Many maternal deaths preventable, study reveals

More maternal deaths in sub-Saharan Africa may be caused by treatable infectious diseases than by conditions related to pregnancy or childbirth, a new study shows, the results suggest that
maternal deaths in the developing world could be slashed dramatically if effective treatments for HIV/AIDS, malaria and bacterial infections were implemented.

EU support for the research came from the EU-funded PREMA-EU (‘Malaria and anaemia in pregnancy’) project, financed under the ‘Confirming the international role of Community research’ priority
of the Fifth Framework Programme (FP5). The research is published by the journal PLoS Medicine.

Every year around 250,000 African women die during pregnancy or childbirth or shortly afterwards, and reducing maternal mortality by three quarters by 2015 is one of the Millennium Development
Goals.

In the developed world, medical autopsies have helped to increase the accuracy of cause-of-death reports and led to improved clinical practices. However, in the developing world, full autopsies
are rarely carried out and so the main sources of information on the causes of maternal death are clinical records and verbal accounts from the relatives of the deceased.

In this latest study, the researchers carried out autopsies on 139 women who had died in childbirth over a period of two years in Maputo General Hospital in Mozambique.

They found that while 38% of the deaths were caused by obstetric complications, 48% were due to infectious diseases that are not specifically linked to pregnancy and childbirth. Just four
diseases – HIV, pyogenic pneumonia, severe malaria and pyogenic meningitis – were responsible for over 40% of the maternal deaths.

According to the researchers, boosting HIV prevention measures, increasing uptake of HIV testing during pregnancy and providing pregnant women with anti-retroviral treatment would substantially
reduce maternal mortality. Other recommended measures include the provision of insecticide-treated bed nets for preventing malaria and ensuring that other infectious diseases, such as pneumonia
and meningitis, are promptly diagnosed and treated.

Of the deaths attributed to conditions relating directly to pregnancy and childbirth, the most common cause of death was haemorrhage – massive blood loss around the time of delivery. These
deaths are also preventable, where adequate obstetric care and safe blood transfusions are available.

‘Infectious, treatable diseases accounted for a higher proportion of maternal deaths than did direct obstetric causes in this study,’ the researchers conclude. ‘Thus, our findings show that
there is a potential to greatly reduce maternal mortality in sub-Saharan Africa, not only through the improved performance of health services for obstetric complications, but also by
implementing measures to adequately prevent and treat a specific group of infectious diseases.’

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