Maternal mortality in South Africa in 2001: From demographic census to epidemiological investigation.
Maternal mortality in South Africa in 2001: From demographic census to epidemiological investigation.
复制标题
2001年南非的孕产妇死亡率：从人口普查到流行病学研究。
DOI：
10.1186/1478-7954-6-4
复制
发表时间：
2008-08-21
影响因子：
3.3
通讯作者：
Nacro, Kourtoum
中科院分区：
文献类型：
--
作者：
Garenne, Michel;McCaa, Robert;Nacro, Kourtoum
非洲对产妇死亡率的研究仍然很少，而且很可能由于艾滋病毒/艾滋病而急剧恶化。2001年南非人口普查包括一个关于过去12个月死亡人数的问题，以及两个关于外因和孕产妇死亡（定义为“与妊娠有关的死亡”）的问题。人口普查的微观数据样本使研究人员能够评估一个受艾滋病毒/艾滋病和外部原因造成的高死亡率严重影响的国家的产妇死亡率水平和差异。在修正了几个较小的偏差后，我们对2001年产妇死亡率（MMR）的估计为每10万活产542例。这一水平远高于以前在艾滋病毒/艾滋病之前的估计。尽管产妇死亡在15 - 49岁妇女死亡中所占比例相对较低（6.4%），但这一高水平的出现是由于成人死亡率高得惊人，比15岁以下或50岁以上的死亡率高出约4.7倍。造成这些过高水平的主要原因是艾滋病毒/艾滋病和外部死亡原因。我们对MMR的区域估计与开普敦地区和阿金库尔DSS的其他调查结果一致。MMR的差异相当大：人口群体（种族）的差异为1 - 9.2，省份的差异为1 - 3.2，教育水平的差异为1 - 2.4。收入与财富的关系较为复杂，中等收入和中等财富指数最高。城市化的影响很小，在多变量分析中是相反的。各省较高的风险不一定与较低的收入、较低的教育程度或较高的家庭分娩比例有关，但主要与艾滋病毒/艾滋病的流行有关。人口普查微观数据提供了对产妇死亡率进行流行病学分析的机会。就南非而言，在过去10年中，MMR的水平急剧上升，很可能是由于艾滋病毒/艾滋病。产妇死亡的间接原因似乎比直接产科原因重要得多。产妇死亡率似乎不再是衡量产科护理质量或安全孕产的可靠指标。
Maternal mortality remains poorly researched in Africa, and is likely to worsen dramatically as a consequence of HIV/AIDS. 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. 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. 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.