BJOG: An International Journal of Obstetrics & Gynaecology

Original Article

Declining maternal mortality in the face of persistently high HIV prevalence in a middle-income country

Corresponding Author

EJ Buchmann

Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa

Correspondence: E Buchmann, Department of Obstetrics and Gynaecology, Room 31, First floor, Maternity and Gynaecology, Chris Hani Baragwanath Academic Hospital, Chris Hani Road, Soweto, Johannesburg, South Africa. Email [email protected]Search for more papers by this author

CN Mnyani,

CN Mnyani

Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa

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KA Frank,

KA Frank

Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa

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MF Chersich,

MF Chersich

Centre for Health Policy, MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa

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JA McIntyre,

JA McIntyre

Anova Health Institute, Johannesburg, South Africa

School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

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EJ Buchmann,

Corresponding Author

EJ Buchmann

Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa

CN Mnyani,

CN Mnyani

Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa

Search for more papers by this author

KA Frank,

KA Frank

Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa

Search for more papers by this author

MF Chersich,

MF Chersich

Centre for Health Policy, MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa

Search for more papers by this author

JA McIntyre,

JA McIntyre

Anova Health Institute, Johannesburg, South Africa

School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

Search for more papers by this author

First published: 12 September 2014

https://doi.org/10.1111/1471-0528.13064

Citations: 10

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Abstract

Objective

To estimate maternal mortality ratio (MMR) and determine maternal death causes and trends in Greater Soweto, Johannesburg, South Africa.

Design

Cross-sectional study.

Setting

Chris Hani Baragwanath Maternity Hospital (CHBMH) in Greater Soweto.

Population

Maternal deaths at CHBMH.

Methods

Record review of maternal deaths from 1997 to 2012, using hospital death records, with denominator data from the district health information system and the hospital.

Main outcome measures

Maternal mortality ratio per 100 000 live births, and causes of death classified as in the South African confidential enquiries.

Results

There were 479 deaths, with a peak MMR of 139 in 2004 and a decline to 86 in 2012. Of 332 women tested, 245 (74%) were HIV-infected. Nonpregnancy-related infection (40%) was the most frequent cause of death, followed by hypertension (16%) and obstetric haemorrhage (13%). HIV infection rates in these groups were 92%, 30% and 61%, respectively. Previous caesarean section was associated with obstetric haemorrhage death (odds ratio [OR] 3.2, 95% confidence interval [95% CI] 1.7–6.0), maternal age ≥35 years with hypertension death (OR 2.2, 95% CI 1.2–3.7) and antenatal anaemia with nonpregnancy-related infection death (OR 4.0, 95% CI 2.3–6.9), compared with other causes of death.

Conclusion

There is evidence of a decline in MMR since HIV treatment for pregnant women was introduced in 2004. Previous caesarean section, advanced maternal age, and anaemia were associated with death from obstetric haemorrhage, hypertensive disorders of pregnancy and nonpregnancy-related infections, respectively. MMR may be further reduced with accelerated initiation of HIV treatment during pregnancy.

Supporting Information

References

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Citing Literature

Volume122, Issue2

Special Issue:Beyond 2015: The future of women's health globally

January 2015

Pages 220-227

This article also appears in:

January 2015: Beyond 2015: The Future of Women's Health Globally

Declining maternal mortality in the face of persistently high HIV prevalence in a middle-income country

Abstract

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusion

Supporting Information

References

Citing Literature

References

Information

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Declining maternal mortality in the face of persistently high HIV prevalence in a middle-income country

Abstract

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusion

Supporting Information

References

Citing Literature

References

Related

Information