title: Human immunodeficiency virus and AIDS and other important predictors of maternal mortality in Mulago Hospital Complex Kampala Uganda.
abstract: BACKGROUND
  Women with severe maternal morbidity are at high risk of dying. Quality and prompt management and sometimes luck have been suggested to reduce on the risk of dying. The objective of the study was to identify the direct and indirect causes of severe maternal morbidity, predictors of progression from severe maternal morbidity to maternal mortality in Mulago hospital, Kampala, Uganda.
  
  
  METHODS
  This was a longitudinal follow up study at the Mulago hospital's Department of Obstetrics and Gynaecology. Participants were 499 with severe maternal morbidity admitted in Mulago hospital between 15th November 2001 and 30th November 2002 were identified, recruited and followed up until discharge or death. Potential prognostic factors were HIV status and CD4 cell counts, socio demographic characteristics, medical and gynaecological history, past and present obstetric history and intra- partum and postnatal care.
  
  
  RESULTS
  Severe pre eclampsia/eclampsia, obstructed labour and ruptured uterus, severe post partum haemorrhage, severe abruptio and placenta praevia, puerperal sepsis, post abortal sepsis and severe anaemia were the causes for the hospitalization of 499 mothers. The mortality incidence rate was 8% (n = 39), maternal mortality ratio of 7815/100,000 live births and the ratio of severe maternal morbidity to mortality was 12.8:1.The independent predictors of maternal mortality were HIV/AIDS (OR 5.1 95% CI 2-12.8), non attendance of antenatal care (OR 4.0, 95% CI 1.3-9.2), non use of oxytocics (OR 4.0, 95% CI 1.7-9.7), lack of essential drugs (OR 3.6, 95% CI 1.1-11.3) and non availability of blood for transfusion (OR 53.7, 95% CI (15.7-183.9) and delivery of amale baby (OR 4.0, 95% CI 1.6-10.1).
  
  
  CONCLUSIONS
  The predictors of progression from severe maternal morbidity to mortality were: residing far from hospital, low socio economic status, non attendance of antenatal care, poor intrapartum care, and HIV/AIDS.There is need to improve on the referral system, economic empowerment of women and to offer comprehensive emergency obstetric care so as to reduce the maternal morbidity and mortality in our community.
authors.affiliation: Department of Obstetrics and Gynaecology, Walter Sisulu University Private Bag X1 Mathatha, South Africa. gjwandabwa@yahoo.com
authors.forename: Julius N
authors.initials: JN
authors.lastname: Wandabwa
authors.forename: Pat
authors.initials: P
authors.lastname: Doyle
authors.forename: Benjamin
authors.initials: B
authors.lastname: Longo-Mbenza
authors.forename: Paul
authors.initials: P
authors.lastname: Kiondo
authors.forename: Betty
authors.initials: B
authors.lastname: Khainza
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Othieno
authors.forename: Noreen
authors.initials: N
authors.lastname: Maconichie
mesh_terms: D000328:Adult; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000401:mortality*; D015497:HIV-1; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008428:Maternal Mortality / Q000639:trends*; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult