No abstract

Background: HIV/AIDS epidemic is one of the major factors affecting women's health and impeding national efforts to improve it especially in sub-Saharan Africa. Current evidence indicates that HIV/ AIDS is increasingly becoming a major cause or contributing factor to pregnancy-related deaths, almost overtaking the "traditional" causes and factors. Objectives: To survey the contribution of HIV infection and AIDS to pregnancy-related deaths in Blantyre, Malawi. Design: A retrospective, descriptive, facility-based survey. Setting: The Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi. Subjects: All women recorded to have had pregnancy-related deaths between January 1, 1999 and December 31, 2000. Results: There were 204 maternal deaths, 154 (75.5%) direct, the top five causes being puerperal sepsis (39.0%), postabortion complications (31.2%), obstetric haemorrhage (14.3%), eclampsia (8.4%) and ectopic pregnancy (3.9%). At least 38 (18.6%) of the total were HIV positive or had AIDS. The main causes of deaths amongst these were meningitis (23.7%), pneumonia (18.4%), puerperal sepsis (13.2%), postabortal sepsis (10.5%), severe anaemia (10.5%) and pulmonary tuberculosis (10.5%) Of those who died of puerperal and postabortal sepsis in the whole study group 8.3% had HIV/AIDS. Of the indirect maternal deaths, 50 (58%) were HIV positive or had AIDS. Conclusion and recommendations: HIV/AIDS contributes to both direct and indirect maternal deaths in Malawi. National strategies to realise MDG5 targets should include addressing the HIV/AIDS epidemic within the entire population as well as scaling up contraceptive uptake and utilisation, especially amongst the most vulnerable groups.