Maternal mortality associated with tuberculosis-HIV-1 co-infection in Durban, South Africa.
OBJECTIVE
To document the impact of tuberculosis and HIV-1 on maternal mortality.


METHODS
Prospective study, 1997 and 1998; retrospective analysis, 1996.


METHODS
Known maternal deaths, defined as the death of a mother within a year post-delivery, were studied in Durban, KwaZulu Natal. The HIV-1 status, presence of tuberculosis, maternal clinical features and perinatal outcomes were documented. The overall as well as HIV-1 and tuberculosis-specific maternal mortality rates for the hospital were calculated. The attributable fraction of deaths as a result of HIV-1 was calculated in the overall group and in those with tuberculosis co-infection.


RESULTS
A total of 50 518 deliveries and 101 maternal deaths were recorded. Of the deaths, 29.7% (30/101) were HIV-1 infected. The overall mortality rate was 200/100 000; for HIV-1-infected women this was 323.3/100 000, HIV-1-negative mothers, 148.6/100 000 live births. The attributable fraction of overall deaths as a result of HIV-1 was 15.9% Fourteen of the 15 mothers with tuberculosis were HIV-1 co-infected. The mortality rate for tuberculosis and HIV-1 co-infection was 121.7/1000; for tuberculosis without HIV-1 co-infection, 38.5/1000. Fifty-four per cent of maternal deaths caused by tuberculosis were attributable to HIV-1 infection. Thirty-five per cent of maternal deaths were associated with stillbirths; perinatal outcomes were no different between groups of mothers with tuberculosis, HIV-1 or neither infection.


CONCLUSIONS
Tuberculosis and HIV-1 are emerging as significant contributors to maternal mortality in KwaZulu Natal. Any attempt to improve maternal health must also include careful screening and investigation for tuberculosis in high-risk pregnant women.
Khan
M
M
Medical Research Council, South Africa.
Pillay
T
T
Moodley
J M
JM
Connolly
C A
CA
D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000150:complications / Q000401:mortality*; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D008428:Maternal Mortality; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology / Q000401:mortality / Q000821:virology; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000401:mortality*
D015483:HIV Antibodies