Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence

Determinants of Maternal Mortality in Southern Africa: A Macro-Level Analysis

This study sought to investigate the macro determinants of maternal mortality in Southern African Development Community (SADC) states. The study drew on the fact that maternal mortality remains a major public health issue in developing countries. The Millennium Development Goals (MDGs) were adopted by UN member states in 2000, and one of them was to reduce maternal deaths by three-quarters by 2015. While the Millennium Development Goals increased efforts, the goal was not met in the countries with the highest death rates. The World Health Organisation (WHO) estimates that every single day about 810 women die from pregnancy or childbirth-related complications around the world. This is despite several international initiatives being adopted to reduce maternal mortality. The study was quantitative, and it used secondary data to achieve its objective. A panel data estimation (Generalized Method of Moments) covering the period from 2005–2019 was used to examine how various factors affect maternal mortality. The analysis included the following variables: education, fertility, GDP per capita, institutional quality, health expenditure and HIV infection. The econometric analysis reveals a significant positive impact of fertility, GDP per capita and HIV on maternal mortality. This implies that when fertility, GDP per capita and HIV are increasing, maternal mortality also increases. The analysis also showed that education has a negative relationship with maternal mortality. This implies that when literacy levels (education) increase, maternal mortality decreases. Based on the results, this study emphasizes that, in order to improve maternal health and consequently reduce maternal mortality, access to family planning (to reduce fertility), access to early prenatal care and promoting women’s access to education should be a priority in government policies.

The HIV paradox: Perinatal mortality is lower in HIV-positive mothers-A field case-control study in Ethiopia

OBJECTIVE

Sub-Saharan African countries have the highest perinatal mortality rates. Although HIV is a risk factor for perinatal death, antioretroviral therapy (ART) programs have been associated with better outcomes. We aimed to investigate how maternal HIV affects perinatal mortality.

METHODS

The authors performed a nested case-control study at Saint Luke Hospital, Wolisso, Ethiopia. Data on sociodemographic characteristics, current maternal conditions, obstetric history, and antenatal care (ANC) services utilization were collected. The association between perinatal mortality and HIV was assessed with logistic regression adjusting for potential confounders.

RESULTS

A total of 3525 birthing women were enrolled, including 1175 cases and 2350 controls. Perinatal mortality was lower among HIV-positive women (18.3% vs. 33.6%, P = 0.007). Crude analysis showed a protective effect of HIV (odds ratio, 0.442 [95% confidence interval, 0.241-0.810]), which remained after adjustment (adjusted odds ratio, 0.483 [95% confidence interval, 0.246-0.947]). Among HIV-negative women, access to ANC for women from rural areas was almost half (18.8% vs. 36.2%; P < 0.001), whereas in HIV-positive women, no differences were noted (P = 0.795).

CONCLUSION

Among HIV-positive mothers, perinatal mortality was halved and differences in access to ANC services by area were eliminated. These data highlight the benefits of integrating ANC and HIV services in promoting access to the health care system, reducing inequalities and improving neonatal mortality.

The social stigma of HIV-AIDS: society's role

AIDS is a devastating and deadly disease that affects people worldwide and, like all infections, it comes without warning. Specifically, childbearing women with AIDS face constant psychological difficulties during their gestation period, even though the pregnancy itself may be normal and healthy. These women have to deal with the uncertainties and the stress that usually accompany a pregnancy, and they have to live with the reality of having a life-threatening disease; in addition to that, they also have to deal with discriminating and stigmatizing behaviors from their environment. It is well known that a balanced mental state is a major determining factor to having a normal pregnancy and constitutes the starting point for having a good quality of life. Even though the progress in both technology and medicine is rapid, infected pregnant women seem to be missing this basic requirement. Communities seem unprepared and uneducated to smoothly integrate these people in their societies, letting the ignorance marginalize and isolate these patients. For all the aforementioned reasons, it is imperative that society and medical professionals respond and provide all the necessary support and advice to HIV-positive child bearers, in an attempt to allay their fears and relieve their distress. The purpose of this paper is to summarize the difficulties patients with HIV infection have to deal with, in order to survive and merge into society, identify the main reasons for the low public awareness, discuss the current situation, and provide potential solutions to reducing the stigma among HIV patients.

HIV and noncommunicable disease comorbidities in the era of antiretroviral therapy: a vital agenda for research in low- and middle-income country settings

In this special 2014 issue of JAIDS, international investigator teams review a host of noncommunicable diseases (NCDs) that are often reported among people living and aging with HIV in sub-Saharan Africa. With the longer lifespans that antiretroviral therapy programs have made possible, NCDs are occurring due to a mix of chronic immune activation, medication side effects, coinfections, and the aging process itself. Cancer; cardiovascular and pulmonary diseases; metabolic, body, and bone disorders; gastrointestinal, hepatic, and nutritional aspects; mental, neurological, and substance use disorders; and renal and genitourinary diseases are discussed. Cost-effectiveness, key research methods, and issues of special importance in Asia, Latin America, and the Caribbean are also addressed. In this introduction, we present some of the challenges and opportunities for addressing HIV and NCD comorbidities in low- and middle-income countries, and preview the research agenda that emerges from the articles that follow.