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HIV and Maternal Mortality: Intersecting Epidemics

Despite a global effort to curb maternal mortality, nearly 275,000 women continue to die in childbirth annually. 1

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HIV and Maternal Mortality: Intersecting Epidemics

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  1. Despite a global effort to curb maternal mortality, nearly 275,000 women continue to die in childbirth annually.1 Recent global health literature implicates HIV as a major etiology of maternal death with an estimated 56,100 HIV-related deaths during pregnancy per year, however little is known regarding the mechanism through which HIV impacts maternal health.1 The results from this analysis suggest that among women experiencing obstetric hemorrhage, HIV positive women had nearly two fold odds of severe obstetric hemorrhage when compared to HIV negative women. Rethinking the etiologies of maternal mortality: a retrospective cohort study investigating the association between HIV status and severe obstetric hemorrhage in Zambia Authors: Megan Rose Curtis1, Alison El Ayadi2, Gricelia Mkumba3, Elizabeth Butrick2, Ashley Leech4, Jillian Geissler2, Suellen Miller2 Overview Motivation and methods Results • We estimated logistic regression models to explore the relationship between HIV status and severe obstetric hemorrhage, defined as blood loss equal to or greater than 1000 mL. Multivariable logistic regression of HIV and other predictors on severe obstetric hemorrhage* *multivariable model controlled for parity, age, and site. Discussion • The sample comprised 321 women admitted to one of three tertiary care facilities in Zambia between September 2010 - March 2012 with two of the following three eligibility criteria: • • Pulse > 100bpm • • Blood pressure < 100mmHg • • Estimated blood loss ≥ 1000 mL • Implications • Suggests HIV may increase severity of obstetric hemorrhage, thus increasing a woman’s risk of maternal mortality. • This study should encourage further research into the ways in which HIV infection operates to impact maternal health. • Limitations • Overlap between eligibility criteria and outcome variable. • Subjectivity of estimated blood loss. • 52% of original sample excluded due to missing variables or clinical differences. • Statistically significant differences in parity between exposure groups. Background HIV and Maternal Mortality: Intersecting Epidemics Participant demographics, N=321 * * Global Progress Towards Reducing Maternal Deaths Acknowledgements: This project was undertaken as the fieldwork component of an MS in Global Health Sciences at UCSF. Special thanks to entire NASG research team at UCSF’s Safe Motherhood Program who provided study data as well as invaluable advice and guidance. Warm thanks to the Zambian nurses/data collectors, without whom this study would not have been possible. * References : 1. R Lozano, HWang, KJ Foreman. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet, 378 (2011), pp. 1138–1161 1. Tulane University School of Medicine 2. Safe Motherhood Program, Bixby Center for Global Reproductive Health, University of California San Francisco. 3.University of Zambia, Lusaka. 4. Boston University The Lancet, 2011 * Variable included in final model

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