Adverse outcomes of pregnancy in Potchefstroom, South Africa

MMed, Community Health, Faculty of Health Sciences, University of the Witwatersrand, 2009Introduction Adverse outcomes of pregnancy are global health problems that are much more pronounced in developing countries. The risk factors associated with adverse outcomes of pregnancy are multifactorial. In South Africa, the population prevalence and associated risk factors of maternal and perinatal mortality are routinely documented, but there are gaps in the data on other pregnancy adverse outcomes. This study was aimed at determining the prevalence rates and related risk factors of preterm births and pregnancy loss in an urban population in South Africa. Methods The study was a cross-sectional analytical community study of women 18 to 49 years of age, living in the Potchefstroom municipality. It was conducted from August 2007 to April 2008. Participants were selected using a systematic random sampling strategy; 1 210 women participated. An adapted reproductive health questionnaire was used to collect sociodemographic, environmental, occupational and reproductive health data. Results Prevalence of pregnancy loss and preterm births were estimated to be 5.6% [95% CI: 5.57% - 5.63%] and 13.4% [95% CI: 13.36% - 13.44%], respectively. Pregnancy loss was associated with psychological stress and working during pregnancy; preterm birth was associated with White, Coloured and Indian race, primary and high school education, psychological stress and chronic disease; and antenatal care use was protective against both pregnancy loss and preterm birth. Conclusion The prevalence of pregnancy loss found in this study was lower than would be expected in the general South African population; while the preterm birth prevalence, although lower than that of other developing and middle income countries, could be improved. Generally, there are common risk factors for pregnancy loss and for preterm births. Some of the existing evidence on risk factors was supported by the findings of this study. Improvement of surveillance and health information systems for pregnancy loss and preterm births would provide essential information on the burden of these outcomes in South Africa and would subsequently guide policy, research and prioritisation of effective control programmes

Risk factors for Coronavirus Disease 2019 (COVID-19) death in a population cohort study from the Western Cape Province, South Africa

BACKGROUND. Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. METHODS. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates. RESULTS. Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID- 19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1). CONCLUSIONS. While our findings may overestimate HIV- and tuberculosis-associated COVID-19 mortality risks due to residual confounding, both living with HIV and having current tuberculosis were independently associated with increased COVID-19 mortality. The associations between age, sex, and other comorbidities and COVID-19 mortality were similar to those in other settings.The Western Cape Provincial Health Data Centre from the Western Cape Department of Health, the US National Institutes for Health (grant numbers R01 HD0804, the Bill and Melinda Gates Foundation, the United States Agency for International Development and the Wellcome Trust.https://academic.oup.com/cid/am2023Veterinary Tropical Disease

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)