Pregnancy-related mortality up to 1 year postpartum in sub-Saharan Africa: an analysis of verbal autopsy data from six countries

Ursula Gazeley*, Georges Reniers, Julio Romero-Prieto, Clara Calvert, Momodou Jasseh, Kobus Herbst, Sammy Khagayi, David Obor, Daniel Kwaro, Albert Dube, Merga Dheresa, Chodziwadziwa Kabudula, Kathleen Kahn, Mark Urassa, Amek Nyaguara, Marleen Temmerman, Laura Magee, Peter Von Dadelszen, Veronique Filippi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

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.
Original languageEnglish
Number of pages12
JournalBritish journal of obstetrics and gynaecology
Early online date19 Jul 2023
DOIs
Publication statusE-pub ahead of print - 19 Jul 2023

Keywords / Materials (for Non-textual outputs)

  • causes of death
  • maternal health
  • pregnancy-related mortality
  • verbal autopsy

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