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APHA Scientific Session and Event Listing

Recorded presentation

Maria Small, MD¹, Edward Magee², Christian Blanc, MD³, YveCarm Colimon, MD³, Rikerdy Frederic, MD³, and Trace Kershaw, PhD¹. (1) School of Public Health, Yale University, 47 College Street, New Haven, CT 06511, 203 785-3441, smallmaria@hotmail.com, (2) UC Davis School of Medicine, xxxx, San Diego, CA 00000, (3) Hopital Albert Schweitzer, 10 Rue Clercine, Port au Prince Haiti, 000000, Haiti

Objective To determine the impact of societal violence on maternal health in rural Haiti

Study Design In 2004, armed conflict between rebels and Haitian government forces resulted in widespread violence. The onset and termination of the most intense period of armed conflict occurred during February 2004. Few hospitals in rural Haiti remained functional during this time. We used the perinatal database from the Hospital Albert Schweitzer (HAS), to compare rates per month of obstetric outcomes for the month of armed conflict with baseline rates from the preceding year, 2003. Chi-square or Fisher's exact test were used for analysis.

Results In 2003, the baseline eclampsia rate was 4.3% per month, and 8.7% per month during the conflict in 2004. (Chi square with Fischer Exact test 4.32, p<.001) Maternal deaths occurred in 1.2% of women at baseline, and 5.2% during the conflict. (Chi square with Fisher Exact test 10.36, p< .001).

Rates of preeclampsia were not significantly different between the baseline and the conflict, 13% and 12%, respectively. (Chi-Square 0.11, p= .75)

Surrounding hospital closures resulted in a marginally significant increase in patients from outside the HAS hospital catchment area. (9.7% at baseline vs. 15.2% during the conflict) Chi=Square=3.20, p=.07.

Conclusion Maternal mortality and eclampsia reflect issues of access. In a period of acute instability, these indices peaked. Measurable adverse outcomes such as maternal mortality and eclampsia represent obstetric markers for the social status of women and the function of health care systems.

Learning Objectives:

• Define the leading contributors to maternal death in Haiti
• Discuss the link between social violence and obstructed access to maternal services
• Examine the association between obstructed access and hypertensive disease in pregnancy

Keywords: Maternal Morbidity, International MCH

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation