Maternal mortality in South Africa in 2001: From demographic census to epidemiological investigation.

Michel Garenne,Kourtoum Nacro,Robert Mccaa

doi:10.1186/1478-7954-6-4

Abstract

BackgroundMaternal mortality remains poorly researched in Africa, and is likely to worsen dramatically as a consequence of HIV/AIDS.MethodsThe 2001 census of South Africa included a question on deaths in the previous 12 months, and two questions on external causes and maternal mortality, defined as "pregnancy-related deaths". A microdata sample from the census permits researchers to assess levels and differentials in maternal mortality, in a country severely affected by high death rates from HIV/AIDS and from external causes.ResultsAfter correcting for several minor biases, our estimate of the Maternal Mortality Ratio (MMR) in 2001 was 542 per 100,000 live births. This level is much higher than previous estimates dating from pre-HIV/AIDS times. This high level occurred despite a relatively low proportion of maternal deaths (6.4%) among deaths of women aged 15–49 years, and was due to the astonishingly high level of adult mortality, some 4.7 times higher than expected from mortality below age 15 or above age 50. The main reasons for these excessive levels were HIV/AIDS and external causes of deaths. Our regional estimates of MMR were found to be consistent with other findings in the Cape Town area, and with the Agincourt DSS. The differentials in MMR were considerable: 1 to 9.2 for population groups (race), 1 to 3.2 for provinces, and 1 to 2.4 for levels of education. Relationship with income and wealth were complex, with highest values for middle income and middle wealth index. The effect of urbanization was small, and reversed in a multivariate analysis. Higher risks in provinces were not necessarily associated with lower income, lower education or higher proportions of home delivery, but correlated primarily with the prevalence of HIV/AIDS.ConclusionDemographic census microdata offer the opportunity to conduct an epidemiologic analysis of maternal mortality. In the case of South Africa, the level of MMR increased dramatically over the past 10 years, most likely because of HIV/AIDS. Indirect causes of maternal deaths appear much more important than direct obstetric causes. The MMR appears no longer to be a reliable measure of the quality of obstetric care or a measure of safe motherhood.

Highlights

Maternal mortality remains poorly researched in Africa, and is likely to worsen dramatically as a consequence of HIV/AIDS
Death registration in the census The IPUMS 10% sample of the 2001 census of South Africa included 36,267 deaths out of a total of 3,725,655 persons enumerated, and 76,292 surviving infants, corresponding to 78,702 births in the past 12 months, with a survival probability of newborns from birth to the census date equal to 0.970. This corresponds to a crude birth rate (CBR) of 21.1 per 1,000 and a crude death rate (CDR) of 9.7 per 1,000
These values are consistent with other estimates for this period in South Africa

Summary

Introduction

Maternal mortality remains poorly researched in Africa, and is likely to worsen dramatically as a consequence of HIV/AIDS. Some of the demographic sample surveys conducted in Africa by the French National Statistical Institute (INSEE) during the 1950s and 1960s included a question on maternal deaths among other questions on deaths in the past 12 months. This was the case with the survey conducted in Burkina Faso in 1960– 1961 (Haute Volta at that time), and again later in the same country with the 1991 demographic survey. Both types of retrospective data provide similar estimates, as shown in a case study in Bangladesh [10]

Results

Discussion

Conclusion