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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)

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)
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)
BACKGROUND: Model-based estimates of the global proportions of maternal deaths that are in HIV-infected women range from 7% to 21%, and the effects 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 defined as pregnancy related. Pregnant or post-partum person-years were calculated for HIV-infected and HIV-uninfected women, and HIV-infected to HIV-uninfected 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.
0140-6736
1763-1771
Zaba, B.
e6c30ee3-64fb-4d0f-8602-599ff1e79043
Calvert, C.
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Marston, M.
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Isingo, R.
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Nakiyingi-Miiro, J.
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Lutalo, T.
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Crampin, A.
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Robertson, L.
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Herbst, K.
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Newell, M.L.
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Todd, J.
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Byass, P.
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Boerma, T.
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Ronsmans, C.
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Zaba, B.
e6c30ee3-64fb-4d0f-8602-599ff1e79043
Calvert, C.
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Marston, M.
e805459e-71c2-4e04-9927-10794820169d
Isingo, R.
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Nakiyingi-Miiro, J.
2392f913-ef6d-467f-90f4-5f4ea73aa1e8
Lutalo, T.
64f94f83-cfdd-47c7-ac30-5b6750144335
Crampin, A.
a6e9b1bc-deec-415c-b5fb-1a098fbc0852
Robertson, L.
b86bf205-09bb-4e1e-bf0a-e7db5405fc2a
Herbst, K.
2f558167-fbfc-478f-9170-f632d1bcfa9b
Newell, M.L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Todd, J.
8d0d2b35-64af-4912-a34f-01cd6b174eb2
Byass, P.
835bb9a9-6764-4723-a26a-3dd89cf02324
Boerma, T.
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Ronsmans, C.
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Zaba, B., Calvert, C., Marston, M., Isingo, R., Nakiyingi-Miiro, J., Lutalo, T., Crampin, A., Robertson, L., Herbst, K., Newell, M.L., Todd, J., Byass, P., Boerma, T. and 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). Lancet, 381 (9879), 1763-1771. (doi:10.1016/S0140-6736(13)60803-X). (PMID:23683643)

Record type: Article

Abstract

BACKGROUND: Model-based estimates of the global proportions of maternal deaths that are in HIV-infected women range from 7% to 21%, and the effects 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 defined as pregnancy related. Pregnant or post-partum person-years were calculated for HIV-infected and HIV-uninfected women, and HIV-infected to HIV-uninfected 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.

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Published date: 18 May 2013
Organisations: Human Development & Health

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Local EPrints ID: 353500
URI: http://eprints.soton.ac.uk/id/eprint/353500
ISSN: 0140-6736
PURE UUID: b3b6e688-3267-4e47-a583-278d665ebf00
ORCID for M.L. Newell: ORCID iD orcid.org/0000-0002-1074-7699

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Date deposited: 10 Jun 2013 11:38
Last modified: 23 Jul 2022 02:07

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Contributors

Author: B. Zaba
Author: C. Calvert
Author: M. Marston
Author: R. Isingo
Author: J. Nakiyingi-Miiro
Author: T. Lutalo
Author: A. Crampin
Author: L. Robertson
Author: K. Herbst
Author: M.L. Newell ORCID iD
Author: J. Todd
Author: P. Byass
Author: T. Boerma
Author: C. Ronsmans

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