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Ebogo-Belobo JT, Kenmoe S, Mbongue Mikangue CA, Tchatchouang S, Robertine LF, Takuissu GR, Ndzie Ondigui JL, Bowo-Ngandji A, Kenfack-Momo R, Kengne-Ndé C, Mbaga DS, Menkem EZ, Kame-Ngasse GI, Magoudjou-Pekam JN, Kenfack-Zanguim J, Esemu SN, Tagnouokam-Ngoupo PA, Ndip L, Njouom R. Systematic review and meta-analysis of seroprevalence of human immunodeficiency virus serological markers among pregnant women in Africa, 1984-2020. World J Crit Care Med 2023; 12:264-285. [PMID: 38188451 PMCID: PMC10768416 DOI: 10.5492/wjccm.v12.i5.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) is a major public health concern, particularly in Africa where HIV rates remain substantial. Pregnant women are at an increased risk of acquiring HIV, which has a significant impact on both maternal and child health. AIM To review summarizes HIV seroprevalence among pregnant women in Africa. It also identifies regional and clinical characteristics that contribute to study-specific estimates variation. METHODS The study included pregnant women from any African country or region, irrespective of their symptoms, and any study design conducted in any setting. Using electronic literature searches, articles published until February 2023 were reviewed. The quality of the included studies was evaluated. The DerSimonian and Laird random-effects model was applied to determine HIV pooled seroprevalence among pregnant women in Africa. Subgroup and sensitivity analyses were conducted to identify potential sources of heterogeneity. Heterogeneity was assessed with Cochran's Q test and I2 statistics, and publication bias was assessed with Egger's test. RESULTS A total of 248 studies conducted between 1984 and 2020 were included in the quantitative synthesis (meta-analysis). Out of the total studies, 146 (58.9%) had a low risk of bias and 102 (41.1%) had a moderate risk of bias. No HIV-positive pregnant women died in the included studies. The overall HIV seroprevalence in pregnant women was estimated to be 9.3% [95% confidence interval (CI): 8.3-10.3]. The subgroup analysis showed statistically significant heterogeneity across subgroups (P < 0.001), with the highest seroprevalence observed in Southern Africa (29.4%, 95%CI: 26.5-32.4) and the lowest seroprevalence observed in Northern Africa (0.7%, 95%CI: 0.3-1.3). CONCLUSION The review found that HIV seroprevalence among pregnant women in African countries remains significant, particularly in Southern African countries. This review can inform the development of targeted public health interventions to address high HIV seroprevalence in pregnant women in African countries.
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Affiliation(s)
- Jean Thierry Ebogo-Belobo
- Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | | | | | | | - Guy Roussel Takuissu
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | | | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala 00237, Cameroon
| | - Donatien Serge Mbaga
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | | | - Ginette Irma Kame-Ngasse
- Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | | | | | - Seraphine Nkie Esemu
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | | | - Lucy Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur du Cameroun, Yaounde 00237, Cameroon
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Musarandega R, Nyakura M, Machekano R, Pattinson R, Munjanja SP. Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020. J Glob Health 2021; 11:04048. [PMID: 34737857 PMCID: PMC8542378 DOI: 10.7189/jogh.11.04048] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Maternal deaths remain high in Sub-Saharan Africa (SSA) and their causes of maternal death must be analysed frequently in this region to guide interventions. Methods We conducted a systematic review of studies published from 2015 to 2020 that reported the causes of maternal deaths in 57 SSA countries. The objective was to identify the leading causes of maternal deaths using the international classification of disease - 10th revision, for maternal mortality (ICD-MM). We searched PubMed, WorldCat Discovery Libraries Worldwide (including Medline, Web of Science, LISTA and CNHAL databases), and Google Scholar databases and citations, using the search words "maternal mortality", "maternal death", "pregnancy-related death", "reproductive age mortality" and "causes" as MeSH terms or keywords. The last date of search from all databases was 21 May 2021. We included original research articles published in English and excluded articles that mentioned SSA country names without study results for those countries, studies that reported death from a single cause or assigned causes of death using computer models or incompletely broke down the causes of death. We exported, de-duplicated and screened the searches electronically in EndNote version 20. We selected the final articles by reading the titles, abstracts and full texts. Two authors searched the articles and assessed the risk of bias using a tool adapted from Montoya and others. Data from the articles were extracted onto an Excel worksheet and the deaths classified into ICD-MM groups. Proportions were calculated with 95% confidence intervals and compared for deaths attributed to each cause and ICD-MM group. We compared the results with WHO and Global Burden of Disease (GDB) estimates. Results We identified 38 studies that reported 11 427 maternal and four incidental deaths. Twenty-one of the third-eight studies were retrospective record reviews. The leading causes of death (proportions and 95% confidence intervals (CI)) were obstetric hemorrhage: 28.8% (95% CI = 26.5%-31.2%), hypertensive disorders in pregnancy: 22.1% (95% CI = 19.9%-24.2%), non-obstetric complications: 18.8% (95% CI = 16.4%-21.2%) and pregnancy-related infections: 11.5% (95% CI = 9.8%-13.2%). The studies reported few deaths of unknown/undetermined and incidental causes. Conclusions Limitations of this review were the failure to access more data from government reports, but the study results compared well with WHO and GDB estimates. Obstetric hemorrhage, hypertensive disorders in pregnancy, non-obstetric complications, and pregnancy-related infections are the leading causes of maternal deaths in SSA. However, deaths from incidental causes are likely under-reported in this region. SSA countries must continue to invest in health information systems that collect and publishes comprehensive, quality, maternal death causes data. A publicly accessible repository of data sets and government reports for causes of maternal death will be helpful in future reviews. This review received no specific funding and was not registered.
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Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, University of Pretoria, South Africa.,Department of Obstetrics and Gynaecology, Victoria Falls Hospital, Zimbabwe
| | - Michael Nyakura
- Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rhoderick Machekano
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, South Africa
| | - Robert Pattinson
- Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Zash RM, Souda S, Leidner J, Binda K, Hick C, Powis K, Makhema J, Mmalane M, Essex M, Lockman S, Shapiro RL. High Proportion of Deaths Attributable to HIV Among Postpartum Women in Botswana Despite Widespread Uptake of Antiretroviral Therapy. AIDS Patient Care STDS 2017; 31:14-19. [PMID: 28051898 DOI: 10.1089/apc.2016.0154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Mortality in the postpartum period may be impacted by antiretroviral therapy (ART) received in pregnancy, and whether ART is continued in the postpartum period. HIV-infected and HIV-uninfected mothers were enrolled within 48 h of delivery at five public hospital maternity wards throughout Botswana and followed for 24 months. Maternal deaths were reported by one of the approved contacts given by the mother at enrollment. Detailed information on the cause of death was not available. Risk factors for 24-month mortality were assessed using Cox proportional hazard models. From February 2012 to March 2013, 3000 mothers (1499 HIV infected and 1501 HIV uninfected) were enrolled, and 2985 (99.5%) were followed to 24 months or death, or until the death of their child. There were 26 total maternal deaths through 24 months postpartum [439 per 100,000 person-years (p-y)], 22 among HIV-infected women (758 per 100,000 p-y) and 4 among HIV-uninfected women (132 per 100,000 p-y). Maternal HIV-infection (aHR 5.0, 95% CI 1.6-15.2) and infant birth injury (aHR 3.8, 95% CI 1.3-11.4) were independent risk factors for maternal death. Universal ART in pregnancy became the standard-of-care after June 2012, and 978 (65%) women received ART in pregnancy; by 24 months postpartum or end of follow-up, 1148 (79%) had started ART overall. There was no significant difference in 24-month mortality among HIV-infected women who took ART in pregnancy and continued throughout the follow-up period compared with HIV-infected women who took ART or zidovudine in pregnancy and stopped postpartum (aHR 0.6, 95% CI 0.2-1.7). Despite high uptake of ART in pregnancy and postpartum, women with HIV infection in Botswana are five times more likely to die than HIV-uninfected women in the 24 months postpartum.
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Affiliation(s)
- Rebecca Marie Zash
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Immunology and Infectious Diseases, TH Chan Harvard School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Sajini Souda
- Department of Pathology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | | | - Chazha Hick
- Care Quality Commission, London, United Kingdom
| | - Kathleen Powis
- Immunology and Infectious Diseases, TH Chan Harvard School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Max Essex
- Immunology and Infectious Diseases, TH Chan Harvard School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Shahin Lockman
- Immunology and Infectious Diseases, TH Chan Harvard School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
| | - Roger L. Shapiro
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Immunology and Infectious Diseases, TH Chan Harvard School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
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Bailey PE, Keyes E, Moran AC, Singh K, Chavane L, Chilundo B. 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 Childbirth 2015; 15:293. [PMID: 26552482 PMCID: PMC4640376 DOI: 10.1186/s12884-015-0725-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 10/30/2015] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Patricia E Bailey
- RMNCH Unit, Global Health Programs, FHI 360 359 Blackwell Street, Durham, NC, 27701, USA. .,Averting Maternal Death & Disability, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Emily Keyes
- RMNCH Unit, Global Health Programs, FHI 360 359 Blackwell Street, Durham, NC, 27701, USA. .,Averting Maternal Death & Disability, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Allisyn C Moran
- Global Health Fellows Program II, United States Agency for International Development (USAID), Washington, DC, USA.
| | - Kavita Singh
- MEASURE Evaluation/Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Baltazar Chilundo
- Departamento de Saúde da Comunidade, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.
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Hanson C, Cox J, Mbaruku G, Manzi F, Gabrysch S, Schellenberg D, Tanner M, Ronsmans C, Schellenberg J. Maternal mortality and distance to facility-based obstetric care in rural southern Tanzania: a secondary analysis of cross-sectional census data in 226 000 households. Lancet Glob Health 2015; 3:e387-95. [PMID: 26004775 DOI: 10.1016/s2214-109x(15)00048-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/02/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Access to skilled obstetric delivery and emergency care is deemed crucial for reducing maternal mortality. We assessed pregnancy-related mortality by distance to health facilities and by cause of death in a disadvantaged rural area of southern Tanzania. METHODS We did a secondary analysis of cross-sectional georeferenced census data collected from June to October, 2007, in five rural districts of southern Tanzania. Heads of georeferenced households were asked about household deaths in the period June 1, 2004, to May 31, 2007, and women aged 13-49 years were interviewed about birth history in the same time period. Causes of death in women of reproductive age were ascertained by verbal autopsy. We also asked for sociodemographic information. Multilevel logistic regression was used to analyse the effects of distance to health facilities providing delivery care on pregnancy-related mortality (direct and indirect maternal and coincidental deaths). FINDINGS The study included 818 583 people living in 225 980 households. Pregnancy-related mortality was high at 712 deaths per 100 000 livebirths, with haemorrhage being the leading cause of death. Deaths due to direct causes of maternal mortality were strongly related to distance, with mortality increasing from 111 per 100 000 livebirths among women who lived within 5 km to 422 deaths per 100 000 livebirths among those who lived more than 35 km from a hospital (adjusted odds ratio 3·68; 95% CI 1·37-9·88). Neither pregnancy-related nor indirect maternal mortality was associated with distance to hospital. Among women who lived within 5 km of a hospital, pregnancy-related mortality was 664 deaths per 100 000 livebirths even though 72% gave birth in hospital and 8% had delivery by caesarean section. INTERPRETATION Large distances to hospital contribute to high levels of direct obstetric mortality. High pregnancy-related mortality in those living near to a hospital suggests deficiencies in quality of care. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Claudia Hanson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK; Department of Public Health Science (Global Health), Karolinska Institutet, Stockholm, Sweden.
| | - Jonathan Cox
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Fatuma Manzi
- Ifakara Health Institute, Dar-es-Salaam, Tanzania
| | - Sabine Gabrysch
- Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - David Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Marcel Tanner
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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Fuhr DC, Calvert C, Ronsmans C, Chandra PS, Sikander S, De Silva MJ, Patel V. Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Psychiatry 2014; 1:213-25. [PMID: 26360733 PMCID: PMC4567698 DOI: 10.1016/s2215-0366(14)70282-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although suicide is one of the leading causes of deaths in young women in low-income and middle-income countries, the contribution of suicide and injuries to pregnancy-related mortality remains unknown. METHODS We did a systematic review to identify studies reporting the proportion of pregnancy-related deaths attributable to suicide or injuries, or both, in low-income and middle-income countries. We used a random-effects meta-analysis to calculate the pooled prevalence of pregnancy-related deaths attributable to suicide, stratified by WHO region. To account for the possible misclassification of suicide deaths as injuries, we calculated the pooled prevalence of deaths attributable to injuries, and undertook a sensitivity analysis reclassifying the leading methods of suicides among women in low-income and middle-income countries (burns, poisoning, falling, or drowning) as suicide. FINDINGS We identified 36 studies from 21 countries. The pooled total prevalence across the regions was 1·00% for suicide (95% CI 0·54-1·57) and 5·06% for injuries (3·72-6·58). Reclassifying the leading suicide methods from injuries to suicide increased the pooled prevalence of pregnancy-related deaths attributed to suicide to 1·68% (1·09-2·37). Americas (3·03%, 1·20-5·49), the eastern Mediterranean region (3·55%, 0·37-9·37), and the southeast Asia region (2·19%, 1·04-3·68) had the highest prevalence for suicide, with the western Pacific (1·16%, 0·00-4·67) and Africa (0·65%, 0·45-0·88) regions having the lowest. INTERPRETATION The available data suggest a modest contribution of injuries and suicide to pregnancy-related mortality in low-income and middle-income countries with wide regional variations. However, this study might have underestimated suicide deaths because of the absence of recognition and inclusion of these causes in eligible studies. We recommend that injury-related and other co-incidental causes of death are included in the WHO definition of maternal mortality to promote measurement and effective intervention for reduction of maternal mortality in low-income and middle-income countries. FUNDING National Institute of Mental Health.
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Affiliation(s)
- Daniela C Fuhr
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Clara Calvert
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Carine Ronsmans
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Prabha S Chandra
- National Institute of Mental Health and Neurosciences, Bangalore
| | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan
| | - Mary J De Silva
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Vikram Patel
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Centre for Mental Health, Public Health Foundation of India, New Delhi, India; Sangath, Goa, India.
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