National impact of Score MAMA on obstetric complications in Ecuador, 2012-2024: interrupted time series…

Abstract

ObjectivesTo evaluate the impact of Score MAMA, Ecuadors national obstetric early-warning system, on rates of severe obstetric complications (hypertensive, hemorrhagic, septic), comparing the 2015 pilot phase (Zones 4/9) with the 2016 national rollout.

MethodsQuasi-experimental ecological interrupted time series study using national administrative data from Ecuador (2012-2024). The denominator came from the live-birth registry (ENV-INEC; n = 3 581 602); the numerator came from hospital discharge records (EDG-INEC), classified by ICD-10 code as Blue Code (O14-O15), Red Code (O44-O46/O67/O72), or Yellow Code (O85-O86/O41.1), aggregated monthly across Ecuadors 9 SENPLADES zones. Negative binomial models with a live-birth offset and zone-nested first-order autoregressive (AR1) correlation estimated incidence rate ratios (IRR). A secondary national-annual analysis modeled maternal mortality by code.

ResultsWe identified 200 075 discharges for an obstetric complication (Blue = 125 848; Red = 55 049; Yellow = 19 178). Blue Code increased in the pilot phase (IRR 1.27; 95% CI 1.03-1.57) and nationally (IRR 1.20; 95% CI 1.09-1.33); Red and Yellow Code showed no change. A national mortality analysis (817 deaths) found no significant change for any code (IRR 0.76-1.62; CI spanned 1).

ConclusionsScore MAMA was associated with a selective increase in recorded hypertensive complications, with no change in hemorrhage, sepsis, or maternal mortality -- a pattern more consistent with improved detection of preeclampsia-eclampsia than a true change in complication incidence.

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BibTeX

@misc{almeida2026national,
  title = {{National impact of Score MAMA on obstetric complications in Ecuador, 2012-2024: interrupted time series analysis}},
  author = {A. S. HERDOIZA ALMEIDA and L. G. Paredes and M. A. Guerrero Salinas and A. W. Guayta Valladares and A. A. T. Solorzano and E. S. LANAS MENDOZA},
  howpublished = {medRxiv},
  year = {2026},
  month = oct,
  doi = {10.64898/2026.10.20.26366065},
  url = {https://www.medrxiv.org/content/10.64898/2026.10.20.26366065v1},
  note = {CC BY},
}

RIS

TY  - UNPB
TI  - National impact of Score MAMA on obstetric complications in Ecuador, 2012-2024: interrupted time series analysis
AU  - A. S. HERDOIZA ALMEIDA
AU  - L. G. Paredes
AU  - M. A. Guerrero Salinas
AU  - A. W. Guayta Valladares
AU  - A. A. T. Solorzano
AU  - E. S. LANAS MENDOZA
PY  - 2026
DA  - 2026/10/20
PB  - medRxiv
DO  - 10.64898/2026.10.20.26366065
UR  - https://www.medrxiv.org/content/10.64898/2026.10.20.26366065v1
AB  - ObjectivesTo evaluate the impact of Score MAMA, Ecuadors national obstetric early-warning system, on rates of severe obstetric complications (hypertensive, hemorrhagic, septic), comparing the 2015 pilot phase (Zones 4/9) with the 2016 national rollout.  MethodsQuasi-experimental ecological interrupted time series study using national administrative data from Ecuador (2012-2024). The denominator came from the live-birth registry (ENV-INEC; n = 3 581 602); the numerator came from hospital discharge records (EDG-INEC), classified by ICD-10 code as Blue Code (O14-O15), Red Code (O44-O46/O67/O72), or Yellow Code (O85-O86/O41.1), aggregated monthly across Ecuadors 9 SENPLADES zones. Negative binomial models with a live-birth offset and zone-nested first-order autoregressive (AR1) correlation estimated incidence rate ratios (IRR). A secondary national-annual analysis modeled maternal mortality by code.  ResultsWe identified 200 075 discharges for an obstetric complication (Blue = 125 848; Red = 55 049; Yellow = 19 178). Blue Code increased in the pilot phase (IRR 1.27; 95% CI 1.03-1.57) and nationally (IRR 1.20; 95% CI 1.09-1.33); Red and Yellow Code showed no change. A national mortality analysis (817 deaths) found no significant change for any code (IRR 0.76-1.62; CI spanned 1).  ConclusionsScore MAMA was associated with a selective increase in recorded hypertensive complications, with no change in hemorrhage, sepsis, or maternal mortality -- a pattern more consistent with improved detection of preeclampsia-eclampsia than a true change in complication incidence.
ER  -

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