Maternal Mortality In South Africa Research Articles

Nurses’ knowledge to identify, prevent and manage hypertensive disorder of pregnancy

Background: Hypertensive disorders of pregnancy are major contributors to maternal mortality in South Africa. Preventative strategies in low- and middle-income countries emphasise frequent antenatal visits, symptom identification, patient education and the prophylactic use of calcium and low-dose aspirin to prevent HDP for nurses because they are the frontline workers at antenatal clinics countrywide.Methods: This was a cross-sectional study where a self-administered questionnaire was conducted among nurses (midwives and professional nurses) employed at hospitals and clinics in Durban, South Africa, to assess their understanding and practices regarding identification and initial management of HDP, particularly for eclampsia and PE with severe features. The questionnaires were distributed in person by the researcher.Results: Of the 106 respondents, most (88.7%) worked in the public sector, with over 5 years of experience (64.9%). There was a varied understanding of HDP categories: 72.6% identified gestational hypertension correctly; 49.1%, chronic hypertension; 93.4% PE and 83.0% eclampsia. Knowledge of the recommended treatments for severe PE (55.7%) and eclampsia (66.0%) was moderate with respect to the recommended anticonvulsant and rapid-acting antihypertensive agents, with only 10% recognising the role of aspirin for the prevention of HDP.Conclusion: Substantial knowledge deficiencies existed among nurses in managing HDP.Contribution: Their crucial role in both emergency and preventative care in South African healthcare settings, enhancing educational training on clinical management by providing continuous training and regular updates are imperative to reduce maternal and perinatal complications associated with HDP.

Curriculum Development for the South African Essential Steps in Managing Obstetric Emergencies (ESMOE) Anesthesiology Training Module: A Delphi Study.

The United Nations Sustainable Development Goal 3 (SDG3) for 2030 aims at <70 maternal deaths per 100,000 live births. South Africa (SA) falls short of this goal and most deaths occur in district and regional hospitals. Due to low anesthesiologist (specialist anesthetist) numbers in the public sector, the anesthetic workforce in these hospitals consists mainly of nonspecialist (general practitioner) junior doctors with limited supervision. The Essential Steps in Managing Obstetric Emergencies (ESMOE) training program for interns was introduced in 2008 to reduce maternal deaths in SA. Training is not consistently offered at all intern-training institutions and it has not been recently revised. This study sought expert suggestions to guide a revision of the regulation, pedagogy, and content of the ESMOE anesthetic module. A 3-round consensus-seeking modified Delphi technique was used whereby experts rated current and suggested learning outcomes as well as pedagogical- and regulatory aspects of the ESMOE anesthetic module in an anonymous, online, Likert-scale questionnaire. Consensus was defined as ≥70% agreement. Open-ended questions sought motivations for decisions and further suggestions for program improvement. Between March 4, 2021 and August 18, 2021, a total of 17/24 (71%), 16/17 (94%), and 15/16 (94%) consenting experts completed the first, second, and third rounds, respectively. During the 3 rounds, the panel achieved consensus on all but 2 questionnaire items. The panel agreed that ESMOE anesthesia training should be mandatory and that it should be offered through a blended learning model. They further concurred that the current learning outcomes should be retained, and suggested additional outcomes based on the most common causes of maternal mortality in SA. Attendance of the ESMOE anesthesia module should be mandatory. Its pedagogy should be updated to a blended learning style to benefit the current digital native intern generation. The content should be updated to address the main causes of maternal mortality in SA in line with SDG3. A national obstetric anesthesia guideline should be considered, and lea-dership and collaboration are required to improve the alignment of undergraduate, internship, and junior doctor anesthesia training in SA. The content, process, and stakeholder engagement suggestions in this study can assist short-course-based anesthesia workforce training in similar global contexts.

A machine learning model to predict preeclampsia in pregnant women

Preeclampsia is the new onset of hypertension and is one of the leading causes of maternal mortality in South Africa and the world. Preeclampsia is usually diagnosed after 20 weeks’ gestation. Due to South Africa’s poor level of antenatal care, the prediction of pregnant women at risk of developing preeclampsia could be an essential component of improving the level of antenatal care. This study used an antenatal care dataset from a South African obstetrician. A literature review identified eight risk factors: systolic blood pressure, diastolic blood pressure, maternal age, body mass index, diabetes status, hypertension history, nulliparity, and maternal disease. Two models were developed that could accurately predict the development of preeclampsia: one before 16 weeks’ gestation, and the other within three check-ups. These models were evaluated using five metrics: classification accuracy, area under the curve, precision, recall and F-Score. The results of this study show a promising future for using machine learning models in healthcare. To the authors’ knowledge, these models are the first machine-learning models for predicting preeclampsia using a South African dataset. Future work will focus on validating the models on data collected from field studies in hospitals and clinics around South Africa.

Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa.

Postpartum haemorrhage is the leading cause of preventable maternal mortality in South Africa. In a significant breakthrough in the management of PPH, the E-MOTIVE trial found that a multifaceted health service intervention reduced severe PPH after vaginal delivery by 60% in 78 hospitals in Nigeria, Kenya, Tanzania and SA. The E-MOTIVE approach comprises objective blood loss measurement monitored every 15 minutes during the first hour after delivery to detect PPH early and trigger a bundle of first-line treatments, including massaging the uterus, oxytocin infusion, tranexamic acid infusion, intravenous crystalloid fluids, examination for the cause, emptying the bladder and, if necessary, escalation of care. E-MOTIVE was integrated into the existing Essential Steps in Managing Obstetric Emergencies algorithm. Certain research-related elements of the trial setting cannot be replicated in routine practice. Therefore, we need to develop local strategies to ensure the essential clinical elements of the intervention are implemented. Potential strategies include incorporating the E-MOTIVE principles into national guidelines, ongoing training strategies and ensuring all facilities are equipped with necessary medication, equipment and delegations. This breakthrough intervention provides hope for women in SA, and requires a purposeful, co-ordinated implementation strategy on a national scale to reach all levels of the health service.

Quality Maternity Care: Implementation of the Guidelines for Hypertensive Disorders in Pregnant Teenagers in KwaZulu-Natal, South Africa

The government of a country is responsible and accountable for the provision of quality healthcare services to its citizens. Teenage pregnancy and its complications occur worldwide. Hypertensive disorders in pregnancy (HDP) are considered the third leading cause of maternal mortality in South Africa. The current study investigated the implementation of the 2016 Department of Health Guidelines for Maternity Care in South Africa for HDP in teenagers. A retrospective quantitative research design was used. A sample of 173 maternity records of pregnant teenagers diagnosed with hypertension were systematically sampled from the period of January 2019 to December 2019 in six district hospitals and one community health centre in one district in KwaZulu-Natal (KZN), South Africa. The respondents were aged between 13 and 19 years. A pretested structured checklist was used to record the data. The Social Sciences Statistics Software IBM SPSS version 26.0 was used to analyse the data, and simple descriptive statistics to present the findings. The findings revealed that maternity care for pregnant teenagers with hypertension was not implemented according to the prescribed GMCSA. None of the pregnant teenagers received aspirin as prophylaxis against the development of hypertension; 82% were not assessed for oedema during the initial visit; and 90.17% were not assessed during antenatal care (ANC) periods. Mental state assessment was done on only 1.7% of the pregnant teenagers. The study found discrepancies in the implementation of the GMCSA for HDP, compromising maternity care among teenagers. Strategies for improving the quality of maternity care for pregnant teenagers are deemed necessary.

Relationship between Government Financial Grants, Internal Revenue and Maternal Mortality Rate in South Africa

Funding of public hospitals and access to quality health care is a universal problem especially in developing countries. This paper aims to examine the relationship between government financial grants, internal revenue and maternal mortality rate. Previous literature has suggested that to achieve better health outcomes, multiple factors including but not limited to finance must be taken into consideration. Secondary data from audited annual health reports (2014/15 – 2018/19) of the nine South African Provinces was analyzed with the employment of the panel data regression technique. Internal Government Revenue was statistically significant at a 5% level of significance (p &lt; 0.05) and Government Financial Grant was not statistically significant (p &gt;0.05). Maternal mortality rate is therefore dependent on internal revenue and not on government financial grants. The findings change the ancient saying that maternal health outcomes shall improve when the government pumps more finances into the health system. Instead, the study reveals that internal revenue generation has an impact on the maternal mortality rate thus bringing in another approach in the fight against maternal mortality. The study adds value to the public health administration in that it brings a different perspective on the fight against maternal mortality in South Africa.

Developing a model for reducing maternal mortality in South Africa

Abstract Objective High maternal mortality ratios (MMRs) remain a concern in many parts of the world, especially in developing countries like South Africa. Different models have been developed, tried, and tested worldwide, in the hope that they will reduce maternal mortality, but without much success. Methods A qualitative approach was used to conveniently select a sample of 10 women attending an antenatal clinic in a rural area, in one of the districts of KwaZulu-Natal (KZN) Province. Data were collected by means of interviews with the women. Data were analyzed employing Burnard's content analysis approach. Results Four themes emerged: (1) age at first pregnancy; (2) birth intervals, risks in pregnancy and hospitalization; (3) the use of contraception; and (4) HIV status. All themes that emerged revealed inattention to reproductive health (RH) needs, resulting in poor RH outcomes as an area of concern. Conclusions Greater emphasis needs to be placed on meeting the sexual and reproductive health (SRH) needs of South African women, if maternal mortality rates are to be reduced. An alternative model for reducing maternal mortality in South Africa is proposed.

The impact of national health promotion policy on stillbirth and maternal mortality in South Africa

ObjectivesIn 2015, the South African government implemented the national health promotion policy (NHPP), intending to reduce stillbirth and maternal mortality. This study was designed to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African population and immigrant citizens. Study designThis was a panel analysis using secondary data issued by Statistic South Africa-Vital Statistics. MethodsThe author exploited the changes in smoking status that the NHPP exerted between 2015 and 2017. The author then builds credible control and treatment groups based on smoking status for both groups. Women who quitted smoking post-NHPP implementation were considered as the treatment group. Women who persisted with smoking post-NHPP implementation were classified as the control group. The author then used a Two-stage Least Squared Model to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African and immigrant populations. ResultsThe model shows that NHPP averts stillbirths by 8.36% in the South African population residing in the urban areas and by 2.84% in the rural segments of the country. NHPP averts South African maternal mortalities by 20.88% in urban areas and by 15.60% in the rural segments of the country.Regarding the immigrant population, the model shows that NHPP averts immigrant's stillbirths by 7.61% in the urban areas and by 2.79% in the rural segments of the country. In addition, NHPP averts immigrant maternal mortalities by 19.22% in the urban areas and by 13.04% in the rural segments of the country. ConclusionsNHPP reduces stillbirth and maternal mortality outcomes slightly biased toward the South African population. These inequalities reflect immigrant's lack of response to the NHPP framework and inadequate access to the South African health system.

Improvements in maternal mortality in South Africa

South Africa introduced confidential enquiries into maternal deaths in 1997, and the first report was published in 1998. Subsequently, six triennial reports have been published ,and the seventh was being prepared at the time of submission of this manuscript. This paper is focused on data from the last 5 years and documents the reduction in maternal deaths since 2009. The main reason for this decline in maternal deaths has been the success of the antiretroviral treatment programme for HIV-positive women. There has also been a decline in deaths owing to obstetric haemorrhage, but deaths owing to complications of hypertension remain stubbornly high. There has been a continuous reduction in potentially preventable maternal deaths since 2008. However, there is still much to do, and efforts need to concentrate on improving the health system to reduce the deaths owing to haemorrhage and hypertension.

Role of kidney biomarkers [Kidney injury molecule-1, Calbindin, Interleukin-18 and Monocyte chemoattractant protein-1] in HIV associated pre-eclampsia

ABSTRACTObjective: Both HIV infection and pre-eclampsia (PE) are associated with considerable maternal mortality in South Africa. This study was designed to compare the urinary levels of kidney injury molecule-1 (KIM-1), calbindin, interleukin-18 (IL-18), and monocyte chemoattractant protein-1 (MCP-1) in HIV associated normotensive and preeclamptic pregnancies.Methods: Following ethical approval and written consent, urine samples were collected from HIV negative (HIV –ve) normotensive pregnant (n = 19), HIV positive (HIV +ve) normotensive pregnant (n = 19), HIV –ve pre-eclamptic (n = 19) and HIV +ve pre-eclamptic (n = 19) women. The concentrations of KIM-1, calbindin, IL-18 and MCP-1 were assessed using the Bioplex technology.Results: In contrast to IL-18 (p > 0.05) and MCP-1 (p > 0.05), the concentrations of KIM-1 (p = 0.02) and calbindin (p = 0.02) were significantly higher in PE compared to normotensive pregnancies, irrespective of HIV status. Based on HIV status, all 4 analytes were similar between HIV+ve and HIV-ve groups. Urinary KIM-1 levels in the HIV –ve pre-eclamptics were significantly higher than those in the HIV –ve women with normal pregnancies (p = 0.007). The maternal hypertension and/or HIV profile has no marked impact on the fetal weight.Conclusion: Our results demonstrate an increase in the urinary level of kidney injury molecule-1 and calbindin in PE, implicating their possible value as biomarkers of kidney injury. We observed no differences in the levels of KIM-1, IL-18, MCP-1 and calbindin based on HIV status. We propose that studies with larger sample sizes using these markers be conducted to establish their use as markers of diagnosing kidney injury in PE.

Space-time patterns in maternal and mother mortality in a rural South African population with high HIV prevalence (2000\u20132014): results from a population-based cohort

BackgroundInternational organs such as, the African Union and the South African Government view maternal health as a dominant health prerogative. Even though most countries are making progress, maternal mortality in South Africa (SA) significantly increased between 1990 and 2015, and prevented the country from achieving Millennium Development Goal 5. Elucidating the space-time patterns and risk factors of maternal mortality in a rural South African population could help target limited resources and policy guidelines to high-risk areas for the greatest impact, as more generalized interventions are costly and often less effective.MethodsPopulation-based mortality data from 2000 to 2014 for women aged 15–49 years from the Africa Centre Demographic Information System located in the Umkhanyakude district of KwaZulu-Natal Province, South Africa were analysed. Our outcome was classified into two definitions: Maternal mortality; the death of a woman while pregnant or within 42 days of cessation of pregnancy, regardless of the duration and site of the pregnancy, from any cause related to or exacerbated by the pregnancy or its management but not from unexpected or incidental causes; and ‘Mother death’; death of a mother whilst child is less than 5 years of age. Both the Kulldorff and Tango spatial scan statistics for regular and irregular shaped cluster detection respectively were used to identify clusters of maternal mortality events in both space and time.ResultsThe overall maternal mortality ratio was 650 per 100,000 live births, and 1204 mothers died while their child was less than or equal to 5 years of age, of a mortality rate of 370 per 100,000 children. Maternal mortality declined over the study period from approximately 600 per 100,000 live births in 2000 to 400 per 100,000 live births in 2014. There was no strong evidence of spatial clustering for maternal mortality in this rural population. However, the study identified a significant spatial cluster of mother deaths in childhood (p = 0.022) in a peri-urban community near the national road. Based on our multivariable logistic regression model, HIV positive status (Adjusted odds ratio [aOR] = 2.5, CI 95%: [1.5–4.2]; primary education or less (aOR = 1.97, CI 95%: [1.04–3.74]) and parity (aOR = 1.42, CI 95%: [1.24–1.63]) were significant predictors of maternal mortality.ConclusionsThere has been an overall decrease in maternal and mother death between 2000 and 2014. The identification of a clear cluster of mother deaths shows the possibility of targeting intervention programs in vulnerable communities, as population-wide interventions may be ineffective and too costly to implement.

Giving Birth in a Foreign Land: Exploring the Maternal Healthcare Experiences of Zimbabwean Migrant Women Living in Johannesburg, South Africa

Maternal mortality in South Africa is unacceptably high, and interventions to address this are urgently needed. Whilst urban centres, such as Johannesburg, are home to significant numbers of non-national migrant women, little is known about their maternal healthcare experiences. In order to inform future research, an exploratory study investigating the maternal healthcare and help-seeking experiences of migrant women living in inner-city Johannesburg was undertaken. Intersections between migration, maternal health and life in the city were explored through semi-structured interviews with 15 Zimbabwean women who had engaged with the public healthcare system in Johannesburg during pregnancy and childbirth. Interviews were dominated by reports of verbal abuse from healthcare providers and delays in receiving care—particularly at the time of delivery. Participants attributed these experiences to their use of English—rather than other South African languages; further work comparing this with the experiences of nationals is required. Beyond the healthcare system, the study suggests that the well-being of these migrant women is compromised by their living and working conditions in the city: maintaining access to income-generating activities is prioritised over accessing antenatal care services. Migrant Zimbabwean women make use of their religious and social networks in the city to inform help-seeking decisions during pregnancy and delivery. Improving the maternal healthcare experiences of urban migrant women should contribute to reducing maternal mortality in South Africa. Further research is required to inform interventions to improve the maternal health of migrant women in the city, including the multiple determinants of urban health that operate outside the biomedical healthcare system.

Patient profi le of a tertiary obstetric-cardiac clinic

Background: Cardiac disease is the most important medical cause of maternal mortality in South Africa. Management of women with cardiac disease in pregnancy is highly specialised and they should ideally be evaluated early in pregnancy and in a multidisciplinary fashion with the aim of formulating a perinatal management plan. In order to facilitate the effi cient management of these patients in the context of a large tertiary hospital in South Africa a combined obstetric-cardiac (O-C) clinic was established at Tygerberg Academic Hospital (TBH) in 2010. Objective: The purpose of this review is to describe the patient profi le of an obstetric-cardiac clinic in South Africa, specifi cally the TBH O-C clinic and to share thelessons learnt from establishing this clinic. Methods: Retrospective review performed at TBH, a referral centre in the Western Cape Province of SouthAfrica. All women evaluated and/or managed at the Obstetric-Cardiac clinic between 10 August 2010 and 4 December 2012 were included. Results: There were 231 women, rheumatic heart disease (n=79; 34.2%) was the predominant cardiac disease followed by congenital heart disease (n=78; 33.8%), medical conditions (n=38; 16.4%) and previous peripartum cardiomyopathy (n=9; 3.9%). Eighty-two women (35.5%) were perceived to be extremely high risk and their entire pregnancies were managed in the Obstetric-Cardiac clinic. The most common RHD lesion was mitral regurgitation (34.2%) and mixed mitral valve disease (24.1%). The most frequent CHD was ventricular septal defects (n=27; 35%). Conclusions: The cardiac disease profi le of patients seen at this obstetric-cardiac clinic in a South African tertiary hospital refl ects a transition from the disease profi le of a typical developing country (high burden of rheumatic heart disease) to the disease profi le seen in a more developed country (high burden of congenital heart disease). This could indicate improved quality of socio-economic development and the health care system. The increasing complexity of cardiac pathology that has to be dealt with in pregnant patients presenting to a tertiary hospital requires close collaboration between the obstetrician, cardiologist, cardiac surgeon and anesthetist caring for these patients. A dedicated obstetric-cardiac clinic is a good model to utilise in a tertiary hospital when aiming to optimise the care of patients with cardiac disease in pregnancy.

Pregnancy and death: An examination of pregnancyrelated deaths among adolescents in South Africa

Background. South Africa (SA)’s high adolescent fertility has been extensively studied. A pregnancy outcome that has not received sufficient attention in research is the causes of death among pregnant adolescents. Objectives. To examine levels and causes of adolescent maternal mortality in SA. Methods. A secondary data analysis of Death Notification Forms from 2006 to 2012 was carried out. SA General Household Surveys from 2006 to 2012 were used to ascertain the number of female adolescents in the population. Frequency distributions and life table techniques were employed. Results. An estimated 1 164 deaths have been recorded among pregnant adolescents between 2006 and 2012. Adolescent maternal and pregnancy-related mortality is lower than adult maternal and pregnancy-related mortality. The main causes of death among adolescents were hypertension (55.6% of all direct causes), abortion (17.6% of all indirect causes) and injuries (48.9% of all indirect causes). The probability of adolescents dying while pregnant without these causes is practically non-existent (range 0.002 - 0.150%). Conclusion. Policies and programmes should prioritise these pregnancy-related causes of death in order to further reduce such deaths among adolescents in SA.

Eclampsia: Still a major problem in rural KwaZulu-Natal Province, South Africa

Background. Eclampsia is a major direct cause of maternal mortality in South Africa (SA). Most cases of morbidity and mortality are probably due to late booking for antenatal care, poor quality of care and poor interfacility transport. Publications on eclampsia in SA are mainly from tertiary hospitals and often do not provide clinical management details at the referring hospital. Objective. To describe the obstetric outcomes of eclampsia in a rural area of KwaZulu-Natal (KZN) Province. Methods. This was a chart review of cases of eclampsia admitted to a regional health facility serving 19 maternity clinics and 17 district hospitals in northern KZN. Results. There were 58 cases of eclampsia with complete data during the 6-month study period. Forty-nine women had booked for antenatal care, of whom 11 (22.4%) had risk factors including persistent proteinuria and haematuria. Of the 11, 2 (18.1%) had gestational hypertension well controlled on methyldopa and managed on an outpatient basis, and 2 with mild to moderate pre-eclampsia on two different types of antihypertensive agents were being treated as outpatients; 3 (27.2%) of these had uncontrolled blood pressure levels on two repeated antenatal visits. Conclusion. This clinical audit indicates that a number of cases of eclampsia could have been avoided if clinical protocols had been followed and timeous delivery and/or referrals had been considered.

Eclampsia : still a major problem in rural KwaZulu-Natal Province, South Africa : research

Background. Eclampsia is a major direct cause of maternal mortality in South Africa (SA). Most cases of morbidity and mortality are probably due to late booking for antenatal care, poor quality of care and poor interfacility transport. Publications on eclampsia in SA are mainly from tertiary hospitals and often do not provide clinical management details at the referring hospital. Objective. To describe the obstetric outcomes of eclampsia in a rural area of KwaZulu-Natal (KZN) Province. Methods. This was a chart review of cases of eclampsia admitted to a regional health facility serving 19 maternity clinics and 17 district hospitals in northern KZN. Results. There were 58 cases of eclampsia with complete data during the 6-month study period. Forty-nine women had booked for antenatal care, of whom 11 (22.4%) had risk factors including persistent proteinuria and haematuria. Of the 11, 2 (18.1%) had gestational hypertension well controlled on methyldopa and managed on an outpatient basis, and 2 with mild to moderate pre-eclampsia on two different types of antihypertensive agents were being treated as outpatients; 3 (27.2%) of these had uncontrolled blood pressure levels on two repeated antenatal visits. Conclusion. This clinical audit indicates that a number of cases of eclampsia could have been avoided if clinical protocols had been followed and timeous delivery and/or referrals had been considered.

Evaluating the accessibility and utility of HIV-related point-of-care diagnostics for maternal health in rural South Africa: a study protocol

IntroductionPoor healthcare access is a major barrier to receiving antenatal care and a cause of high maternal mortality in South Africa (SA). ‘Point-of-care’ (POC) diagnostics is a powerful emerging healthcare...

Maternal near miss and maternal death in the Pretoria Academic Complex, South Africa: A population-based study.

In order to reduce maternal mortality in South Africa (SA), it is important to understand the process of obstetric care, identify weaknesses within the system, and implement interventions for improving care. To determine the spectrum of maternal morbidity and mortality in the Pretoria Academic Complex (PAC), SA. A descriptive population-based study that included all women delivering in the PAC. The World Health Organization definition, criteria and indicators of near miss and maternal death were used to identify women with severe complications in pregnancy. Between 1 August 2013 and 31 July 2014, there were 26,614 deliveries in the PAC. The institutional maternal mortality ratio was 71.4/100,000 live births. The HIV infection rate was 19.9%, and 2.7% of women had unknown HIV status. Of the women, 1120 (4.2%) developed potentially life-threatening conditions and 136 (0.5%) life-threatening conditions. The mortality index was 14.0% overall, 30.0% for non-pregnancy-related infections, 2.0% for obstetric haemorrhage and 13.6% for hypertension. Of the women with life-threatening conditions, 39.3% were referred from the primary level of care. Vascular, uterine and coagulation dysfunctions were the most frequent organ dysfunctions in women with life-threatening conditions. The perinatal mortality rate was 26.9/1000 births overall, 23.1/1000 for women with non-life-threatening conditions, and 198.0/1000 for women with life-threatening conditions. About one in 20 pregnant women in the PAC had a potentially life-threatening condition; 39.3% of women presented to a primary level facility as an acute emergency and had to be transferred for tertiary care. All healthcare professionals involved in maternity care must have knowledge and skills that equip them to manage obstetric emergencies. Review of the basic antenatal care protocol may be necessary.

Knowledge towards Pregnancy-induced Hypertension among Pregnant Women in Vhembe District, Limpopo Province

Hypertensive disorders of pregnancy remain the commonest direct cause of maternal mortality in South Africa. Information about Pregnancy-induced hypertension has not reached many pregnant women in ...

“Without a mother”: caregivers and community members’ views about the impacts of maternal mortality on families in KwaZulu-Natal, South Africa

BackgroundMaternal mortality in South Africa is high and a cause for concern especially because the bulk of deaths from maternal causes are preventable. One of the proposed reasons for persistently high maternal mortality is HIV which causes death both indirectly and directly. While there is some evidence for the impact of maternal death on children and families in South Africa, few studies have explored the impacts of maternal mortality on the well-being of the surviving infants, older children and family. This study provides qualitative insight into the consequences of maternal mortality for child and family well-being throughout the life-course.MethodsThis qualitative study was conducted in rural and peri-urban communities in Vulindlela, KwaZulu-Natal. The sample included 22 families directly affected by maternal mortality, 15 community stakeholders and 7 community focus group discussions. These provided unique and diverse perspectives about the causes, experiences and impacts of maternal mortality.Results and discussionChildren left behind were primarily cared for by female family members, even where a father was alive and involved. The financial burden for care and children’s basic needs were largely met through government grants (direct and indirectly targeted at children) and/or through an obligation for the father or his family to assist. The repercussions of losing a mother were felt more by older children for whom it was harder for caregivers to provide educational supervision and emotional or psychological support. Respondents expressed concerns about adolescent’s educational attainment, general behaviour and particularly girl’s sexual risk.ConclusionThese results illuminate the high costs to surviving children and their families of failing to reduce maternal mortality in South Africa. Ensuring social protection and community support is important for remaining children and families. Additional qualitative evidence is needed to explore differential effects for children by gender and to guide future research and inform policies and programs aimed at supporting maternal orphans and other vulnerable children throughout their development.