Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA)

dc.contributor.authorZaba, Basia
dc.contributor.authorCalvert, Clara
dc.contributor.authorMarston, Milly
dc.contributor.authorIsingo, Raphael
dc.contributor.authorNakiyingi-Miiro, Jessica
dc.contributor.authorLutalo, Tom
dc.contributor.authorCrampin, Amelia
dc.contributor.authorRobertson, Laura
dc.contributor.authorHerbst, Kobus
dc.contributor.authorRonsmans, Carine
dc.date.accessioned2022-03-07T15:59:40Z
dc.date.available2022-03-07T15:59:40Z
dc.date.issued2013
dc.description.abstractModel-based estimates of the global proportions of maternal deaths that are in HIV-infected women range from 7% to 21%, and the eff ects of HIV on the risk of maternal death is highly uncertain. We used longitudinal data from the Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA) network to estimate the excess mortality associated with HIV during pregnancy and the post-partum period in sub-Saharan Africa. Methods The ALPHA network pooled data gathered between June, 1989 and April, 2012 in six community-based studies in eastern and southern Africa with HIV serological surveillance and verbal-autopsy reporting. Deaths occurring during pregnancy and up to 42 days post partum were defi ned as pregnancy related. Pregnant or postpartum person-years were calculated for HIV-infected and HIV-uninfected women, and HIV-infected to HIVuninfected mortality rate ratios and HIV-attributable rates were compared between pregnant or post-partum women and women who were not pregnant or post partum. Findings 138 074 women aged 15–49 years contributed 636 213 person-years of observation. 49 568 women had 86 963 pregnancies. 6760 of these women died, 235 of them during pregnancy or the post-partum period. Mean prevalence of HIV infection across all person-years in the pooled data was 17·2% (95% CI 17·0–17·3), but 60 of 118 (50·8%) of the women of known HIV status who died during pregnancy or post partum were HIV infected. The mortality rate ratio of HIV-infected to HIV-uninfected women was 20·5 (18·9–22·4) in women who were not pregnant or post partum and 8·2 (5·7–11·8) in pregnant or post-partum women. Excess mortality attributable to HIV was 51·8 (47·8–53·8) per 1000 person-years in women who were not pregnant or post partum and 11·8 (8·4–15·3) per 1000 person-years in pregnant or post-partum women. Interpretation HIV-infected pregnant or post-partum women had around eight times higher mortality than did their HIV-uninfected counterparts. On the basis of this estimate, we predict that roughly 24% of deaths in pregnant or post-partum women are attributable to HIV in sub-Saharan Africa, suggesting that safe motherhood programmes should pay special attention to the needs of HIV-infected pregnant or post-partum women.en_US
dc.identifier.citationZaba, B., Calvert, C., Marston, M., Isingo, R., Nakiyingi-Miiro, J., Lutalo, T., ... & Ronsmans, C. (2013). Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). The Lancet, 381(9879), 1763-1771.en_US
dc.identifier.urihttps://journals.lww.com/obstetricanesthesia/Fulltext/2014/09000/Effect_of_HIV_Infection_on_Pregnancy_related.29.aspx
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/2536
dc.language.isoenen_US
dc.publisherThe Lanceten_US
dc.subjectHIV infectionen_US
dc.subjectpregnancyen_US
dc.subjectmortalityen_US
dc.subjectsub-Saharan Africaen_US
dc.titleEffect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA)en_US
dc.typeArticleen_US
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