COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

majority of the women (72%) were cared for by female relatives (either by mothers, sisters or
aunts). Five of the deaths (28%) occurred in women who were having their first pregnancy.
The age of half of the women who died was known and of these only one fell outside the
reproductive years (39 years), if South African criteria are used. Most of the pregnancies were
full term. The demographic profiles were similar to those found in these study sites previously. 7
Causes of Death
Generally causes of death fell into 3 categories:
• AIDS related - 12 (67%)
• Other non-pregnancy related infection - 3 (16.5%)
• Direct perinatal causes - 3 (16.5%)
Deaths were classified as AIDS-related if women were known to be HIV-positive and/or had
classic symptoms of AIDS (weight loss, chronic diarrhoea, loss of appetite, chronic cough, TB,
oral lesions, confusion, unable to care for self). There was one known HIV-positive woman
who died of an acute infection and one woman with chronic diarrhoea with unknown HIV status
who were also classified as AIDS-related deaths. All but two of these 12 women were no
longer able to care for themselves at the time of death.
The women with other non-pregnancy related infections all died with symptoms suggesting
infection, which lasted one week or less but did not appear to be directly related to pregnancy.
The HIV serological status of these women was unknown.
Finally, the direct perinatal causes included placenta praevia with postpartum haemorrhage,
possible anaesthetic accident and post-partum/perinatal infection. This last case also
appeared to involve potential negligence as the woman had had two prior caesarean sections
and was admitted to the hospital in labour but not delivered (by caesarean section) until two
days later.
In five of the cases a death certificate was available for review. One stated AIDS, one TB and
the other three "Natural Causes".
Time of Death
All but one mother died post-partum. The only woman who died in the antenatal period was
five months pregnant with probable AIDS-related symptoms of chronic diarrhoea, weight loss,
etc. The time of the postpartum deaths ranged from five hours to nine months, with a median of
one month. It must be noted that the deaths of women involved in the Good Start study in
Umlazi were selected to favour earlier rather than later postpartum deaths.
The women with an AIDS-related death had been ill between one week and 12 months, with
the majority having been ill for more than three months, and a median of 4.5 months of illness
prior to death. The other two categories died from a few hours to one month after onset of
illness. All but one died within a week. The woman who died at one month was a likely
anaesthetic accident who never woke up post-caesarean section and died after one month in a
coma.
Place of Death and Availability Transport
Twelve of the eighteen deaths occurred in a hospital or hospice setting. Four occurred at home
as they had left the health facility to "die at home". Two deaths occurred on the way to the
hospital. One was an AIDS-related death who had been in and out of the hospital repeatedly.
Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 24