A review of maternal death records of HIV + women in Sedibeng District, Gauteng

Abstract

Introduction: The maternal mortality ratio in Sedibeng District, Gauteng Province, from 2002 – 2004 was 220/100000. For the past decade HIV has been identified as a factor that has slowed the decline in maternal deaths in South Africa. The purpose of this study was to describe personal and service level factors contributing to maternal mortality of HIV positive women. It is hoped that the results of this study will be useful in developing interventions that will assist to curb the maternal mortality ratio. Methodology: Maternal death records were reviewed for the period 2004-2009. Data was collected on antenatal care, hospital care after admission and access to HIV services. The data were analysed using Stata 10. The results were compared with the national guidelines for the care of HIV positive pregnant women so as to identify discrepancies between the two. Results: One hundred and twenty five maternal death records were reviewed. Of these, 90% booked late for antenatal care i.e. beyond 20 weeks gestation. The majority (60.8%) of the women were HIV positive. Of the HIV positive women, 37.5% had CD 4 counts less than 200, which made them eligible for antiretroviral therapy. Of those that were eligible for antiretroviral therapy, 50.0% did not access the antiretrovirals due to late booking and loss to follow-up. Another main finding was that 36% died during the postnatal period. Conclusion: The antenatal bookings occurred after 12 weeks gestation which limited the time for starting patients on antiretroviral therapy. The high number of deaths during the postnatal period may indicate poor postnatal care and follow-up; as antiretroviral therapy could have been started during the postnatal period. Recommendations: Early antenatal booking and early HIV testing should be encouraged in communities. Antenatal services should be integrated so that HIV positive pregnant women are treated comprehensively and that the focus is not only on HIV, but also on other conditions such as TB, pneumonia, anaemia and hypertension. All pregnant HIV positive women must be done CD 4 counts; and all those found to be eligible for antiretroviral therapy should be given antiretrovirals timeously. Such women should be followed up and monitored closely. Postnatal check-up at 3 days should be strengthened for the mother-and-baby pair.