Open this publication in new window or tab >>Medical Research Council Unit The Gambia at LSHTM, Serekunda, Gambia.
Africa Health Research Institute, Durban, South Africa; DSI-MRC South African Population Research Infrastructure Network (SAPRIN), Durban, South Africa.
Kenya Medical Research Institute – Centre for Global Health Research, Kisumu, Kenya.
Kenya Medical Research Institute – Centre for Global Health Research, Kisumu, Kenya.
Kenya Medical Research Institute – Centre for Global Health Research, Kisumu, Kenya.
Malawi Epidemiology and Intervention Research Institute, Karonga, Malawi.
School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
The Tazama Project, National Institute for Medical Research, Mwanza, Tanzania.
KEMRI-Wellcome Trust, Kilifi, Kenya.
Centre of Excellence in Women and Children's Health, Aga Khan University, Nairobi, Kenya.
Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Science and Medicine, King's College London, London, United Kingdom; Institute of Women and Children's Health, King's College London, London, United Kingdom.
Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Science and Medicine, King's College London, London, United Kingdom; Institute of Women and Children's Health, King's College London, London, United Kingdom.
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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2024 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 131, no 2, p. 163-174Article in journal (Refereed) Published
Abstract [en]
Objective: To compare the causes of death for women who died during pregnancy and within the first 42 days postpartum with those of women who died between >42 days and within 1 year postpartum.
Design: Open population cohort (Health and Demographic Surveillance Systems).
Setting: Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa.
Population: 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019.
Methods: InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases-Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42 days versus 43–365 days postpartum adjusting for HDSS and time period (2000–2009 and 2010–2019).
Main outcome measures: Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs).
Results: Of 2114 deaths, 1212 deaths occurred within 42 days postpartum and 902 between 43 and 365 days postpartum. Compared with deaths within 42 days, deaths from HIV and TB, other infectious diseases, and non-communicable diseases constituted a significantly larger proportion of late pregnancy-related deaths beyond 42 days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42 days postpartum was greatest in Southern Africa. The causes of pregnancy-related mortality within and beyond 42 days postpartum did not change significantly between 2000–2009 and 2010–2019.
Conclusions: Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non-communicable diseases to (late) pregnancy-related mortality highlights the need for better integration of non-obstetric care with ante-, intra- and postpartum care in high-burden settings.
Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
causes of death, maternal health, pregnancy-related mortality, verbal autopsy
National Category
Public Health, Global Health and Social Medicine Gynaecology, Obstetrics and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-212490 (URN)10.1111/1471-0528.17606 (DOI)001033430000001 ()37469195 (PubMedID)2-s2.0-85165446451 (Scopus ID)
Funder
Wellcome trust
2023-08-012023-08-012025-04-24Bibliographically approved