HIV/AIDS and pregnancy-related deaths in Blantyre, Malawi

Background: HIV/AIDS epidemic is one of the major factors affecting women’s health and impeding national efforts to improve it especially in sub-Saharan Africa. Current evidence indicates that HIV/ AIDS is increasingly becoming a major cause or contributing factor to pregnancy-related deaths, almost overtaking the “traditional” causes and factors. Objectives: To survey the contribution of HIV infection and AIDS to pregnancy-related deaths in Blantyre, Malawi. Design: A retrospective, descriptive, facility-based survey. Setting: The Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi. Subjects: All women recorded to have had pregnancy-related deaths between January 1, 1999 and December 31, 2000. Results: There were 204 maternal deaths, 154 (75.5%) direct, the top five causes being puerperal sepsis (39.0%), postabortion complications (31.2%), obstetric haemorrhage (14.3%), eclampsia (8.4%) and ectopic pregnancy (3.9%). At least 38 (18.6%) of the total were HIV positive or had AIDS. The main causes of deaths amongst these were meningitis (23.7%), pneumonia (18.4%), puerperal sepsis (13.2%), postabortal sepsis (10.5%), severe anaemia (10.5%) and pulmonary tuberculosis (10.5%) Of those who died of puerperal and postabortal sepsis in the whole study group 8.3% had HIV/AIDS. Of the indirect maternal deaths, 50 (58%) were HIV positive or had AIDS. Conclusion and recommendations: HIV/AIDS contributes to both direct and indirect maternal deaths in Malawi. National strategies to realise MDG5 targets should include addressing the HIV/AIDS epidemic within the entire population as well as scaling up contraceptive uptake and utilisation, especially amongst the most vulnerable groups

Patients’ satisfaction with reproductive health services at Gogo Chatinkha Maternity Unit, Queen Elizabeth Central Hospital, Blantyre, Malawi

Patient satisfaction is an individual’s state of being content with the careprovided in the health system. It is important for reproductive health care providers to get feedback from women regarding satisfaction with reproductive health services. There is a dearth of knowledge about patientsatisfaction in Malawi.AimThe specific objective of the study was to determine the extent to whichwomen are satisfied with the care they receive when they come to deliverat the Queen Elizabeth Central Hospital maternity unit. MethodsA cross sectional study of postpartum women using interviewer administered semi-structured questionnaires was conducted betweenNovember 2008 and May 2009. The questionnaires captured mainly quantitative data.Results1562 women were interviewed. Most women were housewives (79%) whowere referred from Health Centres within the city. Ninety five percent delivered a live baby. The majority of women (97.3%) were satisfied withthe care they received from admission through labour and delivery andthe immediate postpartum period. Most women cited doctors’ and nurses’reviews (65%) as what they liked most about the care they received duringtheir stay in the unit. Most women expected to receive efficient and definitive care. The women’s knowledge on patient’s rights was extremely low (16%) and equally very few women were offered an opportunity to give an opinion regarding their care by the doctors and nurses in the maternity unit.ConclusionMost women who deliver at the hospital are satisfied with the care offered.This satisfaction is mainly due to the frequent reviews of patients by nurses and doctors in the unit. There is a great need to educate both thepopulation of women served and the health workers that serve them onpatient’s rights

A road to obstetric fistula in Malawi: capturing women’s perspectives through a framework of three delays

Josephine Changole,1 Viva Combs Thorsen,1 Ursula Kafulafula2 1Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway; 2Kamuzu College of Nursing, University of Malawi, Blantyre, Malawi Introduction: Obstetric fistula (OF) is a devastating birth injury, which leaves a woman with leaking urine and/or feces accompanied by bad smell, a situation that has been likened to death itself. The condition is caused by neglected obstructed labor. Many factors underlie fistula formation, most of which are preventable. The main purpose of this study was to explore labor and childbirth experiences of women who developed OF with a focus on accessibility of care in the central region of Malawi.Methods: We conducted semi-structured interviews with 25 women with OF at Bwaila Fistula Care Center in Lilongwe and in its surrounding districts. We interviewed 20 women at Bwaila Fistula Care Center; additional five women were identified through snowball sampling and were interviewed in their homes. Data were categorized using Nvivo 11 and were analyzed using thematic analysis. The three delays model by Thaddeus and Maine was used for data analysis.Findings: The majority of women in our study suffered from OF with their subsequent pregnancies. All women experienced delays in one form or another consistent with the three-phase delays described by Thaddeus and Maine. Most of the participants (16) experienced two delays and 15 experienced second-phase delay, which was always coupled with the other; nine participants experienced delay while at the hospital. None of the participants experienced all three delays. Most decisions to seek health care when labor was complicated were made by mothers-in-law and traditional birth attendants. All but two delivered stillborn babies.Conclusion: Testimonies by women in our study suggest the complexity of the journey to developing fistula. Poverty, illiteracy, inaccessible health facilities, negligence, lack of male involvement in childbirth issues, and shortage of staff together conspire to fistula formation. To prevent new cases of OF in Malawi, the above mentioned issues need to be addressed, more importantly, increasing access to skilled attendance at birth and emergency obstetric care and promoting girls’ education to increase their financial autonomy and decision-making power about their reproductive lives. Also men need to be educated and be involved in maternal and women’s reproductive health issues to help them make informed decisions when their spouses end up with a complicated labor or delivery. Keywords: childbirth experience, delays, obstetric fistula, Malaw

Maternal Mortality At The Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi

Background: Maternal mortality in Malawi continues to increase despite the global SMI and national safe motherhood programme\'s efforts to reduce it. Objectives: To identify the social, demographic and reproductive profiles of women suffering a maternal death, the main immediate causes and the operational factors. Design: A retrospective descriptive survey. Setting: The Gogo-Chatinkha Maternity Unit, Queen Elizabeth Central Hospital, Blantyre, Malawi, from January 1, 1999 to December 31, 2000. Subjects: All women who suffered a maternal death in the unit. Results: There were a total of 204 maternal deaths and 19,859 live births, giving a Maternal mortality ratio (MMR) of 1027.2/100,000 live births. Their ages ranged from 16 to 40 years. Adolescents comprised 20.6%, while the majority, (56.4%), were aged 15 - 24 years. Almost half of the group, (43.4%), were para 1 and less, with a range of 0 to 12. The top five causes of death were puerperal sepsis, (29.4%); postabortal complications, (23.5%); other infectious conditions, (20.1%); obstetric haemorrhage, (10.6%), and eclampsia, (6.4%). Some of the identified operational factors included delay in accessing and receiving emergency obstetric care, poor quality services, HIV infection/ AlDS and unsafe induced abortion following unwanted pregnancy. Conclusion and recommendations: Most of the causes and operational factors for maternal deaths are easily avoidable. The country needs to make more commitment and investments necessary to mitigate these deaths. East African Medical Journal Vol.82(1) 2005:3-

HIV/AIDS AND PREGNANCY-RELATED DEATHS IN BLANTYRE, MALAWI

Background: HIV/AIDS epidemic is one of the major factors affecting women’shealth and impeding national efforts to improve it especially in sub-Saharan Africa.Current evidence indicates that HIV/ AIDS is increasingly becoming a major cause orcontributing factor to pregnancy-related deaths, almost overtaking the “traditional”causes and factors.Objectives: To survey the contribution of HIV infection and AIDS to pregnancy-relateddeaths in Blantyre, Malawi.Design: A retrospective, descriptive, facility-based survey.Setting: The Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi.Subjects: All women recorded to have had pregnancy-related deaths between January1, 1999 and December 31, 2000.Results: There were 204 maternal deaths, 154 (75.5%) direct, the top five causes beingpuerperal sepsis (39.0%), postabortion complications (31.2%), obstetric haemorrhage(14.3%), eclampsia (8.4%) and ectopic pregnancy (3.9%). At least 38 (18.6%) of thetotal were HIV positive or had AIDS. The main causes of deaths amongst these weremeningitis (23.7%), pneumonia (18.4%), puerperal sepsis (13.2%), postabortal sepsis(10.5%), severe anaemia (10.5%) and pulmonary tuberculosis (10.5%) Of those who diedof puerperal and postabortal sepsis in the whole study group 8.3% had HIV/AIDS. Ofthe indirect maternal deaths, 50 (58%) were HIV positive or had AIDS.Conclusion and recommendations: HIV/AIDS contributes to both direct and indirectmaternal deaths in Malawi. National strategies to realise MDG5 targets should includeaddressing the HIV/AIDS epidemic within the entire population as well as scalingup contraceptive uptake and utilisation, especially amongst the most vulnerablegroups.INTR

Les déterminants de mortalité maternelle post-partum à Queen Elizabeth Hospital, Blantyre, Malawi : Etude de contrôle de cas 2001 – 2002

The aim of this research is to identify the clinical, demographic and service-based determinants of postpartum maternal mortality within Queen Elizabeth Central Hospital, Blantyre, Malawi, during 2001 and 2002. The study uses a case-control design using all postpartum maternal deaths in 2001 and 2002 as cases, with analysis conducted using conditional logistic regression. The results indicate that the mothers’ reason for admission into hospital and the outcome of the birth were significantly related to maternal death when analysing all potential explanatory variables in one model. A group of high-risk mothers can be identified using these factors. If these criteria were applied as a predictive tool in the clinical setting the resulting sensitivity and specificity would be over 85%. Identification within the hospital setting of a group of very high-risk mothers in whom serious complications are aggressively managed in a coordinated way across the medical specialties may reduce maternal mortality (Afr J Reprod Health 2008; 12[3]:35-48).Cette recherche a pour but d'identifier les déterminants cliniques, démographiques et à base de service de mortalité maternelle postpartum à Elisabeth Central Hospital, Blantyre, Malawi, pendant 2001 et 2002. L'étude utilise une conception de contrôle de cas utilisant toutes les morts maternelles postpartum en 2001 et 2002 comme des cas, avec l'analyse conduite utilisant la régression logistique conditionnelle. Les résultats indiquent que la raison pour laquelle la mère est admise dans l'hôpital et le résultat de la naissance ont été significativement rapprochés de la mort maternelle en analysant toutes les variables potentielles explicatives dans un modèle. Un groupe de mères à haut risque peut être identifié utilisant ces facteurs. Si ces critères ont été appliqués comme un outil prophétique dans l'arrangement clinique, la sensibilité résultante et la spécificité seraient plus de 85 %. L'identification dans le cadre d'hôpital d'un groupe de mères à haut risque dont des complications sérieuses sont agressivement gérées d'une façon coordonnée à travers les souvenirs médicaux peut réduire la mortalité maternelle (Afr J Reprod Health 2008; 12[3]:35-48)

Determinants of Post-Partum Maternal Mortality at Queen Elizabeth Central Hospital, Blantyre, Malawi: A Case-Control Study 2001-2002

The aim of this research is to identify the clinical, demographic and service-based determinants of postpartum maternal mortality within Queen Elizabeth Central Hospital, Blantyre, Malawi, during 2001and 2002. The study uses a case-control design using all postpartum maternal deaths in 2001 and 2002 as cases, with analysis conducted using conditional logistic regression. The results indicate that themothers’ reason for admission into hospital and the outcome of the birth were significantly related to maternal death when analysing all potential explanatory variables in one model. A group of high-risk mothers can be identified using these factors. If these criteria were applied as a predictive tool in the clinical setting the resulting sensitivity and specificity would be over 85%. Identification within the hospital setting of a group of very high-risk mothers in whom serious complications are aggressively managed in a coordinated way across the medical specialties may reduce maternal mortality (Afr J Reprod Health 2008; 12[3]:35-48)

Determinants of post-partum maternal mortality at Queen Elizabeth Central Hospital, Blantyre, Malawi:a case-control study 2001-2002

The aim of this research is to identify the clinical, demographic and service-based determinants of postpartum maternal mortality within Queen Elizabeth Central Hospital, Blantyre, Malawi, during 2001 and 2002. The study uses a case-control design using all postpartum maternal deaths in 2001 and 2002 as cases, with analysis conducted using conditional logistic regression. The results indicate that the mothers' reason for admission into hospital and the outcome of the birth were significantly related to maternal death when analysing all potential explanatory variables in one model. A group of high-risk mothers can be identified using these factors. If these criteria were applied as a predictive tool in the clinical setting the resulting sensitivity and specificity would be over 85%. Identification within the hospital setting of a group of very high-risk mothers in whom serious complications are aggressively managed in a coordinated way across the medical specialties may reduce maternal mortality