Journal articles: 'Maternal Mortality – South Africa'

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Mmusi-Phetoe, R. M. "MAGNITUDE OF MATERNAL MORTALITY IN SOUTH AFRICA: VIEWS FROM SOUTH AFRICAN EXPERTS." Africa Journal of Nursing and Midwifery 18, no. 2 (November 1, 2016): 132–45. http://dx.doi.org/10.25159/2520-5293/884.

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Rout, Chris. "Maternal mortality and anaesthesia in Africa: a South African perspective." International Journal of Obstetric Anesthesia 11, no. 2 (April 2002): 77–80. http://dx.doi.org/10.1054/ijoa.2002.0944.

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Mmusi-Phetoe, Rose Maureen Makapi, and Brian Barasa Masaba. "Developing a model for reducing maternal mortality in South Africa." Frontiers of Nursing 8, no. 3 (September 1, 2021): 269–77. http://dx.doi.org/10.2478/fon-2021-0028.

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Abstract Objective High maternal mortality ratios (MMRs) remain a concern in many parts of the world, especially in developing countries like South Africa. Different models have been developed, tried, and tested worldwide, in the hope that they will reduce maternal mortality, but without much success. Methods A qualitative approach was used to conveniently select a sample of 10 women attending an antenatal clinic in a rural area, in one of the districts of KwaZulu-Natal (KZN) Province. Data were collected by means of interviews with the women. Data were analyzed employing Burnard's content analysis approach. Results Four themes emerged: (1) age at first pregnancy; (2) birth intervals, risks in pregnancy and hospitalization; (3) the use of contraception; and (4) HIV status. All themes that emerged revealed inattention to reproductive health (RH) needs, resulting in poor RH outcomes as an area of concern. Conclusions Greater emphasis needs to be placed on meeting the sexual and reproductive health (SRH) needs of South African women, if maternal mortality rates are to be reduced. An alternative model for reducing maternal mortality in South Africa is proposed.

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VAN COEVERDEN de GROOT, H. A. "Maternal mortality in the Peninsula Maternal and Neonatal Service, Cape Town, South Africa." European Journal of Anaesthesiology 14, no. 5 (September 1997): 528. http://dx.doi.org/10.1097/00003643-199709000-00020.

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Akobirshoev, Ilhom, Hussaini Zandam, Allyala Nandakumar, Nora Groce, Mark Blecher, and Monika Mitra. "The compounding effect of having HIV and a disability on child mortality among mothers in South Africa." PLOS ONE 16, no. 5 (May 5, 2021): e0251183. http://dx.doi.org/10.1371/journal.pone.0251183.

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Background Previous research on the association between maternal HIV status and child mortality in sub–Saharan Africa was published between 2005–2011. Findings from these studies showed a higher child mortality risk among children born to HIV–positive mothers. While the population of women with disabilities is growing in developing countries, we found no research that examined the association between maternal disability in HIV–positive mothers, and child mortality in sub–Saharan Africa. This study examined the potential compounding effect of maternal disability and HIV status on child mortality in South Africa. Methods We analyzed data for women age 15–49 years from South Africa, using the nationally representative 2016 South Africa Demographic and Health Survey. We estimated unadjusted and adjusted risk ratios of child mortality indicators by maternal disability and maternal HIV using modified Poisson regressions. Results Children born to disabled mothers compared to their peers born to non-disabled mothers were at a higher risk for neonatal mortality (RR = 1.80, 95% CI:1.31–2.49), infant mortality (RR = 1.69, 95% CI:1.19–2.41), and under-five mortality (RR = 1.78, 95% CI:1.05–3.01). The joint risk of maternal disability and HIV-positive status on the selected child mortality indicators is compounded such that it is more than the sum of the risks from maternal disability or maternal HIV-positive status alone (RR = 3.97 vs. joint RR = 3.67 for neonatal mortality; RR = 3.57 vs. joint RR = 3.25 for infant mortality; RR = 6.44 vs. joint RR = 3.75 for under-five mortality). Conclusions The findings suggest that children born to HIV-positive women with disabilities are at an exceptionally high risk of premature mortality. Established inequalities faced by women with disabilities may account for this increased risk. Given that maternal HIV and disability amplify each other’s impact on child mortality, addressing disabled women’s HIV-related needs and understanding the pathways and mechanisms contributing to these disparities is crucial.

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KHAN, M., T. PILLAY, J. MOODLEY, and C. CONNOLLY. "Maternal Mortality Associated with Tuberculosis-HIV Coinfection in Durban, South Africa." Annals of the New York Academy of Sciences 918, no. 1 (January 25, 2006): 367–69. http://dx.doi.org/10.1111/j.1749-6632.2000.tb05508.x.

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Moodley, D., A. J. Payne, and J. Moodley. "Maternal Mortality in Kwazulu/Natal: Need for an Information Database System and Confidential Enquiry into Maternal Deaths in Developing Countries." Tropical Doctor 26, no. 2 (April 1996): 50–54. http://dx.doi.org/10.1177/004947559602600202.

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In a 2-year retrospective analysis of 147 maternal deaths in South African urban and rural hospitals, the maternal mortality rate (MMR) was estimated to be 144 per 100 000 live births. MMR was significantly higher ( P = 0.025) in urban hospitals (160 per 100 000) and the main causes of death were hypertensive disease in pregnancy (33%), of which eclampsia contributed to 70% of deaths, and haemorrhage (18%). Only 49.7% of women who died, attended an antenatal clinic. The MMR in South Africa is lower than sub-Saharan countries but unacceptably high for a country with a mix of private and public medicine. Disparities have been noted in maternal mortality rates within the country due to different study designs and poor documentation. Structural changes in the health care system would only be possible if a common information database system were established and confidential enquiries held into maternal deaths.

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Udjo, Eric O., and Pinky Lalthapersad-Pillay. "Estimating maternal mortality and causes in South Africa: National and provincial levels." Midwifery 30, no. 5 (May 2014): 512–18. http://dx.doi.org/10.1016/j.midw.2013.05.011.

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Garenne, Michel, Robert McCaa, and Kourtoum Nacro. "Maternal mortality in South Africa: an update from the 2007 Community Survey." Journal of Population Research 28, no. 1 (September 21, 2010): 89–101. http://dx.doi.org/10.1007/s12546-010-9037-y.

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Yaya, Sanni, Seun Stephen Anjorin, and Sunday A. Adedini. "Disparities in pregnancy-related deaths: spatial and Bayesian network analyses of maternal mortality ratio in 54 African countries." BMJ Global Health 6, no. 2 (February 2021): e004233. http://dx.doi.org/10.1136/bmjgh-2020-004233.

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BackgroundMaternal mortality remains a public health problem despite several global efforts. Globally, about 830 women die of pregnancy-related death per day, with more than two-third of these cases occurring in Africa. We examined the spatial distribution of maternal mortality in Africa and explored the influence of SDoH on the spatial distribution.MethodsWe used country-level secondary data of 54 African countries collected between 2006 and 2018 from three databases namely, World Development Indicator, WHO’s Global Health Observatory Data and Human Development Report. We performed descriptive analyses, presented in tables and maps. The spatial analysis involved local indicator of spatial autocorrelation maps and spatial regression. Finally, we built Bayesian networks to determine and show the strength of social determinants associated with maternal mortality.ResultsWe found that the average prevalence of maternal mortality ratio (MMR) in Africa was 415 per 100 000 live births. Findings from the spatial analyses showed clusters (hotspots) of MMR with seven countries (Guinea-Bissau, Guinea, Sierra Leone, Cote d’Ivoire, Chad and Cameroon, Mauritania), all within the Middle and West Africa. On the other hand, the cold spot clusters were formed by two countries; South Africa and Namibia; eight countries (Algeria, Tunisia, Libya, Ghana, Gabon and Congo, Equatorial Guinea and Cape Verde) formed low–high clusters; thus, indicating that these countries have significantly low MMR but within the neighbourhood of countries with significantly high MMR. The findings from the regression and Bayesian network analysis showed that gender inequities and the proportion of skilled birth attendant are strongest social determinants that drive the variations in maternal mortality across Africa.ConclusionMaternal mortality is very high in Africa especially in countries in the middle and western African subregions. To achieve the target 3.1 of the sustainable development goal on maternal health, there is a need to design effective strategies that will address gender inequalities and the shortage of health professionals.

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Mokwena, Kebogile Mokwena. "Neglecting Maternal Depression Compromises Child Health and Development Outcomes, and Violates Children’s Rights in South Africa." Children 8, no. 7 (July 19, 2021): 609. http://dx.doi.org/10.3390/children8070609.

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The intention of the South African Children’s Act 38 of 2005 is to provide guarantees for the protection and promotion of optimum health and social outcomes for all children. These guarantees are the provision of basic nutrition, basic health care and social services, optimal family or parental care, as well as protection from maltreatment, neglect and abuse services. However, despite these guarantees, child and maternal mortality remain high in South Africa. The literature identifies maternal depression as a common factor that contributes to negative health and social outcomes for both mothers and their children. Despite the availability of easy-to-use tools, routine screening for maternal depression is not carried out in public health services, which is the source of services for the majority of women in South Africa. The results are that the mothers miss out on being diagnosed and treated for maternal depression, which results in negative child outcomes, such as malnutrition, as well as impacts on mental, social and physical health, and even death. The long-term impacts of untreated maternal depression include compromised child cognitive development, language acquisition and deviant behaviors and economic disadvantage in later life. The author concludes that the neglect of screening for, and treatment of maternal depression therefore violates the constitutional rights of the affected children, and goes against the spirit of the Constitution. The author recommends that maternal and child health services integrate routine screening for maternal depression, which will not only satisfy the Constitutional mandate, but also improve the health and developmental outcomes of the children and reduce child mortality.

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Khan, Munira, Thillagavathie Pillay, Jagadesa M. Moodley, and Catherine A. Connolly. "Maternal mortality associated with tuberculosis–HIV-1 co-infection in Durban, South Africa." AIDS 15, no. 14 (September 2001): 1857–63. http://dx.doi.org/10.1097/00002030-200109280-00016.

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Tomkins, Andrew. "Nutrition and maternal morbidity and mortality." British Journal of Nutrition 85, S2 (May 2001): S93—S99. http://dx.doi.org/10.1079/bjn2001358.

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Nearly 600 000 women die every year from pregnancy related conditions and the maternal mortality rates (MMR = deaths per 100 000 live births) in developing countries may be as high as 1000 compared with less than ten in industrialised countries. In the light of the striking impact of deficiencies of micronutrients such as vitamin A and zinc on immune function, morbidity and mortality in children it seems reasonable to suggest that such deficiencies might play a contributing role in the high rates of morbidity and mortality in mothers. Hitherto, there has been rather little published on the contribution of malnutrition to maternal morbidity or mortality but recent results of micronutrient supplementation show a major effect of vitamin A or beta carotene supplementation on maternal mortality in Nepal and an impressive effect of a multiple micronutrient mixture on pregnancy outcome in Tanzania. There is now data showing that subclinical mastitis, a potential risk factor for mother to child transmission of HIV by increasing levels of virus in breast milk, is influenced by maternal diet in Tanzania and feeding patterns in South Africa. Considering the massive tragedy of maternal mortality the recent data provides opportunities for new, innovative nutritional interventions for the reduction of the global burden of maternal morbidity and mortality.

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Coovadia, Ashraf Hassen, Ameena Ebrahim Goga, and Laurie Schowalter. "Call To action - Prevention of mother To child transmission of HIV." Southern African Journal of HIV Medicine 10, no. 4 (December 14, 2009): 12. http://dx.doi.org/10.4102/sajhivmed.v10i4.256.

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The Prevention of Mother to Child Transmission of HIV (PMTCT)programme is a critical intervention to reduce the incidence of paediatric HIV infections . It is also a key intervention to decrease infant, child and maternal mortality. The optimal implementation of a sound, evidence-based PMTCT programme is essential to meet both the HIV reduction targets in the National Strategic Plan1 and to achieve Millennium Development Goals(MDGs) 4 (reducing infant and child mortality) and 5 (reducing maternal mortalty).2 Since 2001, South Africa has been implementing a programme to prevent mother-to-child transmission of HIV. Since 2007, national PMTCT policy has evolved into a strong, enabling framework that should reduce vertical transmission significantly. This paper reviews the milestone studies that have contributed to our knowledge about drug regimens to reduce MTCT (mother-to-child transmission of HIV), reviews the latest South African PMTCT guidelines and the possible future changes. Strengthened / revised drug regimens for PMTCT are, essential but insufficient for measureable decreases in HIV transmission and improvements in maternal and childl health. The main challenge is implementation. Until the enhanced PMTCT policy is effectively operationalised, measureable achievements will remain elusive.

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Kruger, A. M., and S. Bhagwanjee. "HIV/AIDS: Impact on maternal mortality at the Johannesburg Hospital, South Africa, 1995–2001." International Journal of Obstetric Anesthesia 12, no. 3 (July 2003): 164–68. http://dx.doi.org/10.1016/s0959-289x(03)00038-4.

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Ntuli, Sam T., Mabina Mogale, Francis L. M. Hyera, and Shan Naidoo. "An investigation of maternal mortality at a tertiary hospital of the Limpopo province of South Africa." Southern African Journal of Infectious Diseases 32, no. 2 (July 1, 2017): 73–76. http://dx.doi.org/10.4102/sajid.v32i2.57.

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Objective: To understand the elements influencing the maternal deaths in the Limpopo province, South Africa.Methods: A retrospective review of all maternal deaths which occurred at the Pietersburg Hospital, Limpopo province was done over a five-year period (January 2011 to December 2015). The hospital death register was used to collate a list of maternal deaths occurring during the study period. The medical records of maternal deaths were reviewed. The total deliveries and live births for each year were obtained from the delivery registers. The data collected included maternal age, parity, referring facility, date of admission, date and time of death, ward where death occurred, and cause of death.Results: There were 14 685 live births and 232 maternal deaths between 2011 and 2015, resulting in an institutional Maternal Mortality Ratio (iMMR) of 1579/100 000 live births. The mean age of the patients was 29 years. Forty-three per cent of deaths occurred within 24 hours of admission, 35% died in ICU and 89% were referred from regional and district hospitals and community health centres. Of the referred patients, 83% were from district hospitals. Obstetric haemorrhage and pre-eclampsia, or eclampsia, were the main causes of death.Conclusion: The iMMR at Pietersburg Hospital remains unacceptably high. Most of the maternal deaths are due to obstetric haemorrhage, pre-eclampsia or eclampsia, medical and surgical disorder and non-pregnancy related infections.

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Ntuli, Sam T. "Obstetrical Haemorrhagic Mortality in a Tertiary Hospital of the Limpopo Province, South Africa." Medical Science & Healthcare Practice 1, no. 1 (April 6, 2017): 42. http://dx.doi.org/10.22158/mshp.v1n1p42.

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Background: Obstetric haemorrhage is potentially fatal. Its frequency contributes to assessment of population health. So this study purpose was to assess the maternal deathsdue to obstetric haemorrhage in a tertiary hospital of the Limpopo Province, South Africa. Methods: Allmaternal deaths, which occurred at Pietersburg Hospitalfrom January 2011 to December 2015 were reviewed. The hospital death register was used to collate the list of maternal deaths.Maternalage, parity, referring facility, date of admission and death, ward where death occurred, and causes of deathwere collected from delivery registers and patient medical records.Results: There were 232 maternal deaths of which 48 (20.7%) were due to obstetrical haemorrhage. The mean age of the 48 women was 31.7±6.7 year range 15-48 years. Thirty one of 48 haemorrhagic deaths (65%) occurred within 24 hours of admission, 16 of 48 (33%) had a parity of 3 or more, 19 (40%) died in ICU and 12 (25%) in casualty. Forty three of 48 women (90%) were referred, of which 36 (84%) were from district hospitals. Post-partum haemorrhage accounted for 39 of 48 (81%) deaths followed by unspecifiedante-partum haemorrhage accounting for 4 (8%) and placenta abruption 2 of 48 (4%).Conclusion: This study demonstrated that a maternal death due to obstetric haemorrhage remains a major concern in Limpopo Province. Post-partum haemorrhage was the main cause of deaths.

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Marabele, Portia Maphale, Maria Sonto Maputle, Dorah Ursula Ramathuba, and Lizzy Netshikweta. "Cultural Factors Contributing to Maternal Mortality Rate in Rural Villages of Limpopo Province, South Africa." International Journal of Women's Health Volume 12 (August 2020): 691–99. http://dx.doi.org/10.2147/ijwh.s231514.

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Lestari, Indah, Heni Frilasari, and Heru Santoso Wahito Nugroho. "Cultural Factors Contributing to Maternal Mortality Rate in Rural Villages of Limpopo, South Africa [Letter]." International Journal of Women's Health Volume 12 (October 2020): 881–82. http://dx.doi.org/10.2147/ijwh.s283439.

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Mathibe-Neke, J. M. "Evaluation of strategies to reduce maternal mortality in Fezile Dabi District, Free State, South Africa." African Journal for Physical Activity and Health Sciences (AJPHES) 26, no. 3 (September 2020): 300–315. http://dx.doi.org/10.37597/ajphes.2020.26.3.6.

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Mostert, Cyprian Mcwayizeni. "The impact of national health promotion policy on stillbirth and maternal mortality in South Africa." Public Health 198 (September 2021): 118–22. http://dx.doi.org/10.1016/j.puhe.2021.07.009.

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Martin, C. E., and V. Black. "Tuberculosis prevention in HIV-infected pregnant women in South Africa." Southern African Journal of HIV Medicine 13, no. 4 (October 4, 2012): 182. http://dx.doi.org/10.4102/sajhivmed.v13i4.113.

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The high burden of HIV and tuberculosis (TB) among pregnant women in South Africa contributes to a high maternal mortality rate. Isoniazid preventive therapy (IPT) is recommended for the prevention of active TB in HIV-infected individuals, including pregnant women. However, there are few data regarding IPT use in the latter, with concern regarding the concurrent use of IPT with nevirapine in pregnancy, as both treatments are hepatotoxic. The benefit and safety of IPT in HIV-infected pregnant women has not been established. We recommend a simplification of HIV and TB interventions by providing triple antiretroviral therapy to all HIV-infected pregnant women.

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Mothiba, T. M., L. Skaal, and V. Berggren. "Listen to the Midwives in Limpopo Province South Africa: An Exploratory Study on Maternal Care." Open Public Health Journal 12, no. 1 (November 15, 2019): 424–29. http://dx.doi.org/10.2174/1874944501912010424.

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Background and Aim: South Africa is a middle-income country that did not reach the United Nations Millennium Development Goal 5 by 2015, because maternal mortality ratio increased between 1990 and 2015. Limpopo is a rural province, and its institutional maternal mortality ratio is higher than the national average. Studies reported that there is a shortage of midwives and medical equipment in the province. This study is part of a broader research program focusing on strengthening health systems for maternal care in Limpopo province, and it was aimed at exploring the experiences of Midwives prior to debriefing and training sessions conducted. Methods: Qualitative research was used whereby five focus group interviews were conducted with midwives from five districts to share experiences during the provision of maternal healthcare and to propose solutions thereof. Tesch’s open coding qualitative data analysis was used. Results: The findings revealed that there is a lack of resources, feelings of isolation, problems related to logistical issues, staffing issues, demographic characteristics of the population, interinstitutional communication, and lack of administrative support. Conclusion: Hospital managers must revise how they allocate resources, improve inter-institutional cooperation, and change of management attitude. This study concludes that the midwives identified numerous challenges that originate from a lack of resources. Revision for resource allocation is hoped that it will solve logistical problems, increased inter-institutional cooperation in terms of capacity building and patient assessment suggested with the hope to minimize the challenges of communication and staffing.

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Pillay, Y., and P. Barron. "On the path to reach the SDG targets: Decreasing maternal and child mortality in South Africa." South African Medical Journal 108, no. 3a (March 2, 2018): 2. http://dx.doi.org/10.7196/samj.2017.v108i3b.12901.

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Ntuli, Sam Thembelihle, Mabina Mogale, Francis LM Hyera, and Shan Naidoo. "An investigation of maternal mortality at a tertiary hospital of the Limpopo province of South Africa." Southern African Journal of Infectious Diseases 32, no. 2 (April 7, 2017): 73–76. http://dx.doi.org/10.1080/23120053.2017.1293902.

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Black, Vivian, Sebastian Brooke, and Matthew F. Chersich. "Effect of Human Immunodeficiency Virus Treatment on Maternal Mortality at a Tertiary Center in South Africa." Obstetrics & Gynecology 114, no. 2, Part 1 (August 2009): 292–99. http://dx.doi.org/10.1097/aog.0b013e3181af33e6.

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Mashamba-Thompson, Tivani P., Paul K. Drain, Desmond Kuupiel, and Benn Sartorius. "Impact of Implementing Antenatal Syphilis Point-of-Care Testing on Maternal Mortality in KwaZulu-Natal, South Africa: An Interrupted Time Series Analysis." Diagnostics 9, no. 4 (December 10, 2019): 218. http://dx.doi.org/10.3390/diagnostics9040218.

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Background: Syphilis infection has been associated with an increased risk of HIV infection during pregnancy which poses greater risk for maternal mortality, and antenatal syphilis point-of-care (POC) testing has been introduced to improve maternal and child health outcomes. There is limited evidence on the impact of syphilis POC testing on maternal outcomes in high HIV prevalent settings. We used syphilis POC testing as a model to evaluate the impact of POC diagnostics on the improvement of maternal mortality in KwaZulu-Natal, South Africa. Methods: We extracted 132 monthly data points on the number of maternal deaths in facilities and number of live births in facilities for 12 tertiary healthcare facilities in KwaZulu-Natal (KZN), South Africa from 2004 to 2014 from District Health Information System (DHIS) health facility archived. We employed segmented Poisson regression analysis of interrupted time series to assess the impact of the exposure on maternal mortality ratio (MMR) before and after the implementation of antenatal syphilis POC testing. We processed and analyzed data using Stata Statistical Software: Release 13. (Stata, Corp LP, College Station, TX, USA). Results: The provincial average annual maternal mortality ratio (MMR) was estimated at 176.09 ± 43.92 ranging from a minimum of 68.48 to maximum of 225.49 per 100,000 live births. The data comprised 36 temporal points before the introduction of syphilis POC test exposure and 84 after the introduction in primary health care clinics in KZN. The average annual MMR for KZN from 2004 to 2014 was estimated at 176.09 ± 43.92. A decrease in MMR level was observed during 2008 after syphilis POC test implementation, followed by a rise during 2009. Analysis of the MMR trend estimates a significant 1.5% increase in MMR trends during the period before implementation and 1.3% increase after implementation of syphilis POC testing (p < 0.001). Conclusion: Although our finding suggests a brief reduction in the MMR trend after the implementation of antenatal syphilis POC testing, a continued increase in syphilis rates is seen in KwaZulu-Natal, South Africa. The study used one of the most powerful quasi-experimental research methods, segmented Poisson regression analysis of interrupted time series to model the impact of syphilis POC on maternal outcome. The study finding requires confirmation by use of more rigorous primary study design.

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Leslie, Joanne, Elizabeth Ciemins, and Suzanne Bibi Essama. "Female Nutritional Status across the Life-Span in Sub-Saharan Africa. 1. Prevalence Patterns." Food and Nutrition Bulletin 18, no. 1 (January 1997): 1–22. http://dx.doi.org/10.1177/156482659701800105.

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This article reviews and synthesizes existing nutritional studies that provide gender-disaggregated data from sub-Saharan Africa. The analytic focus is on female nutritional status across the life-span. However, it was found that available data are biased towards preschool children and women of reproductive age. As in other economically disadvantaged parts of the world, the two most prevalent nutritional deficiencies among females in sub-Saharan Africa are iron-deficiency anaemia and protein-energy malnutrition. In comparison with other regions of the world, sub-Saharan African females seem to be nutritionally better off than females in South Asia, but as malnourished as, or more malnourished than, females elsewhere. Indirect indicators of nutritional status, such as birthweight and maternal mortality, suggest that the nutritional situation of women in Western Africa is poorer than that of women in Eastern and Southern Africa. In comparison with males in sub-Saharan Africa, however, no consistent pattern of female nutritional disadvantage was found.

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Michaelis, Isabel A., Ingeborg Krägeloh-Mann, Ncomeka Manyisane, Mikateko C. Mazinu, and Esme R. Jordaan. "Prospective cohort study of mortality in very low birthweight infants in a single centre in the Eastern Cape province, South Africa." BMJ Paediatrics Open 5, no. 1 (February 2021): e000918. http://dx.doi.org/10.1136/bmjpo-2020-000918.

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BackgroundNeonatal mortality is a major contributor worldwide to the number of deaths in children under 5 years of age. The primary objective of this study was to assess the overall mortality rate of babies with a birth weight equal or below 1500 g in a neonatal unit at a tertiary hospital in the Eastern Cape Province, South Africa. Furthermore, different maternal-related and infant-related factors for higher mortality were analysed.MethodsThis is a prospective cohort study which included infants admitted to the neonatal wards of the hospital within their first 24 hours of life and with a birth weight equal to or below 1500 g. Mothers who consented answered a questionnaire to identify factors for mortality.Results173 very low birth weight (VLBW) infants were recruited in the neonatal department between November 2017 and December 2018, of whom 55 died (overall mortality rate 32.0%). Twenty-three of the 44 infants (53,5%) with a birth weight below 1000 g died during the admission. One hundred and sixty-one mothers completed the questionnaire and 45 of their babies died.Main factors associated with mortality were lower gestational age and lower birth weight. Need for ventilator support and sepsis were associated with higher mortality, as were maternal factors such as HIV infection and age below 20 years.ConclusionThis prospective study looked at survival of VLBW babies in an underprivileged part of the Eastern Cape of South Africa. Compared with other public urban hospitals in the country, the survival rate remains unacceptably low. Further research is required to find the associated causes and appropriate ways to address these.

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Price, Jessica, Merlin Willcox, Vuyiswa Dlamini, Audrey Khosa, Phindile Khanyile, Janet Seeley, Anthony Harnden, Kathleen Kahn, and Lisa Hinton. "Care-seeking during fatal childhood illness in rural South Africa: a qualitative study." BMJ Open 11, no. 4 (April 2021): e043652. http://dx.doi.org/10.1136/bmjopen-2020-043652.

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ObjectivesThis study aimed to better understand reasons why children in South Africa die at home, including caregivers’ care-seeking experiences, decision-making, choice of treatment provider and barriers to accessing care during a child’s final illness.DesignThis qualitative study included semi-structured in-depth interviews and focus group discussions with caregivers of children who died below the age of 5 years. Data were thematically analysed, and key findings compared with the Pathways to Survival Framework—a model frequently used in the study of child mortality. An adapted model was developed.SettingTwo rural health and demographic surveillance system (HDSS) sites in South Africa—the Agincourt HDSS and the Africa Health Research Institute.ParticipantsThirty-eight caregivers of deceased children (29 participated in in-depth interviews and 9 were participants in two focus group discussions). Caregivers were purposively sampled to ensure maximum variation across place of death, child age at death, household socioeconomic status, maternal migration status and maternal HIV status.FindingsAlthough caregivers faced barriers in providing care to children (including insufficient knowledge and poor transport), almost all did seek care from the formal health system. Negative experiences in health facilities did not deter care-seeking, but most respondents still received poor quality care and were not given adequate safety-netting advice. Traditional healers were only consulted as a last resort when other approaches had failed.ConclusionBarriers to accessing healthcare disrupt the workings of previously accepted care-seeking models. The adapted model presented in this paper more realistically reflects care-seeking experiences and decision-making during severe childhood illness in rural South Africa and helps explain both the persistence of home deaths despite seeking healthcare, and the impact of a child’s death on care-seeking in future childhood illness. This model can be used as the basis for developing interventions to reduce under-5 mortality.

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Irene Ramavhoya, Thifhelimbilu, Maria Sonto Maputle, Rachel Tsakani Lebese, and Lufuno Makhado. "Midwives’ challenges in the management of postpartum haemorrhage at rural PHC facilities of Limpopo province, South Africa: an explorative study." African Health Sciences 21, no. 1 (April 16, 2021): 311–9. http://dx.doi.org/10.4314/ahs.v21i1.40.

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Background: Postpartum haemorrhage is one of the causes of the rise in maternal mortality. Midwives’ experiences related to postpartum haemorrhage (PPH) management remain unexplored, especially in Limpopo. The purpose of the study was to explore the challenges experienced by midwives in the management of women with PPH. Methods: Qualitative research was conducted to explore the challenges experienced by midwives in the management of women with PPH. Midwives were sampled purposefully. Unstructured interviews were conducted on 18 midwives working at primary health care facilities. Data were analysed after data saturation. Results: After data analysis, one theme emerged “challenges experienced by midwives managing women with PPH” and five subthemes, including: “difficulty experienced resulting in feelings of frustrations and confusion and lack of time and shortage of human resource inhibits guidelines consultation”. Conclusion: The study findings revealed that midwives experienced difficulty when managing women with postpartum haemorrhage. For successful implementation of maternal health care guidelines, midwives should be capacitated through training, supported and supervised in order to execute PPH management with ease. Keywords: Midwifery in South Africa; implementation of maternal guidelines; postpartum haemorrhage; maternal mortality.

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Mejia-Pailles, Gabriela, Ann Berrington, Nuala McGrath, and Victoria Hosegood. "Trends in the prevalence and incidence of orphanhood in children and adolescents <20 years in rural KwaZulu-Natal South Africa, 2000-2014." PLOS ONE 15, no. 11 (November 24, 2020): e0238563. http://dx.doi.org/10.1371/journal.pone.0238563.

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Background In South Africa, large increases in early adult mortality during the 1990s and early 2000s have reversed since public HIV treatment rollout in 2004. In a rural population in KwaZulu-Natal, we investigate trends in parental mortality and orphanhood from 2000–2014. Methods Using longitudinal demographic surveillance data for a population of approximately 90,000, we calculated annual incidence and prevalence of maternal, paternal and double orphanhood in children and adolescents (<20 years) and, overall and cause-specific mortality of parents by age. Results The proportion of children and adolescents (<20 years) for whom one or both parents had died rose from 26% in 2000 to peak at 36% in 2010, followed by a decline to 32% in 2014. The burden of orphanhood remains high especially in the oldest age group: in 2014, 53% of adolescents 15–19 years had experienced the death of one or both parents. In all age groups and years, paternal orphan prevalence was three-five times higher than maternal orphan prevalence. Maternal and paternal orphan incidence peaked in 2005 at 17 and 27 per 1,000 person years respectively (<20 years) before declining by half through 2014. The leading cause of parental death throughout the period, HIV/AIDS and TB cause-specific mortality rates declined substantially in mothers and fathers from 2007 and 2009 respectively. Conclusions The survival of parents with children and adolescents <20 years has improved in tandem with earlier initiation and higher coverage of HIV treatment. However, comparatively high levels of parental deaths persist in this rural population in KwaZulu-Natal, particularly among fathers. Community-level surveillance to estimate levels of orphanhood remains important for monitoring and evaluation of targeted state welfare support for orphans and their guardians.

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Bone, Jeffrey N., Kelly Pickerill, Mai-Lei Woo Kinshella, Marianne Vidler, Rachel Craik, Lucilla Poston, William Stones, et al. "Pregnancy cohorts and biobanking in sub-Saharan Africa: a systematic review." BMJ Global Health 5, no. 11 (November 2020): e003716. http://dx.doi.org/10.1136/bmjgh-2020-003716.

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BackgroundTechnological advances and high throughput biological assays can facilitate discovery science in biobanks from population cohorts, including pregnant women. Biological pathways associated with health outcomes differ depending on geography, and high-income country data may not generalise to low-resource settings. We conducted a systematic review to identify prospective pregnancy cohorts in sub-Saharan Africa (SSA) that include biobanked samples with potential to enhance discovery science opportunity.MethodsInclusion criteria were prospective data collection during pregnancy, with associated biobanking in SSA. Data sources included: scientific databases (with comprehensive search terms), grey literature, hand searching applicable reference lists and expert input. Results were screened in a three-stage process based on title, abstract and full text by two independent reviewers. The review is registered on PROSPERO (CRD42019147483).ResultsFourteen SSA studies met the inclusion criteria from database searches (n=8), reference list searches (n=2) and expert input (n=4). Three studies have ongoing data collection. The most represented countries were South Africa and Mozambique (Southern Africa) (n=3), Benin (Western Africa) (n=4) and Tanzania (Eastern Africa) (n=4); including an estimated 31 763 women. Samples commonly collected were blood, cord blood and placenta. Seven studies collected neonatal samples. Common clinical outcomes included maternal and perinatal mortality, malaria and preterm birth.ConclusionsIncreasingly numerous pregnancy cohorts in SSA that include biobanking are generating a uniquely valuable resource for collaborative discovery science, and improved understanding of the high regional risks of maternal, fetal and neonatal morbidity and mortality. Future studies should align protocols and consider their added value and distinct contributions.

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Aftab, Fahad, Imran Ahmed, Salahuddin Ahmed, Said Mohammed Ali, Seeba Amenga-Etego, Shabina Ariff, Rajiv Bahl, et al. "Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A population-based prospective cohort study in 8 countries." PLOS Medicine 18, no. 6 (June 28, 2021): e1003644. http://dx.doi.org/10.1371/journal.pmed.1003644.

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Background Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa. Methods and findings This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman’s self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes. Conclusions Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths. Trial registration The study is not a clinical trial.

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Kim, Hae-Young, Adrian Dobra, and Frank Tanser. "Migration and first-year maternal mortality among HIV-positive postpartum women: A population-based longitudinal study in rural South Africa." PLOS Medicine 17, no. 3 (March 31, 2020): e1003085. http://dx.doi.org/10.1371/journal.pmed.1003085.

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Black, Vivian, Andrew D. Black, Helen V. Rees, Franco Guidozzi, Fiona Scorgie, and Matthew F. Chersich. "Increased Access to Antiretroviral Therapy Is Associated with Reduced Maternal Mortality in Johannesburg, South Africa: An Audit from 2003-2012." PLOS ONE 11, no. 12 (December 29, 2016): e0168199. http://dx.doi.org/10.1371/journal.pone.0168199.

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Onyekwulu, Fidelis A., and Tochukwu C. Okeke. "Trends of critical care management of obstetric patients in a tertiary hospital in sub-Saharan Africa." International Journal of Research in Medical Sciences 7, no. 5 (April 26, 2019): 1420. http://dx.doi.org/10.18203/2320-6012.ijrms20191627.

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Background: The maternal mortality rate in sub-Saharan Africa is high compared to other regions of the world. Management of critically ill obstetric patients is very challenging. We therefore evaluate the trends, clinical characteristics and outcome of the obstetric patients admitted into the intensive care unit of a tertiary hospital in sub Saharan Africa.Methods: This was a 9- year retrospective study carried out at the multidisciplinary Intensive Care Unit (ICU) of a University Teaching Hospital which serves as a referral centre for the south east region of the country. Data were collected from the patients’ record, ICU admission and discharge register. Also collected was data concerning labor ward admission and deliveries. Data was analyzed using SPSS Version 17 (SPSS Inc., Chicago, IL, USA).Results: The total admission into the ICU during the study period was 1243 patients of which 73 (5.87%) were obstetric patients. They were between the ages of 17 and 54 years with mean of 32.05±5.96 years. The total number of deliveries within the period was 11224 (1247 per year). The commonest obstetric cases admitted into the ICU were (pre) eclampsia 28.8% followed by obstetric hemorrhage 24.7%. The overall mortality rate in this study was 39.7%. The commonest intervention carried out in the ICU was mechanical ventilation.Conclusions: The two leading indications for ICU admission and maternal mortality are (pre)eclampsia and obstetric hemorrhage.

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Langenegger, Eduard J., DR Hall, F. Mattheyse, and J. Harvey. "The impact of an obstetrician-led, labor ward critical care unit: A prospective comparison of outcomes before and after establishment." Obstetric Medicine 13, no. 3 (April 16, 2019): 132–36. http://dx.doi.org/10.1177/1753495x19838193.

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Objective To investigate the outcomes of critically ill obstetric patients managed in a obstetric critical care unit in South Africa. Methods Patients with severe maternal morbidity managed in the labor ward of Tygerberg Hospital were studied over three months before the establishment of the obstetrician-led obstetric critical care unit. One year later, patients managed in the obstetric critical care unit were studied using the same methods. The primary outcome measures were maternal morbidity and mortality. Results In the before-obstetric critical care unit prospective audit 63 patients met criteria for obstetric critical care. During the second period 60 patients were admitted to the obstetric critical care unit. There were no significant differences between the groups in baseline characteristics, admission indications or Acute Physiology and Chronic Health Evaluation scores. Continuous positive airway pressure ( p < 0.01) was utilized more in the second group. Seven deaths occurred in the first, but none in the second group ( p = 0.01). Conclusion The establishment of an obstetrician-led obstetric critical care unit facilitated a decrease in maternal mortality. Trial registration: Not applicable.

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Makuei, Gabriel, Mali Abdollahian, and Kaye Marion. "Optimal Profile Limits for Maternal Mortality Rates (MMR) Influenced by Haemorrhage and Unsafe Abortion in South Sudan." Journal of Pregnancy 2020 (June 1, 2020): 1–13. http://dx.doi.org/10.1155/2020/2793960.

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Maternal mortality rate (MMR) is one of the main worldwide public health challenges. Presently, the high levels of MMR are a common problem in the world public health and especially, in developing countries. Half of these maternal deaths occur in Sub-Saharan Africa where little or nothing progress has been made. South Sudan is one of the developing countries which has the highest MMR. Thus, this paper deploys statistical analysis to identify the significant physiological causes of MMR in South Sudan. Prediction models based on Poisson Regression are then developed to predict MMR in terms of the significant physiological causes. Coefficients of determination and variance inflation factor are deployed to assess the influence of the individual causes on MMR. Efficacy of the models is assessed by analyzing their prediction errors. The paper for the first time has used optimization procedures to develop yearly lower and upper profile limits for MMR. Hemorrhaging and unsafe abortion are used to achieve UN 2030 lower and upper MMR targets. The statistical analysis indicates that reducing haemorrhaging by 1.91% per year would reduce MMR by 1.91% (95% CI (42.85–52.53)), reducing unsafe abortion by 0.49% per year would reduce MMR by 0.49% (95% CI (11.06–13.56)). The results indicate that the most influential predictors of MMR are; hemorrhaging (38%), sepsis (11.5%), obstructed labour (11.5%), unsafe abortion (10%), and indirect causes such as anaemia, malaria, and HIV/AIDs virus (29%). The results also show that to obtain the UN recommended MMR levels of minimum 21 and maximum 42 by 2030, the Government and other stakeholders should simultaneously, reduce haemorrhaging from the current value of 62 to 33.38 and 16.69, reduce unsafe abortion from the current value of 16 to 8.62 and 4.31. Thirty years of data is used to develop the optimal reduced Poisson Model based on hemorrhaging and unsafe abortion. The model with R2 of 92.68% can predict MMR with mean error of −0.42329 and SE-mean of 0.02268. The yearly optimal level of hemorrhage, unsafe abortion, and MMR can aid the government and other stakeholders on resources allocation to reduce the risk of maternal death.

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Buck, Sean, Kevin Rolnick, Amanda A. Nwaba, Jens Eickhoff, Kelechi Mezu-Nnabue, Emma Esenwah, and Olachi J. Mezu-Ndubuisi. "Longer Breastfeeding Associated with Childhood Anemia in Rural South-Eastern Nigeria." International Journal of Pediatrics 2019 (June 10, 2019): 1–6. http://dx.doi.org/10.1155/2019/9457981.

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Introduction. Child mortality rate in sub-Saharan Africa is 29 times higher than that in industrialized countries. Anemia is one of the preventable causes of child morbidity. During a humanitarian medical mission in rural South-Eastern Nigeria, the prevalence and risk factors of anemia were determined in the region in order to identify strategies for reduction. Methods. A cross-sectional study was done on 96 children aged 1-7 years from 50 randomly selected families. A study questionnaire was used to collect information regarding socioeconomic status, family health practices, and nutrition. Anemia was diagnosed clinically or by point of care testing of hemoglobin (Hb) levels. Results. 96 children were selected for the study; 90 completed surveys were analyzed (43% male and 57% females). Anemia was the most prevalent clinical morbidity (69%), followed by intestinal worm infection (53%) and malnutrition (29%). Mean age (months) at which breastfeeding was stopped was 11.8 (±2.2) in children with Hb <11mg/dl (severe anemia), 10.5±2.8 in those with Hb = 11-11.9mg/dl (mild-moderate anemia), and 9.4±3.9 in children with Hb >12mg/dl (no anemia) (P=0.0445). Conclusions. The longer the infant was breastfed, the worse the severity of childhood anemia was. Childhood anemia was likely influenced by the low iron content of breast milk in addition to maternal anemia and poor nutrition. A family-centered preventive intervention for both maternal and infant nutrition may be more effective in reducing childhood anemia and child mortality rate in the community.

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Balogun, S. T., F. A. Fehintola, O. A. Adeyanju, and A. A. Adedeji. "Asexual and sexual stages of Plasmodium falciparum in Nigerian pregnant women attending antenatal booking clinic." Obstetric Medicine 3, no. 3 (September 2010): 106–9. http://dx.doi.org/10.1258/om.2010.090060.

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Susceptibility to infection by Plasmodium falciparum is increased in pregnant women. In sub-Saharan Africa, the consequences of maternal malaria include preterm birth, fetal growth restriction and increased infant mortality. Malaria transmission requires the circulation of viable gametocytes that can be ingested by the female mosquito taking a blood meal. This study was conducted to evaluate the presence of asexual and sexual stages of P. falciparum in pregnant women attending antenatal booking clinics in south-western Nigeria, an area hyper-endemic for malaria. Gametocyte carriage was about 13%, similar to that documented for children symptomatic for malaria in our area of study.

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Whitehouse, Anna M., and Anthony J. Hall-Martin. "Elephants in Addo Elephant National Park, South Africa: reconstruction of the population's history." Oryx 34, no. 1 (January 2000): 46–55. http://dx.doi.org/10.1046/j.1365-3008.2000.00093.x.

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AbstractThe history of the Addo elephant population in South Africa, from the creation of the Addo Elephant National Park (AENP) in 1931 to the present (every elephant currently living within the park is known), was reconstructed. Photographic records were used as a primary source of historical evidence, in conjunction with all documentation on the population. Elephants can be identified in photographs taken throughout their life by study of the facial wrinkle patterns and blood vessel patterns in their ears. These characteristics are unique for each elephant and do not change during the individual's life. The life histories of individual elephants were traced: dates of birth and death were estimated and, wherever possible, the identity of the individual's mother was ascertained. An annual register of elephants living within the population, from 1931 to the present, was compiled, and maternal family trees constructed. Preliminary demographic analyses for the period 1976–98 are presented. The quantity and quality of photographs taken during these years enabled thorough investigation of the life histories of all elephants. Prior to 1976, insufficient photographs were available to provide reliable data on the exact birth dates and mothers' identities for every calf born. However, data on annual recruitment and mortality are considered sufficiently reliable for use in analyses of the population's growth and recovery.

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Mothupi, Mamothena Carol, Jeroen De Man, Hanani Tabana, and Lucia Knight. "Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa." PLOS ONE 16, no. 5 (May 25, 2021): e0252182. http://dx.doi.org/10.1371/journal.pone.0252182.

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Introduction The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in a province in South Africa with the possibility of nationwide use. Materials and methods The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013–2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index. Results The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs = -0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r = 0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health. Conclusions This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.

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Tey, Nai-Peng, and Siow-li Lai. "Correlates of and Barriers to the Utilization of Health Services for Delivery in South Asia and Sub-Saharan Africa." Scientific World Journal 2013 (2013): 1–11. http://dx.doi.org/10.1155/2013/423403.

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The high maternal and neonatal mortality rates in South Asia and Sub-Saharan Africa can be attributed to the lack of access and utilization of health services for delivery. Data from the Demographic and Health Surveys conducted in Bangladesh, India, Pakistan, Kenya, Nigeria, and Tanzania show that more than half of the births in these countries were delivered outside a health facility. Institutional delivery was closely associated with educational level, family wealth, place of residence, and women’s media exposure status, but it was not influenced by women’s work status and their roles in decision-making (with the exception of Nigeria). Controlling for other variables, higher parity and younger women were less likely to use a health facility for delivery. Within each country, the poorer, less educated and rural women had higher unmet need for maternal care services. Service related factors (accessibility in terms of cost and distance) and sociocultural factors (e.g., did not perceive the need for the services and objections from husband and family) also posed as barriers to institutional delivery. The paper concludes with some suggestions to increase institutional delivery.

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Goli, Srinivas, Dipty Nawal, Anu Rammohan, T. V. Sekher, and Deepshikha Singh. "DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA." Journal of Biosocial Science 50, no. 6 (October 30, 2017): 749–69. http://dx.doi.org/10.1017/s0021932017000530.

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SummaryThe gap in access to maternal health care services is a challenge of an unequal world. In 2015, each day about 830 women died due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. This study quantified the contributions of the socioeconomic determinants of inequality to the utilization of maternal health care services in four countries in diverse geographical and cultural settings: Bangladesh, Ethiopia, Nepal and Zimbabwe. Data from the 2010–11 Demographic and Health Surveys of the four countries were used, and methods developed by Wagstaff and colleagues for decomposing socioeconomic inequalities in health were applied. The results showed that although the Concentration Index (CI) was negative for the selected indicators, meaning maternal health care was poorer among lower socioeconomic status groups, the level of CI varied across the different countries for the same outcome indicator: CI of −0.1147, −0.1146, −0.2859 and −0.0638 for <3 antenatal care visits; CI of −0.1338, −0.0925, −0.1960 and −0.2531 for non-institutional delivery; and CI of −0.1153, −0.0370, −0.1817 and −0.0577 for no postnatal care within 2 days of delivery for Bangladesh, Ethiopia, Nepal and Zimbabwe, respectively. The marginal effects suggested that the strength of the association between the outcome and explanatory factors varied across the different countries. Decomposition estimates revealed that the key contributing factors for socioeconomic inequalities in maternal health care varied across the selected countries. The findings are significant for a global understanding of the various determinants of maternal health care use in high-maternal-mortality settings in different geographical and socio-cultural contexts.

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Fraser, Andrew, Jessica Newberry Le Vay, Peter Byass, Stephen Tollman, Kathleen Kahn, Lucia D'Ambruoso, and Justine I. Davies. "Time-critical conditions: assessment of burden and access to care using verbal autopsy in Agincourt, South Africa." BMJ Global Health 5, no. 4 (April 2020): e002289. http://dx.doi.org/10.1136/bmjgh-2020-002289.

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BackgroundTime-critical conditions (TCC) are estimated to cause substantial mortality in low and middle-income countries. However, quantification of deaths and identification of contributing factors to those deaths are challenging in settings with poor health records.AimTo use verbal autopsy (VA) data from the Agincourt health and sociodemographic surveillance system in rural South Africa to quantify the burden of deaths from TCC and to evaluate the barriers in seeking, reaching and receiving quality care for TCC leading to death.MethodologyDeaths from 1993 to 2015 were analysed to identify causality from TCC. Deaths due to TCC were categorised as communicable, non-communicable, maternal, neonatal or injury-related. Proportion of deaths from TCC by age, sex, condition type and temporal trends was described. Deaths due to TCC from 2012 to 2015 were further examined by circumstances of mortality (CoM) indicators embedded in VA. Healthcare access, at illness onset and during the final day of life, as well as place of death, was extracted from free text summaries. Summaries were also analysed qualitatively using a Three Delays framework to identify barriers to healthcare.ResultsOf 15 305 deaths, 5885 (38.45%) were due to TCC. Non-communicable diseases were the most prevalent cause of death from TCC (2961/5885 cases, 50.31%). CoM indicators highlighted delays in a quarter of deaths due to TCC, most frequently in seeking care. The most common pattern of healthcare access was to die outwith a facility, having sought no healthcare (409/1324 cases, 30.89%). Issues in receipt of quality care were identified by qualitative analysis.ConclusionTCCs are responsible for a substantial burden of deaths in this rural South African population. Delays in seeking and receiving quality care were more prominent than those in reaching care, and thus further research and solution development should focus on healthcare-seeking behaviour and quality care provision.

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Lavin, Tina, Robert Clive Pattinson, Erin Kelty, Yogan Pillay, and David Brian Preen. "The impact of implementing the 2016 WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience on perinatal deaths: an interrupted time-series analysis in Mpumalanga province, South Africa." BMJ Global Health 5, no. 12 (December 2020): e002965. http://dx.doi.org/10.1136/bmjgh-2020-002965.

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ObjectivesTo investigate if the implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience reduced perinatal mortality in a South African province. The recommendations were implemented which included increasing the number of contacts and also the content of the contacts.MethodsRetrospective interrupted time-series analysis was conducted for all women accessing a minimum of one antenatal care contact from April 2014 to September 2019 in Mpumalanga province, South Africa. Retrospective interrupted time-series analysis of province level perinatal mortality and birth data comparing the pre-implementation period (April 2014–March 2017) and post-implementation period (April 2018–September 2019). The main outcome measure was unadjusted prevalence ratio (PR) for perinatal deaths before and after implementation; interrupted time-series analyses for trends in perinatal mortality before and after implementation; stillbirth risk by gestational age; primary cause of deaths (and maternal condition) before and after implementation.ResultsOverall, there was a 5.8% absolute decrease in stillbirths after implementation of the recommendations, however this was not statistically significant (PR 0.95, 95% CI 0.90% to 1.05%; p=0.073). Fresh stillbirths decreased by 16.6% (PR 0.86, 95% CI 0.77% to 0.95%; p=0.003) while macerated stillbirths (p=0.899) and early neonatal deaths remained unchanged (p=0.499). When stratified by weight fresh stillbirths >2500 g decreased by 17.2% (PR 0.81, 95% CI 0.70% to 0.94%; p=0.007) and early neonatal deaths decreased by 12.8% (PR 0.88, 95% CI 0.77% to 0.99%; p=0.041). The interrupted time-series analysis confirmed a trend for decreasing stillbirths at 0.09/1000 births per month (−0.09, 95% CI −1.18 to 0.01; p=0.059), early neonatal deaths (−0.09, 95% CI −0.14 to 0.04; p=<0.001) and perinatal mortality (−1.18, 95% CI −0.27 to −0.09; p<0.001) in the post-implementation period. A decrease in stillbirths, early neonatal deaths or perinatal mortality was not observed in the pre-implementation period. During the period when additional antenatal care contacts were implemented (34–38 weeks), there was a decrease in stillbirths of 18.4% (risk ratio (RR) 0.82, 95% CI 0.73% to 0.91%, p=0.0003). In hypertensive disorders of pregnancy, the risk of stillbirth decreased in the post-period by 15.1% (RR 0.85; 95% CI 0.76% to 0.94%; p=0.002).ConclusionThe implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience may be an effective public health strategy to reduce stillbirths in South African provinces.

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Chola, Lumbwe, Shelley McGee, Aviva Tugendhaft, Eckhart Buchmann, and Karen Hofman. "Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa." PLOS ONE 10, no. 6 (June 15, 2015): e0130077. http://dx.doi.org/10.1371/journal.pone.0130077.

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Dorrington, Rob E., and Debbie Bradshaw. "Maternal mortality in South Africa: lessons from a case study in the use of deaths reported by households in censuses and surveys." Journal of Population Research 28, no. 1 (February 27, 2011): 49–73. http://dx.doi.org/10.1007/s12546-011-9050-9.

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Mianda, Solange, and Anna Silvia Voce. "Enablers and barriers to clinical leadership in the labour ward of district hospitals in KwaZulu-Natal, South Africa." BMJ Leader 3, no. 3 (July 20, 2019): 75–80. http://dx.doi.org/10.1136/leader-2018-000130.

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Introduction and backgroundLike many health systems in low-income and middle-income countries, the South African health system has failed to decrease both maternal and perinatal mortality significantly, especially in district hospitals. Inappropriately trained healthcare providers and poor clinical leadership are repeatedly linked to healthcare providers’ preventable factors contributing to most maternal and perinatal deaths. Clinical skills of healthcare providers have been largely addressed, while clinical leadership remained neglected. One strategy implemented recently to support clinical leadership is the introduction of District Clinical Specialist Teams (DCSTs). Clinical leadership in the labour ward of district hospitals in KwaZulu-Natal (KZN) is conceptualised as an emergent phenomenon arising from dynamic interactions in the labour ward and the broader health system, converging to attain optimal patient care.AimTo evaluate the enablers and barriers to clinical leadership in the labour ward of district hospitals.MethodIterative data collection and analysis, following the Corbin and Strauss grounded theory approach, was applied. In-depth interviews were carried out with the midwifery members of the DCSTs in KZN. The emergent enablers and barriers to clinical leadership were presented and discussed at a workshop with broader midwifery representation, leading to a final classification of enablers and barriers to clinical leadership.Results and conclusionEnablers and barriers to clinical leadership arise as a result of emergent dynamic interactions within the labour ward and the broader health system, located at policy, organisational, team and individual healthcare provider levels, with the policy context as the overriding factor framing the implementation of clinical leadership.

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Journal articles on the topic 'Maternal Mortality – South Africa'

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