The impact of HIV/AIDS on maternal mortality in Lusaka
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The increasing number of women infected with HIV as demonstrated by the sentinel antenatal surveillance system is believed to be an important factor in the worsening maternal mortality being witnessed in Lusaka. By 1989, HIV/AIDS was already believed to have been the cause of a few maternal deaths in Lusaka. Through the 1990s the seroprevalence of HIV in antenatal attendees in Lusaka had approached 30% in some centers. Records of maternal mortalities are kept in the Department of Obstetrics and Gynaecology. This study was undertaken to review trends in maternal mortality over the 1990s in Lusaka and particularly to highlight the impact of HIV/AIDS.Cases for 1993, 1996 and 1999 were reviewed to determine the medical cause of death. In a proportion of cases, there was no direct or indirect cause noted. These cases had stigmata of HIV/AIDS and were classified as presumptive HIV/AIDS. The only other variables collected were age and parity. Direct causes of maternal mortality were noted to have declined over the three time periods (1993,6,9) from 55.8%, 38.2% to 37.7% respectively. Correspondingly, those cases classified as presumptive HIV/AIDS (HIV/AIDS) increased from 22.4% to 25.7% and finally 39.6% in 1999. Direct causes were the commonest cause of maternal mortalities in 1993, although in 1999 the commonest cause was presumptive HIV/AIDS.Most cases of maternal mortality due to HIV/AIDS were in the age range 25-34 years illustrating the demography of women affected by HIV. Also, 5.1 % of all cases of maternal mortality due to HIV/AIDS were in those aged 10-19 years. The mean age of cases due to HIV/AIDS was 26.5 years. This was statistically less than those who had died of haemorrhage (mean age 30.3 years) but greater than those who had died of puerperal sepsis (mean age 22.2 years).Information on parity was mainly available in 1999 due to missing data for the other two years. The parity of those who died due to HIV/AIDS was spread over all parities. Nevertheless 11.8% were para 0, 27.9% and 26.5% were para 1 and 2 respectively while 8.1% were of parity 6 or more. The percentage of cases of maternal mortality over the three- year periods that died and were para 0 decreased from 24.2% in 1993 to 11.1 % in 1999. Correspondingly, those who were para 3 increased from 6.3% to 16.8%.Maternal mortality due to HIV/AIDS is now the commonest cause of maternal mortality in Lusaka. Efforts need to be directed to preventative strategies to prevent unwanted pregnancy, particularly in those who are HIV infected. For those women who embark on pregnancy, case management would have to be strengthened to avoid morbidity and mortality associated with HIV/AIDS.