os dados correspondentes às mortes de mulheres em idade fértil, entre 10 e 49 anos, por doenças cardiovasculares (Capítulo IX do CID-10), no estado de Goiás, no período de 2000 a 2014. As doenças cardiovasculares ocuparam a terceira colocação no número de óbitos no grupo estudado. As doenças mais prevalentes que levaram as mulheres em idade fértil a óbito foram, respectivamente, as doenças cerebrovasculares, as doenças isquêmicas do coração e outras formas de doenças do coração. Houve queda da mortalidade no grupo de mulheres entre 20 e 49 anos, com declínio mais acentuado na faixa etária de 40 a 49 anos. Em relação ao estado civil, observou-se queda no número de óbitos de mulheres casadas e viúvas e aumento entre mulheres em união estável. Em se tratando de escolaridade, houve diminuição do número de óbitos entre as mulheres com instrução não informada ou ignorada e sem nenhuma instrução, enquanto entre as mulheres com quatro anos ou mais de instrução registrou-se aumento do número de óbitos. Foram identificados aumento do número de óbitos entre mulheres de cor parda e queda entre mulheres brancas. Em sua maioria, as mulheres vieram a óbito especialmente em ambiente hospitalar, ficando em segundo lugar os óbitos em seus domicílios. Conclui-se que, ao longo dos anos, as mulheres em idade fértil têm apresentado melhores respostas quanto à modificação dos fatores de risco das doenças cardiovasculares, assim como em relação à adesão aos princípios norteadores para a diminuição destes fatores de risco. Embora as políticas de saúde e educação venham acompanhando tal tendência, ainda carecem de evidências epidemiológicas para seu melhor direcionamento e implementação.