National impact of Score MAMÁ on obstetric complications in Ecuador, 2012–2024: interrupted time series analysis
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Objectives
To evaluate the impact of Score MAMÁ, Ecuador’s 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.
Methods
Quasi-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 Ecuador’s 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.
Results
We 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).
Conclusions
Score MAMÁ 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.
