Maternal mortality in Guatemala:: differences between hospital and non-hospital deaths.

Objective: To estimate the association between obstetric and socio-demographic characteristics and risk factors related to intra- and extra-hospital maternal mortality in Guatemala during the year 2000. Materials and Methods: A cross-sectional epidemiologic study was carried out in 649 maternal mortality (MM) cases that occurred in Guatemala during 2000, comparing characteristics of intra- and extra-hospital maternal deaths. Multivariate statistical analysis was conducted using Stata 7.0 software. Results: Out of 649 registered MM cases, 270 (41.6%) were classified as intra-hospital MM and 379 (58.4%) as extra-hospital MM.A larger proportion of deaths occurred in women over 35 years of age (29.28%), those of indigenous ethnicity (65.49%), married or cohabiting (87.83%),who had unpaid employment (94.78%), and without formal education (66.56%). Compared with intra-hospital MM cases,the risk of extra-hospital MM was greater among indigenous women (OR 3.4; CI95% 2.8-5.3),those who had unpaid employment (OR 8.95; CI95% 1.7-46.4), a low level of formal education (OR 1.96; CI95% 1.0-3.8) and hemorrhaging as the immediate cause of death (OR 4.28; CI95% 2.3-7.9).Conclusions: Although some characteristics of intra- and extra-hospital MM cases are similar, a greater proportion of deaths were extra-hospital. This could be related to the high percentage of the population that lives in rural or marginalized areas, which in addition to certain cultural aspects (related to the fact that most of the population is indigenous) may impede access to health services. The results of this study can be useful for determining intervention strategies to prevent maternal mortality in intra- and extra-hospital contexts in Guatemala.