A Structural Equation Modeling-Based Maternal Mortality Prediction Model with Three Levels of Determinants

Abstract

Maternal mortality is an important indicator of national health. The Sustainable Development Goals (SDGs) target reducing maternal mortality to a maximum of 70 per 100,000 live births by 2030. No country can accept a doubling of the maternal mortality rate. Maternal mortality is caused by distant, intermediate, and immediate factors. Given the high rate, the Lampung Health Service prioritizes addressing maternal mortality. This study evaluates the factors that contribute to maternal mortality as variables that influence its prevalence and analyzes the equation model in Lampung, Indonesia. This study was conducted in Lampung Province, using analytical descriptive method with case-control approach. The population was divided into case and control groups, using a complete and proportional randomly selected sample from 87 community health centers in 90 sub-districts in Lampung. Each case and control group consisted of 97 samples. Distant determinants included socioeconomic and environmental health issues; intermediate determinants included maternal health status, access to health services, and use of those services; while immediate determinants were pregnancy complications. In this study, SPSS (Statistical Package for the Social Sciences) and PLS-SEM (Partial Least Squares - Structural Equation Modeling) were applied for data analysis. The results of the analysis identified 11 path hypotheses, with 7 of them having a significant effect on maternal mortality. In Lampung Province, socioeconomic factors, environmental health, utilization and access to health services, maternal health conditions, and pregnancy complications contributed to maternal mortality. Socioeconomic factors and access to health services contributed 97.79% to maternal mortality. The findings suggest the importance of hand hygiene promotion, job creation in the community, diversification of food choices, improved access to delivery facilities, and implementation of better health practices. In addition, prevention, health promotion and treatment of conditions such as preeclampsia/eclampsia need to be prioritized.