A research report submitted to the School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, in partial fulfillment of the requirements for the degree of
Master of Public Health in the field of Health Systems and Policy / Introduction: The maternal mortality ratio in Sedibeng District, Gauteng Province, from 2002 – 2004 was
220/100000. For the past decade HIV has been identified as a factor that has slowed the decline
in maternal deaths in South Africa. The purpose of this study was to describe personal and
service level factors contributing to maternal mortality of HIV positive women. It is hoped that
the results of this study will be useful in developing interventions that will assist to curb the
maternal mortality ratio.
Methodology:
Maternal death records were reviewed for the period 2004-2009. Data was collected on
antenatal care, hospital care after admission and access to HIV services. The data were analysed
using Stata 10. The results were compared with the national guidelines for the care of HIV
positive pregnant women so as to identify discrepancies between the two.
Results:
One hundred and twenty five maternal death records were reviewed. Of these, 90% booked late
for antenatal care i.e. beyond 20 weeks gestation. The majority (60.8%) of the women were HIV
positive. Of the HIV positive women, 37.5% had CD 4 counts less than 200, which made them
eligible for antiretroviral therapy. Of those that were eligible for antiretroviral therapy, 50.0% did
not access the antiretrovirals due to late booking and loss to follow-up. Another main finding
was that 36% died during the postnatal period.
Conclusion:
The antenatal bookings occurred after 12 weeks gestation which limited the time for starting
patients on antiretroviral therapy. The high number of deaths during the postnatal period may
indicate poor postnatal care and follow-up; as antiretroviral therapy could have been started
during the postnatal period.
Recommendations:
Early antenatal booking and early HIV testing should be encouraged in communities. Antenatal
services should be integrated so that HIV positive pregnant women are treated comprehensively
and that the focus is not only on HIV, but also on other conditions such as TB, pneumonia,
anaemia and hypertension. All pregnant HIV positive women must be done CD 4 counts; and all
those found to be eligible for antiretroviral therapy should be given antiretrovirals timeously.
Such women should be followed up and monitored closely. Postnatal check-up at 3 days should
be strengthened for the mother-and-baby pair.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/13776 |
| Date | January 2012 |
| Creators | Sejake, Senate Betty |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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