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| Title |
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) |
| Author(s) |
Basia Zaba, Clara Calvert, Milly Marston, et al - Personal Name
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Subject |
Maternal Health |
| Publisher |
Lancet |
| Publishing Year |
2013 |
| Specific Detail Info |
Background: Model-based estimates of the global proportions of maternal deaths that are in HIV-infected women range from 7% to 21%, and the eff ects of HIV on the risk of maternal death is highly uncertain. We used longitudinal data from the Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA) network to estimate the excess mortality associated with HIV during pregnancy and the post-partum period in sub-Saharan Africa. Methods: The ALPHA network pooled data gathered between June, 1989 and April, 2012 in six community-based
studies in eastern and southern Africa with HIV serological surveillance and verbal-autopsy reporting. Deaths
occurring during pregnancy and up to 42 days post partum were defi ned as pregnancy related. Pregnant or postpartum person-years were calculated for HIV-infected and HIV-uninfected women, and HIV-infected to HIV uninfected mortality rate ratios and HIV-attributable rates were compared between pregnant or post-partum women
and women who were not pregnant or post partum. Findings: 138074 women aged 15–49 years contributed 636213 person-years of observation. 49568 women had 86963 pregnancies. 6760 of these women died, 235 of them during pregnancy or the post-partum period. Mean prevalence of HIV infection across all person-years in the pooled data was 17·2% (95% CI 17·0–17·3), but 60 of 118 (50·8%) of the women of known HIV status who died during pregnancy or post partum were HIV infected. The mortality rate ratio of HIV-infected to HIV-uninfected women was 20·5 (18·9–22·4) in women who were not pregnant or post partum and 8·2 (5·7–11·8) in pregnant or post-partum women. Excess mortality attributable to HIV was 51·8 (47·8–53·8) per 1000 person-years in women who were not pregnant or post partum and 11·8 (8·4–15·3) per 1000 person-years in pregnant or post-partum women. Interpretation: HIV-infected pregnant or post-partum women had around eight times higher mortality than did their HIV-uninfected counterparts. On the basis of this estimate, we predict that roughly 24% of deaths in pregnant or post-partum women are attributable to HIV in sub-Saharan Africa, suggesting that safe motherhood programmes should pay special attention to the needs of HIV-infected pregnant or post-partum women. |
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