Estimating maternal mortality and causes in South Africa: National and provincial levels

Udjo, Eric O.; Lalthapersad-Pillay, Pinky

doi:10.1016/j.midw.2013.05.011

Cited by 17 publications

(14 citation statements)

References 20 publications

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“…As expected, the most populous provinces KZN, EC and GT had the highest numbers of deaths. Other studies conducted in South Africa also found that these three provinces presented with the highest numbers of maternal deaths [ 4 , 7 , 22 ]. This could be due to a number of reasons, a combination of better reporting, an actual increase in deaths and poor health care services.…”

Section: Discussionmentioning

confidence: 71%

“…Provincial level estimates indicate that the Free State had the highest MMR of 286/100 000 live births, higher than the national average of 183/100 000 live births during this period while the Western Cape had the lowest MMR (87/100 000 live births) and was the only province that had a steady decline in maternal deaths during this period (see Figures 1 and 2 ). The overall MMR (183/100 000 live births) for the period under review according to data from StatsSA is substantially lower than the 2007 MMR (299/100 000 live births) computed from civil registration and vital statistics systems [ 1 ] and the 2007 South Africa Community Survey MMR (764/100 000 live births) computed by Udjo et al [ 22 ] indicating a significant increase in maternal mortality ratio after 2006. A substantial annual increase in maternal deaths between 2002 and 2006 occurred in South Africa as depicted in Figure 2 .…”

Section: Resultsmentioning

confidence: 83%

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A cross-sectional analysis of the geographic distribution and causes of maternal mortality in South Africa: 2002–2006

Bomela

2015

BMC Public Health

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BackgroundMajor changes in health policy, health service delivery, specific protocols, guidelines and recommendations for the management of common causes of maternal death have been developed in South Africa since the advent of the current democratic government. However, maternal mortality ratio remains high. The scientific community has conducted numerous studies on maternal mortality in South Africa; save for an analysis of the causes of maternal deaths, stratified by province. This study examines the geographic distribution of maternal causes of death in South Africa.MethodsA pooled cross-sectional dataset for the years 2002–2006 retrieved from the vital registration database of Statistics South Africa was used to analyse maternal causes of death. About 8773 maternal deaths between 10–55 years were analysed using frequency tables, cross-tabulations and logistic regression. Maternal mortality ratios (MMR), odds ratios (OR) and 95% confidence intervals (CI) were used to analyse provincial disparities.ResultsMMR was highest in the Free State (286/100 000) and lowest in the Western Cape (87/100 000). Tuberculosis (10.4%) was the leading single indirect cause of maternal deaths while hypertensive disorders (9.1%) were the leading direct cause of death. KwaZulu-Natal women had a significantly higher risk of dying from sepsis (aOR=3.1,95% CI=1.2-7.9). North West women had the lowest risk of dying from hypertensive disorders (aOR=0.4,95% CI=0.2-0.7). The risk of dying from complications of labour was lowest for Gauteng women (aOR=0.4,95% CI=0.1-0.9). The 30–34 years age group had a significantly high risk (aOR=2.5,95% CI=1.6-4.0) of dying from abortion while the 25–29 years age group had a significantly higher risk of dying from maternal infectious diseases (aOR=2.3,95% CI=1.3-3.9). The 40–44 years age group had a significantly higher risk of dying from haemorrhage (aOR=2.3,95% CI=1.3-3.9 and the 45+ age group from other maternal diseases (aOR=3.3,95% CI=1.2-8.5) and miscellaneous direct causes (aOR=4.1,95% CI=1.7-9.9) respectively.ConclusionsThe study shows great variations in the distribution and causes of maternal deaths by age and provincial level. Poorer provinces had lower MMR than the better off provinces. The provincial variations in the leading causes of death indicate the importance of targeted interventions at sub-national level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1597-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 71%

Section: Resultsmentioning

confidence: 83%

A cross-sectional analysis of the geographic distribution and causes of maternal mortality in South Africa: 2002–2006

Bomela

2015

BMC Public Health

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“…The period of the sharp increase in maternal mortality ratios countries coincides with the period of sharp increases in HIV prevalence in the countries but it would be incorrect to attribute the increase solely to HIV prevalence. For example, Udjo and Lalthapersad-Pillay (2014) estimated that in 2007 only about 11% of the differences in maternal mortality ratio in the provinces in South Africa were explained by differences in HIV prevalence at provincial level. The beta coefficients in Table 5 indicate that during the period 1990 to 2008, the increase in maternal mortality ratio per unit time period was about 2% in Namibia, 9% in Botswana and 12% in Lesotho, South Africa and Swaziland.…”

Section: Resultsmentioning

confidence: 99%

Assessing the achievements of the Millennium Development Goals in Southern Africa

Udjo

Lalthapersad-Pillay

2015

APS

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Section: Introductionmentioning

confidence: 99%

“…The maternal mortality ratio (MMR) in South Africa remains high, and is unlikely to decrease sufficiently to achieve the millennium development goal of a 75% reduction in MMR between 1990 and 2015 . Although estimates of the national MMR vary widely, the causes of maternal deaths, especially those in health facilities, are better understood. Since 1997, compulsory reporting of maternal deaths has provided data on causes of maternal death in South Africa, published in triennial Saving Mothers reports from the National Committee on Confidential Enquiries into Maternal Deaths.…”

Section: Introductionmentioning

confidence: 99%

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

Buchmann

Mnyani

Frank

et al. 2014

BJOG

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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.

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Estimating maternal mortality and causes in South Africa: National and provincial levels

Cited by 17 publications

References 20 publications

A cross-sectional analysis of the geographic distribution and causes of maternal mortality in South Africa: 2002–2006

A cross-sectional analysis of the geographic distribution and causes of maternal mortality in South Africa: 2002–2006

Assessing the achievements of the Millennium Development Goals in Southern Africa

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

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