The impact of HIV infection on maternal deaths in South Africa

Abstract

Aim. To assess the impact of HIV infection on maternal deaths in South Africa from 2008 to 2010.

Method. Data extracted from the National Committee on Confidential Enquiries into Maternal Deaths database of maternal deaths, numbers of births from the District Health Information System (DHIS), and the estimated prevalence of HIV infection in the general population from the antenatal HIV and syphilis surveys were analysed. Estimations of the institutional maternal mortality ratios (iMMRs) for HIV-positive women compared with HIV-negative women and women of unknown status were made for each province and category of underlying cause of disease.

Results. The estimated iMMR for HIV-positive women was 430/100 000 live births and that for HIV-negative women 75/100 000 live births. In all categories of causes of death, the iMMR was increased in HIV-positive women. The major categories of causes of maternal death in HIV-negative women were complications of hypertensive disorders of pregnancy (18.8/100 000 live births), obstetric haemorrhage (17.2/100 000 live births) and medical and surgical disorders (11.5/100 000 live births), while in HIV-positive women they were non-pregnancy related infections (NPRIs) (267.3/100 000 live births), obstetric haemorrhage (38.4/100 000 live births) and pregnancy-related sepsis (miscarriages and sepsis following viable pregnancies – 34.1/100 000 live births). The major complications resulting in deaths were shock (38.0%), cardiac failure (31.9%) and respiratory failure.

Tuberculosis (26.9%), community-acquired pneumonia (26.7%) and pneumocystis pneumonia (13.3%), and cryptococcal meningitis (4.2%) and other meningitis (8.7%) were the main underlying causes of death in the NPRI group, of which 87.4% were HIV positive. Complications of highly active antiretroviral therapy (HAART) were recorded as the underlying cause of death in 73 women (8.1% of those on HAART).

Conclusion. HIV infection is the most important condition contributing to maternal death in South Africa. HIV-positive women are more likely to die of any underlying cause than HIV-negative women, with NPRI being the most common contributory condition.