An Autopsy Study of Maternal Mortality in Mozambique: The Contribution of Infectious Diseases

Abstract

BackgroundMaternal mortality is a major health problem concentrated in resource-poor regions. Accurate data on its causes using rigorous methods is lacking, but is essential to guide policy-makers and health professionals to reduce this intolerable burden. The aim of this study was to accurately describe the causes of maternal death in order to contribute to its reduction, in one of the regions of the world with the highest maternal mortality ratios.Methods and FindingsWe conducted a prospective study between October 2002 and December 2004 on the causes of maternal death in a tertiary-level referral hospital in Maputo, Mozambique, using complete autopsies with histological examination. HIV detection was done by virologic and serologic tests, and malaria was diagnosed by histological and parasitological examination. During 26 mo there were 179 maternal deaths, of which 139 (77.6%) had a complete autopsy and formed the basis of this analysis. Of those with test results, 65 women (52.8%) were HIV-positive. Obstetric complications accounted for 38.2% of deaths; haemorrhage was the most frequent cause (16.6%). Nonobstetric conditions accounted for 56.1% of deaths; HIV/AIDS, pyogenic bronchopneumonia, severe malaria, and pyogenic meningitis were the most common causes (12.9%, 12.2%, 10.1% and 7.2% respectively). Mycobacterial infection was found in 12 (8.6%) maternal deaths.ConclusionsIn this tertiary hospital in Mozambique, infectious diseases accounted for at least half of all maternal deaths, even though effective treatment is available for the four leading causes, HIV/AIDS, pyogenic bronchopneumonia, severe malaria, and pyogenic meningitis. These observations highlight the need to implement effective and available prevention tools, such as intermittent preventive treatment and insecticide-treated bed-nets for malaria, antiretroviral drugs for HIV/AIDS, or vaccines and effective antibiotics for pneumococcal and meningococcal diseases. Deaths due to obstetric causes represent a failure of health-care systems and require urgent improvement.

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“…33 Our study showed that comorbid conditions, such as HIV/AIDS, and diseases of poverty, such as anaemia, contributed to late pregnancy-related deaths after a near miss. Except for direct obstetric complications, HIV infection was the most important contributor to pregnancy-related deaths in our study.…”

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Guidelines and considerations for testing malaria vaccines in pregnant women

“…However, recent evidence suggests that the impact of malaria on maternal deaths in sub-Saharan Africa has been under estimated and that MiP may be an important direct cause of maternal mortality. [17][18][19] In a recent autopsic study of maternal deaths carried out in Mozambique, malaria was a direct cause of death in 10% of women, representing the fourth cause of death. 19 The burden of malaria during pregnancy in Africa has been exacerbated by the advent of HIV which increases susceptibility to malaria in pregnancy in all parities, reduces the efficacy of antimalarial interventions and complicates the use of antimalarials due to drug interactions.…”

“…[17][18][19] In a recent autopsic study of maternal deaths carried out in Mozambique, malaria was a direct cause of death in 10% of women, representing the fourth cause of death. 19 The burden of malaria during pregnancy in Africa has been exacerbated by the advent of HIV which increases susceptibility to malaria in pregnancy in all parities, reduces the efficacy of antimalarial interventions and complicates the use of antimalarials due to drug interactions. 20 Regardless of endemicity or the level of immunity, maternal malaria causes anaemia.…”