A biosocial analysis of perinatal and late neonatal mortality among Indigenous Maya Kaqchikel communities in Tecpán, Guatemala

A mixed-methods study

Bibliographic Data

ID21880448
AuthorsAnahí Venzor Strader (0000-0001-9604-7708, Boston Children's Hospital, corresponding author), Magda Sotz (Center for Indigenous Health Research, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala), Hannah Gilbert (0000-0001-5965-0460, Harvard University), Hannah N Gilbert (Harvard Medical School), Ann C Miller (0000-0001-6841-9439, Harvard University), Anne CC Lee (0000-0003-2654-9862, Brigham and Women's Hospital), Peter Rohloff (0000-0001-7274-8315, Brigham and Women's Hospital)
Year2024
Volume9
Issue4
Pagese013940
Publication date2024-04-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2023-013940
PMID38631704
OpenAlexW4394875022
LanguageEN
Citations received2
References cited42

INTRODUCTION: Neonatal mortality is a global public health challenge. Guatemala has the fifth highest neonatal mortality rate in Latin America, and Indigenous communities are particularly impacted. This study aims to understand factors driving neonatal mortality rates among Maya Kaqchikel communities. METHODS: We used sequential explanatory mixed methods. The quantitative phase was a secondary analysis of 2014-2016 data from the Global Maternal and Newborn Health Registry from Chimaltenango, Guatemala. Multivariate logistic regression models identified factors associated with perinatal and late neonatal mortality. A number of 33 in-depth interviews were conducted with mothers, traditional Maya midwives and local healthcare professionals to explain quantitative findings. RESULTS: Of 33 759 observations, 351 were lost to follow-up. There were 32 559 live births, 670 stillbirths (20/1000 births), 1265 (38/1000 births) perinatal deaths and 409 (12/1000 live births) late neonatal deaths. Factors identified to have statistically significant associations with a higher risk of perinatal or late neonatal mortality include lack of maternal education, maternal height <140 cm, maternal age under 20 or above 35, attending less than four antenatal visits, delivering without a skilled attendant, delivering at a health facility, preterm birth, congenital anomalies and presence of other obstetrical complications. Qualitative participants linked severe mental and emotional distress and inadequate maternal nutrition to heightened neonatal vulnerability. They also highlighted that mistrust in the healthcare system-fueled by language barriers and healthcare workers' use of coercive authority-delayed hospital presentations. They provided examples of cooperative relationships between traditional midwives and healthcare staff that resulted in positive outcomes. CONCLUSION: Structural social forces influence neonatal vulnerability in rural Guatemala. When coupled with healthcare system shortcomings, these forces increase mistrust and mortality. Collaborative relationships among healthcare staff, traditional midwives and families may disrupt this cycle

Environmental health · Infant mortality · Live birth · Logistic regression · Population · Pregnancy · Public health · Demography · Global Maternal and Child Health · Indigenous Health and Education · Maternal and Neonatal Healthcare · Medicine · Nursing · Pediatrics

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