Presentation on theme: "R ETHINKING THE ETIOLOGIES OF MATERNAL MORTALITY : A RETROSPECTIVE COHORT STUDY INVESTIGATING THE ASSOCIATION BETWEEN HIV STATUS AND SEVERE OBSTETRIC HEMORRHAGE."— Presentation transcript:
R ETHINKING THE ETIOLOGIES OF MATERNAL MORTALITY : A RETROSPECTIVE COHORT STUDY INVESTIGATING THE ASSOCIATION BETWEEN HIV STATUS AND SEVERE OBSTETRIC HEMORRHAGE IN Z AMBIA 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. HIV and Maternal Mortality: Intersecting Epidemics 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. Authors: Megan Rose Curtis 1, Alison El Ayadi 2, Gricelia Mkumba 3, Elizabeth Butrick 2, Ashley Leech 4, Jillian Geissler 2, Suellen Miller 2 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. O VERVIEW M OTIVATION AND METHODS Global Progress Towards Reducing Maternal Deaths B ACKGROUND 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 R ESULTS Multivariable logistic regression of HIV and other predictors on severe obstetric hemorrhage* Participant demographics, N=321 D ISCUSSION 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. * * * HIV + n=59 HIV – n=262 P-Value Mean age27.47 S.D.=6.00 28.23 S.D.=7.15 0.45 Mean parity2.19 S.D.=1.70 2.82 S.D.=2.31 0.05 Mean gestational age31.82 S.D.=9.57 33.38 S.D.=8.33 0.22 Condition on entry: Normal19%25%0.29 Confused75%71%0.58 Unconscious5%2%0.24 Under anesthesia2% 0.93 Site: Lusaka65%60%0.56 Kitwe20%25%0.43 Ndola15% 0.88 Variable included in final model * VariableOdds Ratio95% Confidence Interval P-value HIV status 1.921.05 - 3.50.033 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 *multivariable model controlled for parity, age, and site. 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 The Lancet, 2011
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