Date Published: February 19, 2008
Publisher: Public Library of Science
Author(s): Clara Menéndez, Cleofé Romagosa, Mamudo R Ismail, Carla Carrilho, Francisco Saute, Nafissa Osman, Fernanda Machungo, Azucena Bardaji, Llorenç Quintó, Alfredo Mayor, Denise Naniche, Carlota Dobaño, Pedro L Alonso, Jaume Ordi, Linda Wright
Abstract: BackgroundMaternal mortality is a major health problem concentrated in resource-poor regions. Accurate data on its causes using rigorous methods is lacking, but is essential to guide policy-makers and health professionals to reduce this intolerable burden. The aim of this study was to accurately describe the causes of maternal death in order to contribute to its reduction, in one of the regions of the world with the highest maternal mortality ratios.Methods and FindingsWe conducted a prospective study between October 2002 and December 2004 on the causes of maternal death in a tertiary-level referral hospital in Maputo, Mozambique, using complete autopsies with histological examination. HIV detection was done by virologic and serologic tests, and malaria was diagnosed by histological and parasitological examination. During 26 mo there were 179 maternal deaths, of which 139 (77.6%) had a complete autopsy and formed the basis of this analysis. Of those with test results, 65 women (52.8%) were HIV-positive. Obstetric complications accounted for 38.2% of deaths; haemorrhage was the most frequent cause (16.6%). Nonobstetric conditions accounted for 56.1% of deaths; HIV/AIDS, pyogenic bronchopneumonia, severe malaria, and pyogenic meningitis were the most common causes (12.9%, 12.2%, 10.1% and 7.2% respectively). Mycobacterial infection was found in 12 (8.6%) maternal deaths.ConclusionsIn this tertiary hospital in Mozambique, infectious diseases accounted for at least half of all maternal deaths, even though effective treatment is available for the four leading causes, HIV/AIDS, pyogenic bronchopneumonia, severe malaria, and pyogenic meningitis. These observations highlight the need to implement effective and available prevention tools, such as intermittent preventive treatment and insecticide-treated bed-nets for malaria, antiretroviral drugs for HIV/AIDS, or vaccines and effective antibiotics for pneumococcal and meningococcal diseases. Deaths due to obstetric causes represent a failure of health-care systems and require urgent improvement.
Partial Text: Every year approximately 250,000 African women die during pregnancy, delivery, or the puerperium, but we know very little of the causes of these deaths. In Africa maternal mortality ratios (number of maternal deaths per 100,000 live births) are more than 100 times higher than those in the developed world , and the international community has included the reduction of maternal mortality by three-quarters by 2015 as one of the targets of the Millennium Development Goals . However, efforts to reduce maternal mortality in Africa are not being driven by evidence. In developing countries the main source of information on the causes of maternal death is clinical records and verbal autopsies [2–10]. Both sources have substantial limitations due to discrepancies between the clinically presumed and the actual cause of death . Information provided by medical autopsies has played an important role in increasing the accuracy of cause-of-death reports and improving clinical practice in the developed world [11,12]. Autopsies may also provide important data on the causes of maternal death, an essential component to reducing maternal mortality and to directing public health efforts.
To our knowledge, this is the first description of the causes of maternal death in sub-Saharan Africa based on complete autopsies. In a previous study in the same setting no CNS examinations were conducted, thus preventing the accurate diagnosis of cerebral malaria [4,23]. Another study in Nigeria did not mention malaria specifically .