title: An autopsy study of maternal mortality in Mozambique: the contribution of infectious diseases.
abstract: BACKGROUND
  Maternal mortality is a major health problem concentrated in resource-poor regions. Accurate data on its causes using rigorous methods is lacking, but is essential to guide policy-makers and health professionals to reduce this intolerable burden. The aim of this study was to accurately describe the causes of maternal death in order to contribute to its reduction, in one of the regions of the world with the highest maternal mortality ratios.
  
  
  RESULTS
  We conducted a prospective study between October 2002 and December 2004 on the causes of maternal death in a tertiary-level referral hospital in Maputo, Mozambique, using complete autopsies with histological examination. HIV detection was done by virologic and serologic tests, and malaria was diagnosed by histological and parasitological examination. During 26 mo there were 179 maternal deaths, of which 139 (77.6%) had a complete autopsy and formed the basis of this analysis. Of those with test results, 65 women (52.8%) were HIV-positive. Obstetric complications accounted for 38.2% of deaths; haemorrhage was the most frequent cause (16.6%). Nonobstetric conditions accounted for 56.1% of deaths; HIV/AIDS, pyogenic bronchopneumonia, severe malaria, and pyogenic meningitis were the most common causes (12.9%, 12.2%, 10.1% and 7.2% respectively). Mycobacterial infection was found in 12 (8.6%) maternal deaths.
  
  
  CONCLUSIONS
  In this tertiary hospital in Mozambique, infectious diseases accounted for at least half of all maternal deaths, even though effective treatment is available for the four leading causes, HIV/AIDS, pyogenic bronchopneumonia, severe malaria, and pyogenic meningitis. These observations highlight the need to implement effective and available prevention tools, such as intermittent preventive treatment and insecticide-treated bed-nets for malaria, antiretroviral drugs for HIV/AIDS, or vaccines and effective antibiotics for pneumococcal and meningococcal diseases. Deaths due to obstetric causes represent a failure of health-care systems and require urgent improvement.
authors.affiliation: Barcelona Center for International Health Research (CRESIB) and Department of Pathology, Hospital Clinic, Institut d'Investigaçions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain. menendez@clinic.ub.es
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
authors.forename: Cleofé
authors.initials: C
authors.lastname: Romagosa
authors.forename: Mamudo R
authors.initials: MR
authors.lastname: Ismail
authors.forename: Carla
authors.initials: C
authors.lastname: Carrilho
authors.forename: Francisco
authors.initials: F
authors.lastname: Saute
authors.forename: Nafissa
authors.initials: N
authors.lastname: Osman
authors.forename: Fernanda
authors.initials: F
authors.lastname: Machungo
authors.forename: Azucena
authors.initials: A
authors.lastname: Bardaji
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quintó
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mayor
authors.forename: Denise
authors.initials: D
authors.lastname: Naniche
authors.forename: Carlota
authors.initials: C
authors.lastname: Dobaño
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
authors.forename: Jaume
authors.initials: J
authors.lastname: Ordi
mesh_terms: D000328:Adult; D001344:Autopsy; D003141:Communicable Diseases / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008428:Maternal Mortality / Q000639:trends; D009073:Mozambique / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D011446:Prospective Studies