The triple threat of pregnancy, HIV infection and malaria: reported causes of maternal mortality in two nationwide health facility assessments in Mozambique, 2007 and 2012

BMC Pregnancy and Childbirth

Baltazar Chilundo⁶  Leonardo Chavane⁴  Kavita Singh¹  Allisyn C. Moran³  Emily Keyes²  Patricia E. Bailey⁵ 

[1] Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;Averting Maternal Death & Disability, Mailman School of Public Health, Columbia University, New York, NY, USA;Global Health Fellows Program II, United States Agency for International Development (USAID), Washington, DC, USA;MCSP/Jhpiego, Maputo, Mozambique;RMNCH Unit, Global Health Programs, FHI 360 359 Blackwell Street, Durham 27701, NC, USA;Departamento de Saúde da Comunidade, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique

关键词: HIV infection;    Malaria;    Mozambique;    Direct and indirect causes of death;    Maternal mortality;   

Others  :  1232709
DOI  :  10.1186/s12884-015-0725-7

 received in 2014-12-03, accepted in 2015-10-30,  发布年份 2015

【 摘 要 】

Background

The paper’s primary purpose is to determine changes in magnitude and causes of institutional maternal mortality in Mozambique. We also describe shifts in the location of institutional deaths and changes in availability of prevention and treatment measures for malaria and HIV infection.

Methods

Two national cross-sectional assessments of health facilities with childbirth services were conducted in 2007 and 2012. Each collected retrospective data on deliveries and maternal deaths and their causes. In 2007, 2,199 cases of maternal deaths were documented over a 12 month period; in 2012, 459 cases were identified over a three month period. In 2007, data collection also included reviews of maternal deaths when records were available (n = 712).

Results

Institutional maternal mortality declined from 541 to 284/100,000 births from 2007 to 2012. The rate of decline among women dying of direct causes was 66 % compared to 26 % among women dying of indirect causes. Cause-specific mortality ratios fell for all direct causes. Patterns among indirect causes were less conclusive given differences in cause-of-death recording. In absolute numbers, the combination of antepartum and postpartum hemorrhage was the leading direct cause of death each year and HIV and malaria the main non-obstetric causes. Based on maternal death reviews, evidence of HIV infection, malaria or anemia was found in more than 40 % of maternal deaths due to abortion, ectopic pregnancy and sepsis. Almost half (49 %) of all institutional maternal deaths took place in the largest hospitals in 2007 while in 2012, only 24 % occurred in these hospitals. The availability of antiretrovirals and antimalarials increased in all types of facilities, but increases were most dramatic in health centers.

Conclusions

The rate at which women died of direct causes in Mozambique’s health facilities appears to have declined significantly. Despite a clear improvement in access to antiretrovirals and antimalarials, especially at lower levels of health care, malaria, HIV, and anemia continue to exact a heavy toll on child-bearing women. Going forward, efforts to end preventable maternal and newborn deaths must maximize the use of antenatal care that includes integrated preventive/treatment options for HIV infection, malaria and anemia.

【 授权许可】

   
2015 Bailey et al.

【 图 表 】

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【 参考文献 】

• [1]Souza J, Tunçalp O, Vogel J, Bohren M, Widner M, Oladapo O, Say L, Gulmezoglu A, Temmerman M. Obstetric transition: the pathway towards ending preventable maternal deaths. BJOG. 2014; 121 Suppl. 1:1-4.
• [2]Ministério da Saúde. Avaliação das Necessidades de Serviços de Cuidados Obstétricos Neonatais de Emergência em Moçambique, 2012. Maputo. 2014
• [3]Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. World Health Organization, UNICEF, UNFPA, The World Bank, Geneva; 2014.
• [4]Say L, Chou D, Gemmill A, Tunçalp O, Moller A, Daniels J, Gulmezoglu A, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Global Health. 2014; 2014:1-11.
• [5]Khan K, Wojdyla D, Say L, Gulmezoglu A, Van Look P. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006; 367:1066-74.
• [6]Ter Kuile F, Parise M, Verhoeff F, Udhayakumar V, Newman R, Van Ejik AEA. The burden of co-infection with human immunodeficiency virus type 1 and malaria in pregnant women in sub-saharan Africa. Am J Trop Med Hyg. 2004; 71:41-54.
• [7]Zaba B, Calvert C, Marston M, Isingo R, Nakiyingi-Miiro J, Lutalo T, Crampin A, Robertson L, Herbst K, Newell ML, Todd J, Byass P, Boerma T, Ronsmans C. Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). Lancet. 2013; 381:1763-71.
• [8]Calvert C, Ronsmans C. The contribution of HIV to pregnancy-related mortality: a systematic review and meta-analysis. AIDS. 2013; 27:1631-1639.
• [9]Calvert C, Ronsmans C. HIV and the Risk of Direct Obstetric Complications: A Systematic Review and Meta-Analysis. PLOS One. 2013; 8:e74848.
• [10]Instituto Nacional de Estatística, Ministério da Saúde, Orc Macro/DHS Program. Moçambique Inquérito Demográfico e de Saúde 2003. Maputo. 2005
• [11]Minstério da Saúde, Instituto Nacional de Estatística, ICF International. Mozambique Demographic and Health Survey 2011. Maputo. 2013
• [12]Grollman C, Ronsmans C. Systematic review of the proportion of pregnancy-related deaths attributed to HIV in population-based studies in sub-Saharan Africa. Trop Med Int Health. 2014; 19:83-97.
• [13]Mortality in Mozambique: Results from a 2007–2008 Post-Census Mortality Survey. MEASURE Evaluation, Chapel Hill; 2012.
• [14]Singh K, Moran A, Story W, Bailey P, Chavane L. Acknowledging HIV and malaria as major causes of maternal mortality in Mozambique. Int J Gynaecol Obstet. 2014; 127(1):35-40.
• [15]Menéndez C, Romagosa C, Ismail M, Carrilho C, Saute F, Osman N, Machungo F, Bardaji A, Quinto L, Mayor A, Naniche D, Dobaño C, Alonso P, Ordi J. An Autopsy Study of Maternal Mortality in Mozambique: The Contribution of Infectious Diseases. PLoS Med. 2008; 5:e44.
• [16]Ordi J, Ismail MR, Carrilho C, Romagosa C, Osman N, Machungo F, Bombí JA, Balasch J, Alonso PL, Menéndez C. Clinico-pathological discrepancies in the diagnosis of causes of maternal death in sub-Saharan Africa: Retropective analysis. PLoS Med. 2009; 6:0174-0180.
• [17]Adler AJ, Filippi V, Thomas SL, Ronsmans C. Quantifying the global burden of morbidity of unsafe abortion: Magnitude in hospital-based studies and methodological issues. Int J Gynaecol Obstet. 2012; 118 Supplement 2:S65-S71.
• [18]Mabunda S, Mathe G, Streat E, Nery S, Kilian A. National Malaria Indicator Survey, Mozambique (MIS - 2007). Maputo: Ministry of Health; 2009.
• [19]Mcgregor IA. Epidemiology, malaria and pregnancy. Am J Trop Med Hyg. 1984; 33:517-525.
• [20]Desai M, Ter Kuile FO, Nosten F, Mcgready R, Asamoa K, Brabin B, Newman RD. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis. 2007; 7:93-104.
• [21]Romagosa C, Ordi J, Saute F, Quinto L, Machungo F, Ismail M, Carrilho C, Osman N, Alonso P, Menendez C. Seasonal variations in maternal mortality in Maputo, Mozambique: the role of malaria. Trop Med Int Health. 2007; 12:62-67.
• [22]World Health Organization. Strategies toward ending preventable maternal mortality (EPMM) [http://apps.who.int/iris/bitstream/10665/153544/1/9789241508483_eng.pdf?ua=1]. Accessed 5 Nov 2015.
• [23]Ministério da Saúde. Avaliação de Necessidades em Saúde Materna e Neonatal em Moçambique (Parte 1). Maputo. 2009.
• [24]Monitoring emergency obstetric care: a handbook. World Health Organization, Geneva; 2009.
• [25]Ministério da Saúde, Instituto Nacional de Estatística. Inquérito Nacional da Prevalência, Riscos Comportamentais, e Informação sobre SIDA em Moçambique (INSIDA). Maputo. 2009.
• [26]Li N, Matchi E, Speigelman D, Chalamilla G, Hertz-Mank E, Sando D, Dando M, Liu E, Muya A, Fawzi W. Maternal mortality among HIV-infected pregnant women in Tanzania. Acta Obstet Gynecol Scand. 2014; 93:463-468.
• [27]Brentlinger PE, Dgedge M, Chadreque Correia MA, Blanco Rojas AJ, Saúte F, Gimbel-Sherr KH, Stubbs BA, Mercer MA, Gloyd S. Intermittent preventive treatment of malaria during pregnancy in central Mozambique. Bull World Health Organ. 2007; 85:873-879.
• [28]Boene H, González R, Valá A, Rupérez M, Velasco C, Machevo S, Sacoor C, Sevene E, Macete E, Menéndez C, Munguambe K. Perceptions of Malaria in Pregnancy and Acceptability of Preventive Interventions among Mozambican Pregnant Women: Implications for Effectiveness of Malaria Control in Pregnancy. PLoS One. 2014; 9:e86038.
• [29]Agadjanian V, Hayford S. PMTCT, HAART, and Childbearing in Mozambique: An Institutional Perspective. AIDS Behavior. 2009; 13:S103-S112.
• [30]AMDD. AMDD Needs Assessment Toolkit [http://www.amddprogram.org/content/emoc-needs-assessments].