Mortality in women of reproductive age in rural South Africa

Abstract

ObjectiveTo determine causes of death and associated risk factors in women of reproductive age in rural South Africa.MethodsDeaths and person-years of observation (pyo) were determined for females (aged 15–49 years) resident in 15,526 households in a rural South African Demographic and Health Surveillance site from 2000 to 2009. Cause of death was ascertained by verbal autopsy and ICD-10 coded; causes were categorized as HIV/TB, non-communicable, communicable/maternal/perinatal/nutrition, injuries, and undetermined (unknown). Characteristics of women were obtained from regularly updated household visits, while HIV and self-reported health status was obtained from the annual HIV surveillance. Overall and cause-specific mortality rates (MRs) with 95% confidence intervals (CI) were calculated. The Weibull regression model (HR, 95% CI) was used to determine risk factors associated with mortality.ResultsA total of 42,703 eligible women were included; 3,098 deaths were reported for 212,607 pyo. Overall MRwas 14.6 deaths/1,000 pyo (95% CI: 14.1–15.1), peaking in 2003 (MR 18.2/1,000 pyo, 95% CI: 16.4–20.1) and declining thereafter (2009: MR 9.6/1,000 pyo, 95% CI: 8.4–10.9). Mortality was highest for HIV/TB (MR 10.6/1,000 pyo, 95% CI: 10.2–11.1), accounting for 73.1% of all deaths, ranging from 61.2% in 2009 to 82.7% in 2002. Adjusting for education level, marital status, age, employment status, area of residence, and migration, all-cause mortality was associated with external migration (adjusted hazard ratio, or aHR), 1.70, 95% CI: 1.41–2.05), self-reported poor health status (aHR 8.26, 95% CI: 2.94–23.15), and HIV-infection (aHR 7.84, 95% CI: 6.26–9.82); external migration and HIV infection were also associated with causes of mortality other than HIV/TB (aHR 1.62, 95% CI: 1.12–2.34 and aHR 2.59, 95% CI: 1.79–3.75).ConclusionHIV/TB was the leading cause of death among women of reproductive age, although rates declined with the rollout of HIV treatment in the area from 2004. Women's age, external migration status and HIV-positive status were significantly associated with all-cause and cause-specific mortality.

Health and Health Care in South Africa — 20 Years after Mandela

“…29 Reported trends in maternal mortality vary widely. 31 Although the combination of HIV and tuberculosis is the leading cause of death among women of reproductive age in KwaZulu-Natal province, death rates have declined since the launch of the ART program in 2003 (Fig. 6 Many maternal deaths in South Africa are related to HIV infection.…”

“…6 Many maternal deaths in South Africa are related to HIV infection. 31 Estimates of life expectancy at birth in the general population increased from 54 years in 2005 to 60 years in 2012 (Table 1). 2).…”

Correlates of Lifetime Trauma Exposure Among Pregnant Women from Cape Town, South Africa

“…Among women, a history of trauma exposure is associated with the development of common mental disorders such as post-traumatic stress disorder, depression, and substance use disorders (Kaminer et al, 2013; Nabakulu, Klipstein-Grobusch, Herbst, & Newell, 2013; Seedat et al, 2009), which not only reduce women's quality of life but also increase risk of HIV acquisition from increased sexual-risk taking behaviour (Jewkes, Dunkle, Nduna, Jama, & Puren, 2010; Myers et al, 2013; Wechsberg et al, 2013). These correlates of trauma exposure have also been found among pregnant women.…”

The changing face of the HIV epidemic in sub‐Saharan Africa

“…Women's age, external migration and HIV‐positive status were significantly associated with all‐cause mortality; in the study, the overall mortality rate was 14.6 deaths per 1000 person‐years of observation, peaking in 2003 at 18.2/1000 and declining to 9.6/1000 in 2009 (Nabukalu et al . ).…”