Thomas van den Akker1, Stefan de Vroome, Beatrice Mwagomba, Nathan Ford, Jos van Roosmalen. 1. From the Thyolo District Health Office, Ministry of Health, Thyolo, Malawi; Médecins Sans Frontières Operational Center Brussels, Brussels, Belgium; the Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; the Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands; and the Center for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
Abstract
OBJECTIVE: To assess associations between maternal mortality and severe morbidity and human immunodeficiency virus (HIV) infection, uptake of antiretroviral therapy, obstetric infections, and nonobstetric infections in a rural Malawian district, where the estimated HIV prevalence is 21%. METHODS: We studied the incidence and outcomes of maternal peripartum infections between September 2007 and September 2009 at the district hospital. We used a facility-based prospective cohort study design, including all cases of severe maternal peripartum infection up to 42 days postpartum, and recorded maternal and pregnancy-related characteristics. We assessed the association between mortality and covariates (including nonobstetric infection, HIV prevalence, and uptake of antiretroviral therapy) using univariable and multivariable logistic regression models. RESULTS: In total, 140 infections occurred: 79 (56%) obstetric and 53 (38%) nonobstetric (eight unknown). Half of the women were HIV-positive. Multivariable analysis showed that nonobstetric infection was the most important explanatory variable for mortality (adjusted odds ratio [OR] 4.23, 95% confidence interval [CI] 1.53-11.73). HIV-positive women not on antiretroviral therapy were at higher risk of mortality (adjusted OR 3.02, 95% CI 1.06-8.60) but there was no significant mortality increase among those on treatment (adjusted OR 0.51, 95% CI 0.10-2.71). The most common infections were puerperal sepsis (obstetric, case fatality rate 7%) and pneumonia (nonobstetric, case fatality rate 41%). CONCLUSION: Untreated HIV infection and nonobstetric infections are independently associated with maternal mortality. Prompt treatment of HIV and nonobstetric infections in pregnant women must be prioritized to reduce maternal mortality. LEVEL OF EVIDENCE: II.
OBJECTIVE: To assess associations between maternal mortality and severe morbidity and human immunodeficiency virus (HIV) infection, uptake of antiretroviral therapy, obstetric infections, and nonobstetric infections in a rural Malawian district, where the estimated HIV prevalence is 21%. METHODS: We studied the incidence and outcomes of maternal peripartum infections between September 2007 and September 2009 at the district hospital. We used a facility-based prospective cohort study design, including all cases of severe maternal peripartum infection up to 42 days postpartum, and recorded maternal and pregnancy-related characteristics. We assessed the association between mortality and covariates (including nonobstetric infection, HIV prevalence, and uptake of antiretroviral therapy) using univariable and multivariable logistic regression models. RESULTS: In total, 140 infections occurred: 79 (56%) obstetric and 53 (38%) nonobstetric (eight unknown). Half of the women were HIV-positive. Multivariable analysis showed that nonobstetric infection was the most important explanatory variable for mortality (adjusted odds ratio [OR] 4.23, 95% confidence interval [CI] 1.53-11.73). HIV-positive women not on antiretroviral therapy were at higher risk of mortality (adjusted OR 3.02, 95% CI 1.06-8.60) but there was no significant mortality increase among those on treatment (adjusted OR 0.51, 95% CI 0.10-2.71). The most common infections were puerperal sepsis (obstetric, case fatality rate 7%) and pneumonia (nonobstetric, case fatality rate 41%). CONCLUSION: Untreated HIV infection and nonobstetric infections are independently associated with maternal mortality. Prompt treatment of HIV and nonobstetric infections in pregnant women must be prioritized to reduce maternal mortality. LEVEL OF EVIDENCE: II.
Authors: Lisa M Bebell; Joseph Ngonzi; Mark J Siedner; Winnie R Muyindike; Bosco M Bwana; Laura E Riley; Yap Boum; David R Bangsberg; Ingrid V Bassett Journal: AIDS Care Date: 2018-02-16
Authors: Eric Nagaonlé Somé; Ingunn M S Engebretsen; Nicolas Nagot; Nicolas Y Meda; Roselyne Vallo; Chipepo Kankasa; James K Tumwine; Mandisa Singata; Justus G Hofmeyr; Philippe Van de Perre; Thorkild Tylleskär Journal: PLoS One Date: 2017-05-09 Impact factor: 3.240
Authors: Thomas van den Akker; Jogchum Beltman; Joey Leyten; Beatrice Mwagomba; Tarek Meguid; Jelle Stekelenburg; Jos van Roosmalen Journal: PLoS One Date: 2013-01-25 Impact factor: 3.240