Impact Of Socio-Economic Factors On Postpartum Haemorrhage in Three Health Centres In Dili, Timor Leste- Cross-Sectional Study
DOI:
https://doi.org/10.55018/janh.v7i2.369Keywords:
Socioeconomic status, Postpartum haemorrhage, Household income, Community Health Centre, Timor-LesteAbstract
Background: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality in low- and middle-income countries, including Timor-Leste. Socioeconomic factors may significantly influence the risk of PPH, yet limited local evidence is available. This study aimed to analyse the influence of education, occupation, and household income on the incidence of PPH in three Community Health Centres (CHCs) in Dili City, Timor-Leste.
Methods: A cross-sectional study was conducted from January to December 2024, involving 130 postpartum mothers who delivered at CHC Comoro, CHC Becora, and CHC Vera-Cruz. Inclusion criteria were postpartum mothers aged ≥19 years, vaginal delivery at ≥37 weeks gestation, and complete medical records, including maternal and child health books or Liziu, and family socioeconomic data. Exclusion criteria included mothers with incomplete records or those who underwent medical interventions such as oxytocin induction or vacuum extraction. Data were collected retrospectively from medical records, KIA books, and antenatal care cohorts. Socioeconomic variables (education, occupation, household income) were categorised using standardised criteria. Data were analysed using chi-square tests and simple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). This report follows the STROBE guidelines for observational studies.
Results: Most mothers (84.6%) were aged 19–34 years, and 61.5% had high-risk obstetric factors. Among respondents, 54.6% had high education, 62.3% were employed in the non-formal sector, and 64.6% had household income at or below the national minimum wage (USD 115). Only household income was significantly associated with PPH (OR = 3.309; 95% CI: 1.429–6.465; p = 0.006), indicating that mothers from low-income families had over three times higher risk of PPH. Education and occupation were not significantly associated with PPH.
Conclusion: Household income is a significant socioeconomic determinant of postpartum haemorrhage in Dili, Timor-Leste. Strengthening community-based interventions targeting low-income families, including improved access to maternal health services and socioeconomic support is recommended to reduce PPH incidence
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Ameh, C. A., Meka, R. J., West, F., Dickinson, F., Allott, H., & Godia, P. (2022). A synthesis of clinical and health system bottlenecks to implementing new WHO postpartum hemorrhage recommendations: Secondary data analysis of the Kenya Confidential Enquiry into Maternal Deaths 2014–2017. International Journal of Gynecology and Obstetrics, 158(S1), 14–22. https://doi.org/10.1002/ijgo.14270
Asif, M. F., Ali, S., Ali, M., Abid, G., & Lassi, Z. S. (2022). The Moderating Role of Maternal Education and Employment on Child Health in Pakistan. Children, 9(10). https://doi.org/10.3390/children9101559
Borovac-Pinheiro, A., Ribeiro, F. M., & Pacagnella, R. C. (2021). Risk Factors for Postpartum Hemorrhage and its Severe Forms with Blood Loss Evaluated Objectively - A Prospective Cohort Study. Revista Brasileira de Ginecologia e Obstetricia : Revista Da Federacao Brasileira Das Sociedades de Ginecologia e Obstetricia, 43(2), 113–118. https://doi.org/10.1055/s-0040-1718439
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it’s time to consider the causes of the causes. Public Health Reports (Washington, D.C. : 1974), 129 Suppl(Suppl 2), 19–31. https://doi.org/10.1177/00333549141291S206
Bruno, S. K. B., Rocha, H. A. L., Rocha, S. G. M. O., Araújo, D. A. B. S., Campos, J. S., Silva, A. C. e., & Correia, L. L. (2021). Prevalence, socioeconomic factors and obstetric outcomes associated with adolescent motherhood in Ceará, Brazil: a population-based study. BMC Pregnancy and Childbirth, 21(1), 1–10. https://doi.org/10.1186/s12884-021-04088-7
Delie, A. M., Melese, M., Limenh, L. W., Esubalew, D., Worku, N. K., Fenta, E. T., Hailu, M., Abie, A., Mehari, M. G., & Dagnaw, T. E. (2024). Magnitude and predictors of obstetric complications during delivery among postpartum women in Ethiopia: evidence from PMA Ethiopia longitudinal survey. BMC Pregnancy and Childbirth, 24(1), 703. https://doi.org/10.1186/s12884-024-06904-2
EIS CHC Becora. (2024). Estatistika Informasaun Saude.
EIS CHC Comoro. (2023). Estatistika Informasaun Saude (EIS).
EIS CHC Vera-Cruz. (2024). Estatistika Informasaun Saude.
Erickson, E. N., & Carlson, N. S. (2022). Maternal Morbidity Predicted by an Intersectional Social Determinants of Health Phenotype: A Secondary Analysis of the NuMoM2b Dataset. Reproductive Sciences, 29(7), 2013–2029. https://doi.org/10.1007/s43032-022-00913-2
Getahun, G. K., Wubishet, D., Wubete, B. Y., Akalu, S. Y., & Shitemaw, T. (2024). Predictors of postpartum hemorrhage at public hospitals in Addis Ababa, Ethiopia: A case-control study. Heliyon, 10(4), e26762. https://doi.org/10.1016/j.heliyon.2024.e26762
Governu Timor-Leste. (2012). Komisaun Nasionál Servisu Aprova saláriu mínimu ba Setór Privadu. Portal Oficial Do Governu Timor-Leste.
Habonimana, D., & Batura, N. (2021). Empirical analysis of socio-economic determinants of maternal health services utilisation in Burundi. BMC Pregnancy and Childbirth, 21(1), 1–11. https://doi.org/10.1186/s12884-021-04162-0
Ifeadike, C. O., Uchenna Eleje, G., Stanley Umeh, U., & Okaforcha, E. I. (2018). Emerging trend in the etiology of postpartum hemorrhage in a low resource setting. Journal of Pregnancy and Neonatal Medicine, 02(02). https://doi.org/10.35841/neonatal-medicine.2.2.34-39
INETL, U. and U. (2022). Population and Housing Census Timor-Leste 2022, Thematic report - Education.
Kota, K., Chomienne, M. H., Geneau, R., & Yaya, S. (2023). Socio-economic and cultural factors associated with the utilization of maternal healthcare services in Togo: a cross-sectional study. Reproductive Health, 20(1), 1–14. https://doi.org/10.1186/s12978-023-01644-6
Mitta, K., Tsakiridis, I., Dagklis, T., Grigoriadou, R., Mamopoulos, A., Athanasiadis, A., & Kalogiannidis, I. (2023). Incidence and Risk Factors for Postpartum Hemorrhage: A Case-Control Study in a Tertiary Hospital in Greece. Medicina (Kaunas, Lithuania), 59(6), 1151. https://doi.org/10.3390/medicina59061151
OECD. (2023). Health at a Glance 2023: EOCD Indicators. In Leadership and Governance in Primary Healthcare: An Exemplar for Practice in Resource Limited Settings.
Olonade, O., Olawande, T. I., Alabi, O. J., & Imhonopi, D. (2019). Maternal mortality and maternal health care in Nigeria: Implications for socio-economic development. Open Access Macedonian Journal of Medical Sciences, 7(5), 849–855. https://doi.org/10.3889/oamjms.2019.041
Rahayuningsih, F. B., & Kristinawati, B. (2023). The Effectiveness of Audiovisual Media and Leaflets in Enhancing Knowledge, Attitudes, and Practices of Pregnancy Services. JURNAL PENDIDIKAN KEPERAWATAN INDONESIA, 9(2), 193–208. https://doi.org/10.17509/jpki.v9i2.68250
Samsi, S. N., Rufaridah, A., Marlia, S., Dahlan, A., Komalasari, W., & Husni, L. (2023). Edukasi Pendidikan Kesehatan Pada Pasangan Usia Subur Dalam Pemilihan Kontrasepsi: Health Education Education for Couples of Childbearing Age in Choosing Contraception. Jurnal Abdi Kesehatan Dan Kedokteran, 2(1 SE-Articles), 74–83. https://doi.org/10.55018/jakk.v2i1.30
Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology, 61(3), 261–264. https://doi.org/10.4103/0019-5154.182410
Soares, C. (2025). Saláriu Mínimu $115 Lasufisiente ba Nesesidade Família. The Dili Weekly.
Sousa, C. de. (2024a). President Horta Calls for Minimum Wage increase in Timor Leste. Tatoli.
Sousa, C. de. (2024b). Strengthening Health System to Reduce Maternal and Perinatal Mortality in Timor Leste. Tatoli.
Wardani, D. S., A’tul Al Fadhillah, P. S., Jannah, M., Putri, R., Fransisca, R. D., & Retno Hastuti, N. A. (2024). The Effectiveness of Audiovisual Method Counseling on the Knowledge and Attitudes of Adolescents Regarding Early Marriage. International Journal of Medical Science and Health Research, 08(06), 80–88. https://doi.org/10.51505/ijmshr.2024.8608
Williams, C. R., Adnet, G., Gallos, I. D., Coomarasamy, A., Gülmezoglu, A. M., Islam, M. A., Rushwan, S., Widmer, M., Althabe, F., & Oladapo, O. T. (2024). Research agenda for ending preventable maternal deaths from postpartum haemorrhage: a WHO research prioritisation exercise. BMJ Global Health, 9(11), e015342. https://doi.org/10.1136/bmjgh-2024-015342
World Health Organization. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. In World Health Organization (WHO).
World Health Organization. (2017). Social determinants of health. World Health Organization (WHO).
World Health Organization. (2023). A roadmap to combat postpartum haemorrhage between 2023 and 2030. In World Health Organisation Geneva, Switzerland.
World Health Organization. (2025a). Maternal mortality. World Health Organisation Geneva, Switzerland.
World Health Organization. (2025b). WHO recommendations on maternal health: guidelines approved by the WHO Guidelines Review Committee. In World Health Organization (2nd ed).
World Health Organization. (2025c). WHO releases 2025 update to the International Classification of Diseases (ICD-11). World Health Organization.
Ximenes, F. (2025). SEFOPE FIRME TAU IMPORTANSIA SALARIU MINIMU BA TRABALHADOR. Tatoli.
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