Do hot-spots of maternal mortality ratio exist in India? A district-level spatial analysis

Amitha Puranik, Suma Nair, V. S. Binu, Seena Biju

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1 Citation (Scopus)


Background: Hot-spot detection of Maternal Mortality Ratio (MMR) can assist in identifying the exact geographic location of regions that need urgent attention. Aims &Objectives: To detect hot-spots of MMR at district level in the selected nine states of India and the observed pattern was further correlated with hot-spots of certain known risk factors of MMR in the same region. Material &Methods: Data on MMR was obtained from Annual Health Survey 2012-13. Moran’s I was computed for MMR to quantify spatial autocorrelation. The hot-spot analysis of MMR and its potential risk factors were performed using Getis-Ord Gi* statistic, a measure of local indicators of spatial autocorrelation (LISA). The spatial analysis was based on queen’s contiguity weight matrix and analyses were done using ArcGIS 10.3. Results: The Moran’s I value of MMR was found to be 0.69 indicating a positive spatial autocorrelation. Districts with MMR hot-spotting was largely observed in Uttar Pradesh and Madhya Pradesh, followed by Assam, Bihar and Jharkhand. The hot-spot analysis unveiled an inverse relation of MMR with female literacy rate, mothers who received any antenatal check-up (%), mothers who utilized Janani Suraksha Yojana (%), safe delivery (%) and urbanization (%). Marriages among females below 18 years (%), total fertility rate and women with unmet need for spacing (%) had a direct relation with MMR. Conclusion: Information on hot-spots as depicted in this study can help locate the regions vulnerable to MMR and the potential risk factors, which in turn could aid in implementing targeted intervention programs.

Original languageEnglish
Pages (from-to)369-370
Number of pages2
JournalIndian Journal of Community Health
Issue number4
Publication statusPublished - 31-12-2017

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health


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