Maternal mortality in South Africa in 2001: From demographic census to epidemiological investigation

<p>Abstract</p> <p>Background</p> <p>Maternal mortality remains poorly researched in Africa, and is likely to worsen dramatically as a consequence of HIV/AIDS.</p> <p>Methods</p> <p>The 2001 census of South Africa included a question on deaths in the previous 12 months, and two questions on external causes and maternal mortality, defined as "pregnancy-related deaths". A microdata sample from the census permits researchers to assess levels and differentials in maternal mortality, in a country severely affected by high death rates from HIV/AIDS and from external causes.</p> <p>Results</p> <p>After correcting for several minor biases, our estimate of the Maternal Mortality Ratio (MMR) in 2001 was 542 per 100,000 live births. This level is much higher than previous estimates dating from pre-HIV/AIDS times. This high level occurred despite a relatively low proportion of maternal deaths (6.4%) among deaths of women aged 15–49 years, and was due to the astonishingly high level of adult mortality, some 4.7 times higher than expected from mortality below age 15 or above age 50. The main reasons for these excessive levels were HIV/AIDS and external causes of deaths. Our regional estimates of MMR were found to be consistent with other findings in the Cape Town area, and with the Agincourt DSS. The differentials in MMR were considerable: 1 to 9.2 for population groups (race), 1 to 3.2 for provinces, and 1 to 2.4 for levels of education. Relationship with income and wealth were complex, with highest values for middle income and middle wealth index. The effect of urbanization was small, and reversed in a multivariate analysis. Higher risks in provinces were not necessarily associated with lower income, lower education or higher proportions of home delivery, but correlated primarily with the prevalence of HIV/AIDS.</p> <p>Conclusion</p> <p>Demographic census microdata offer the opportunity to conduct an epidemiologic analysis of maternal mortality. In the case of South Africa, the level of MMR increased dramatically over the past 10 years, most likely because of HIV/AIDS. Indirect causes of maternal deaths appear much more important than direct obstetric causes. The MMR appears no longer to be a reliable measure of the quality of obstetric care or a measure of safe motherhood.</p

Mortality impact of AIDS in Abidjan, 1986-1992

To quantify the mortality impact of AIDS in the city of Abidjan (Côte d'Ivoire) by a full scale analysis of mortality trends before and after the onset of the epidemic. Data on deaths registered in the 10 vital registration centers of the city between 1973 and 1992, and data on causes of deaths in the four public hospitals were coded and investigated. Data on deaths were compared with census data in order to compute death rates. Life tables were computed for each of the 20 years of the study. The trends in death rates were analysed during the 10 years before the onset of the AIDS epidemic (1973-1982) and compared with the changing death rates in the following 10 years (1983-1992). Deaths attributable to AIDS were defined as those in excess of the original trends. The evolution in the number of deaths in the hospital allowed an analysis by cause of death. There was a marked increase in death rates starting in 1986, date of the first diagnosed AIDS cases in the city. This increase was significant for both sexes, but more pronounced among men. It was concentrated primarily among young adults (aged 25-44 years) and among older children (aged 5-14 years), and most of it was considered to be attributable to AIDS and related infections, tuberculosis in particular. When data were cumulated from 1986 to 1992, approximately 25000 persons were estimated to have died of AIDS. The high number of AIDS deaths estimated in Abidjan underlines the heavy toll already paid by african populations, and calls for intensive action. (Résumé d'auteur

The Agincourt demographic and health study - site description, baseline findings and implications

No Abstract

Conséquences démographiques du sida en Abidjan : 1986-1992

Les statistiques de l'état civil et des formations sanitaires sont notoirement peu utilisées en Afrique pour étudier les tendances de la mortalité. L'étude d'Abidjan montre que c'est une situation très regrettable, car ces statistiques peuvent fournir de précieux renseignements sur l'état sanitaire de la population. Dans le cas présent, l'analyse fine des tendances de la mortalité, couplée avec l'analyse des causes de décès dans les hôpitaux, révèle assez précisément les conséquences démographiques du sida dans la capitale de la Côte d'Ivoire, malgré l'imperfection des données. Les estimations indiquent que près de 25 000 personnes seraient décédées du sida entre 1986 et 1992, les sept premières années de l'épidémie, ce qui confirme qu'Abidjan est une des villes les plus touchées au monde par cette troublante épidémie. Ce sont surtout les jeunes de sexe masculin qui ont été les plus touchés, dans toutes les couches de la société. Un modèle a permis de reconstruire la dynamique de l'épidémie, qui montre que le premier pic des infections se serait produit vers 1987. On peut s'attendre à une moyenne d'environ 7 000 cas de sida par an dans la ville jusqu'à l'an 2000, ce qui aura des conséquences importantes sur l'utilisation des infrastructures hospitalières. L'importance numérique de ces estimations souligne l'urgence de renforcer la lutte contre l'épidémie de sida en Côte d'Ivoire et dans le monde. (Résumé d'auteur

Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition

BACKGROUND: Excess male morbidity and mortality is well recognised in neonatal medicine and infant health. In contrast, within global nutrition, it is commonly assumed that girls are more at risk of experiencing undernutrition. We aimed to explore evidence for any male/female differences in child undernutrition using anthropometric case definitions and the reasons for differences observed. METHODS: We searched: Medline, Embase, Global health, Popline and Cochrane databases with no time limits applied. Eligible studies focused on children aged 0–59 months affected by undernutrition where sex was reported. In the meta-analysis, undernutrition-specific estimates were examined separately for wasting, stunting and underweight using a random-effects model. RESULTS: 74 studies were identified: 44/74 studies were included in the meta-analysis. In 20 which examined wasting, boys had higher odds of being wasted than girls (pooled OR 1.26, 95% CI 1.13 to 1.40). 38 examined stunting: boys had higher odds of stunting than girls (pooled OR 1.29 95% CI 1.22 to 1.37). 23 explored underweight: boys had higher odds of being underweight than girls (pooled OR 1.14, 95% CI 1.02 to 1.26). There was some limited evidence that the female advantage, indicated by a lower risk of stunting and underweight, was weaker in South Asia than other parts of the world. 43/74 (58%) studies discussed possible reasons for boy/girl differences; 10/74 (14%) cited studies with similar findings with no further discussion; 21/74 (28%) had no sex difference discussion. 6/43 studies (14%) postulated biological causes, 21/43 (49%) social causes and 16/43 (37%) to a combination. CONCLUSION: Our review indicates that undernutrition in children under 5 is more likely to affect boys than girls, though the magnitude of these differences varies and is more pronounced in some contexts than others. Future research should further explore reasons for these differences and implications for nutrition policy and practice

The Future Mortality of High Mortality Countries: A Model Incorporating Expert Arguments

This paper examines the future of mortality in the 65 countries still experiencing high mortality in 2010, as defined by a cutoff of 40 deaths before age five per thousand live births. Mortality declines in several countries stagnated or reversed in the last two decades of the twentieth century due mainly to HIV/AIDS. The forces underlying past mortality trends and affecting the future course of mortality are examined by reviewing the existing literature and reporting the results of the global survey and invited meeting, both involving mortality experts. The experts assessed the likelihood and weight of forces hypothesized to influence mortality. A statistical model is combined with these expert assessments to produce a set of mortality assumptions that are incorporated into the projections reported in this paper. This paper also addresses the limited availability of reliable data on age-specific mortality rates