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Systematic review of the proportion of pregnancy‐related deaths attributed to HIV in population‐based studies in sub‐ S aharan A frica
Author(s) -
Grollman C.,
Ronsmans C.
Publication year - 2014
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12226
Subject(s) - medicine , pregnancy , confidence interval , demography , population , human immunodeficiency virus (hiv) , meta analysis , obstetrics , environmental health , immunology , biology , genetics , sociology
Abstract Objectives To estimate the proportion of pregnancy‐related deaths attributed to HIV in population‐based studies in sub‐ S aharan A frica, and to document the methods used to make such attribution. Methods Four 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. Results In 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. Conclusions The 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.