Declining maternal mortality in the face of persistently high <scp>HIV</scp> prevalence in a middle‐income country

Buchmann, Eckhart; Mnyani, Coceka Nandipha; Frank, KA; Chersich, Matthew; Ja, McIntyre

doi:10.1111/1471-0528.13064

Cited by 15 publications

(18 citation statements)

References 17 publications

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“…[4,20] Although deaths in the third period of this review still remain three-fold higher among HIV-positive than negative women, this differential is half of what it was in the first period. In an audit of all maternal deaths in South Africa for the years 2008 to 2010, the relative risk of dying during pregnancy was six-fold higher for HIV-positive compared with HIV-negative women.…”

Section: Discussionmentioning

confidence: 99%

Increased Access to Antiretroviral Therapy Is Associated with Reduced Maternal Mortality in Johannesburg, South Africa: An Audit from 2003-2012

Black

Rees

et al. 2016

PLoS ONE

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ObjectiveTo assess the impact of expanded access to antiretroviral treatment (ART) on maternal mortality in Johannesburg, South Africa between 2003 and 2012.MethodsAudit of patient files, birth registers and death certificates at a tertiary level referral hospital. Cause of death was assigned independently, by two reviewers. We compared causes of deaths and the maternal mortality ratios (MMR, deaths/100,000 live births) over three periods corresponding to changes in government policy on ART provision: period one, 2003–2004 (pre-ART); period two, 2005–2009 (ART eligibility with CD4 count <200cells/μL or WHO stage 4 disease); and period three, 2010–2012 (eligibility with CD4 count <350 cells/μL).ResultsThere were 232 deaths and 80,376 deliveries in the three periods. The proportion of pregnant women tested for HIV rose from 43.4% in 2003 to 94.6% in 2012. MMR was 301, 327 and 232 in the three periods, (p = 0.10). The third period MMR was lower than the first and second combined (p = 0.03). Among HIV-positive women, the MMR fell from 836 in the first time period to 431 in the third (p = 0.008) but among HIV negative women it remained unchanged over the three periods, averaging 148. Even in the third period, however, the MMR among HIV-infected women was 3-fold higher than in other women. Mortality from direct obstetric causes such as hemorrhage did not decline over time, but deaths from tuberculosis and HIV-associated malignancy did. In 38.3% of deaths, women had not attended antenatal care.ConclusionHigher coverage of HIV testing and ART has substantially reduced MMR in this hospital setting. Though the gap in MMR between women with and without HIV narrowed, a third of deaths still remain attributable to HIV. Lowering overall MMR will require further strengthening of HIV services, increased antenatal care coverage, and improved care for obstetric emergencies at all levels of care.

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Section: Discussionmentioning

confidence: 99%

Increased Access to Antiretroviral Therapy Is Associated with Reduced Maternal Mortality in Johannesburg, South Africa: An Audit from 2003-2012

Black

Rees

et al. 2016

PLoS ONE

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“…По другим данным из этого же региона, в группе матерей, умерших от инфекции, не связанной с беременностью, 92% составили ВИЧ-инфицированные больные [8].…”

Section: Abstract: Hiv Infection and Pregnancy; Drug Addiction And Punclassified

“…доля ВИЧ-инфицированных беременных увеличилась с 33 до 63% при неизвестном статусе ВИЧ соответственно у 61 -14% пациенток [8].…”

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Hiv Infection and Maternal Mortality

Repina¹,

Павелец

2020

VIČ-infekc. immunosupr.

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2 Общество с ограниченной ответственностью «Ава-Петер», Санкт-Петербург, Россия 3 Северо-Западный государственный медицинский университет им. И. И. Мечникова, Санкт-Петербург, Россия Цель исследования: оценка количества и причин материнской смертности на фоне ВИЧ-инфекции в Санкт-Петербурге. Материалы и методы. Учтены все случаи материнской смертности с момента начала эпидемии ВИЧ-инфекции в городе. Результаты. В Санкт-Петербурге первый случай материнской смертности на фоне ВИЧ-инфекции зарегистрирован в 2002 году. В те же 2002-2015 годы в городе было 164 случая материнских смертей, 31 из них на фоне ВИЧ (18,98±9,4%). Число смертей увеличилось до 31 случая к концу 2015 года. Отмечена высокая частота сочетания ВИЧ-инфекции с применением инъекционных наркотиков (67,0±8,4%) и хроническими формами парентеральных вирусных гепатитов (58,0±8,8%). Наркомания на фоне ВИЧ-инфекции индуцировала высокую частоту развития ангиогенного сепсиса, ставшего самой частой причиной смертности (12 из 31случая). СПИД-индикаторные коинфекции (генерализованные формы туберкулеза, пневмоцистная пневмония) явились причиной смерти еще 12 женщин. Общая доля инфекции как причины материнских смертей составила 80,6±7,2%. У большинства пациенток были отмечены сочетания различных СПИД-индикаторных состояний: генерализованный криптококкоз, некротический токсоплазменный энцефалит, хронический изоспороз, истощение, орофарингеальный кандидоз, кандидоз пищевода и др. Поражения печени вплоть до цирроза выявлены в 14 случаях коинфекций ВИЧ ХВГС+В и ВИЧ/ХВГС. В то же время не отмечено влияния ВИЧ на развитие и утяжеление акушерской патологии. Акушерские осложнения встретились только у двух пациенток, госпитализированных с необратимыми последствиями эклампсии (инсульт и преждевременная отслойка плаценты, осложненная кортикальным некрозом). Эти женщины до момента госпитализации не обращались за медицинской помощью. В целом за медицинской помощью при беременности ни разу не обратились 18 женщин, что свидетельствует о влиянии социальных факторов на исходы беременности и родов. Ключевые слова: ВИЧ-инфекция и беременность, наркомания и беременность, материнская смертность Конфликт интересов: авторы заявили об отсутствии конфликта интересов. Для цитирования: Репина М.А., Павелец Д.А. ВИЧ-инфекция и материнская смертность // ВИЧ-инфекция и иммуносупрессии. 2019. № 4. С. 30-39, DOI: http://dx.

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“…Institutional MMR progressively escalated from the late 1990s onwards, up to levels of 176 nationally in the 2008–2010 triennium, but dropped thereafter to 147 by 2012 [4, 5]. The wide scale-up of antiretroviral treatment (ART) across the country, and especially among pregnant women, is credited with these reductions [5, 6]. While HIV-related mortality has decreased, maternal deaths due to haemorrhage have actually risen, especially among women who had a caesarean section [5].…”

Section: Introductionmentioning

confidence: 99%

“…The district monitoring systems have been strengthened [2] and the factors contributing to maternal deaths are frequently assessed [4, 6, 7]. What we lack, however, is an assessment of access to maternal health services at a population level, disaggregated by population group, and assessed over time.…”

Section: Introductionmentioning

confidence: 99%

Growing inequities in maternal health in South Africa: a comparison of serial national household surveys

Wabiri

Chersich

Shisana

et al. 2016

BMC Pregnancy Childbirth

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BackgroundRates of maternal mortality and morbidity vary markedly, both between and within countries. Documenting these variations, in a very unequal society like South Africa, provides useful information to direct initiatives to improve services. The study describes inequalities over time in access to maternal health services in South Africa, and identifies differences in maternal health outcomes between population groups and across geographical areas.MethodsData were analysed from serial population-level household surveys that applied multistage-stratified sampling. Access to maternal health services and health outcomes in 2008 (n = 1121) were compared with those in 2012 (n = 1648). Differences between socio-economic quartiles were quantified using the relative (RII) and slope (SII) index of inequality, based on survey weights.ResultsHigh levels of inequalities were noted in most measures of service access in both 2008 and 2012. Inequalities between socio-economic quartiles worsened over time in antenatal clinic attendance, with overall coverage falling from 97.0 to 90.2 %. Nationally, skilled birth attendance remained about 95 %, with persistent high inequalities (SII = 0.11, RII = 1.12 in 2012). In 2012, having a doctor present at childbirth was higher than in 2008 (34.4 % versus 27.8 %), but inequalities worsened. Countrywide, levels of planned pregnancy declined from 44.6 % in 2008 to 34.7 % in 2012. The RII and SII rose over this period and in 2012, only 22.4 % of the poorest quartile had a planned pregnancy. HIV testing increased substantially by 2012, though remains low in groups with a high HIV prevalence, such as women in rural formal areas, and from Gauteng and Mpumalanga provinces. Marked deficiencies in service access were noted in the Eastern Cape ad North West provinces.ConclusionsThough some population-level improvements occurred in access to services, inequalities generally worsened. Low levels of planned pregnancy, antenatal clinic access and having a doctor present at childbirth among poor women are of most concern. Policy makers should carefully balance efforts to increase service access nationally, against the need for programs targeting underserved populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1048-z) contains supplementary material, which is available to authorized users.

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

Cited by 15 publications

References 17 publications

Increased Access to Antiretroviral Therapy Is Associated with Reduced Maternal Mortality in Johannesburg, South Africa: An Audit from 2003-2012

Increased Access to Antiretroviral Therapy Is Associated with Reduced Maternal Mortality in Johannesburg, South Africa: An Audit from 2003-2012

Hiv Infection and Maternal Mortality

Growing inequities in maternal health in South Africa: a comparison of serial national household surveys

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