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Trop. Med. Int. Health · Jan 2014
Review Meta AnalysisSystematic review of the proportion of pregnancy-related deaths attributed to HIV in population-based studies in sub-Saharan Africa.
- C Grollman and C Ronsmans.
- Trop. Med. Int. Health. 2014 Jan 1;19(1):83-97.
ObjectivesTo estimate the proportion of pregnancy-related deaths attributed to HIV in population-based studies in sub-Saharan Africa, and to document the methods used to make such attribution.MethodsFour databases were searched for studies on causes of maternal and pregnancy-related mortality published from 2003 to June 2013. Data were extracted, and meta-analysis of proportions with random effects was used to obtain summary estimates.ResultsIn the 19 studies found, the proportion of deaths attributed to HIV ranged from 0.0% to 27.0%. The summary proportion was 3.4% (95% confidence interval: 1.8–6.3), with high heterogeneity. Subregionally, the summary proportions were 1.1% (0.4–3.3%) in West Africa, 4.5%(1.7–11.2%) in East Africa and 26.1% (21.9–30.7%) in Southern Africa. Criteria for assigning HIV as a cause of maternal death were rarely reported, and overall, methods were poor.ConclusionsThe proportion of pregnancy-related/maternal deaths attributed to HIV is substantially lower than modelled estimates, but comparisons are hampered by the absence of standard approaches. Clear guidelines on how to classify pregnancy-related deaths as attributable to HIV are urgently needed, so that the effect of the HIV epidemic on pregnancy-related mortality can be monitored and action taken accordingly.
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