Women's risk of death beyond 42 days post partum: a pooled analysis of longitudinal Health and Demographic Surveillance System data in sub-Saharan Africa

Gazeley, Ursula; Reniers, Georges; Eilerts-Spinelli, Hallie; Prieto, Julio Romero; Jasseh, Momodou; Khagayi, Sammy; Filippi, Véronique

doi:10.1016/s2214-109x(22)00339-4

Cited by 10 publications

(11 citation statements)

References 17 publications

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“…These findings suggest ANC and PNC programmes in high-prevalence contexts require more emphasis on facilitating treatment adherence during pregnancy and postpartum, and also echo earlier calls for complication readiness programmes to include postpartum monitoring of HIV-positive women, 26 which -for some high-risk women -should extend beyond 42 days. 8 Consistent with other research 16,27 our analysis reveals low concordance between physician-assigned and algorithm-determined underlying cause of death and adapted ICD-MM category, though concordance is high for the type of death (obstetric or non-obstetric). Unlike the algorithms, physicians can use the VA narrative report that describes the sequencing of events that led to death to help attribute an underlying cause, but the quality of training affects the accuracy of physician-coded VA.…”

Section: Main Findingssupporting

confidence: 90%

“…While recognising these competing explanations for the persistence of HIV and TB, COMCATs emphasise the contribution of health system factors (difficulty in receiving care and adhering to treatment) and knowledge factors (lack of recognition of the severity or seriousness of disease). These findings suggest ANC and PNC programmes in high‐prevalence contexts require more emphasis on facilitating treatment adherence during pregnancy and postpartum, and also echo earlier calls for complication readiness programmes to include postpartum monitoring of HIV‐positive women, 26 which – for some high‐risk women – should extend beyond 42 days 8 …”

Section: Discussionsupporting

confidence: 61%

“…These findings suggest ANC and PNC programmes in high‐prevalence contexts require more emphasis on facilitating treatment adherence during pregnancy and postpartum, and also echo earlier calls for complication readiness programmes to include postpartum monitoring of HIV‐positive women, 26 which – for some high‐risk women – should extend beyond 42 days. 8 …”

Section: Discussionmentioning

confidence: 99%

“…First, although late maternal deaths occurring beyond 42 days but within 1 year of the end of pregnancy are defined (‘any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes’ 7 ) only maternal deaths within 42 days are included in the numerator of the Maternal Mortality Ratio (MMR) – the primary indicator used to monitor trends in maternal survival between countries and over time. For pregnancy‐related deaths (‘a female death occurring within 42 days of termination of pregnancy, irrespective of cause’ 7 ), there is no corollary definition of what could be called ‘late pregnancy‐related mortality’ for deaths between 43 and 365 days postpartum, despite recent evidence that the risk of pregnancy‐related mortality remains elevated until 4 months after delivery 8 . Many countries, therefore, either do not monitor or do not report estimates of mortality levels and causes beyond 42 days postpartum.…”

Section: Introductionmentioning

confidence: 99%

“…For pregnancy‐related deaths (‘a female death occurring within 42 days of termination of pregnancy, irrespective of cause’ 7 ), there is no corollary definition of what could be called ‘late pregnancy‐related mortality’ for deaths between 43 and 365 days postpartum, despite recent evidence that the risk of pregnancy‐related mortality remains elevated until 4 months after delivery. 8 Many countries, therefore, either do not monitor or do not report estimates of mortality levels and causes beyond 42 days postpartum.…”

Section: Introductionmentioning

confidence: 99%

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

Gazeley

Reniers

Prieto

et al. 2023

BJOG

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ObjectiveTo 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.DesignOpen population cohort (Health and Demographic Surveillance Systems).SettingTen Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa.Population2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019.MethodsInterVA5 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 measuresCause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs).ResultsOf 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.ConclusionsCause 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.

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