Levels and factors associated with maternal death in Agincourt, a rural sub-district of Mpumalanga Province, South Africa

M.Sc. (Med.) (Epidemiology and Biostatistics), Faculty of Health Sciences, University of the Witwatersrand, 2011Introduction: The reduction of maternal death is a high priority for the international community, especially in view of the increased attention to Millennium Development Goal 5 Maternal mortality in developing countries has been estimated at 400 per 100,000 live births whereas levels in most developed countries are below 25 per 100,000 live births. According to the World Health Organization (WHO), at least 500,000 women worldwide die every year from complications of pregnancy, abortions and delivery. Objectives: The study main objectives were to establish the maternal mortality ratio and trend from 1993 to 2006 in the rural Agincourt sub-district; to describe the main causes of death of women of reproductive age from 1993 to 2006; and to identify socio-demographic factors associated with maternal death among rural pregnant women 15-49 years. Methods: A retrospective cohort design was employed using secondary data collected as part of the Agincourt health and socio-demographic surveillance system. The total cohort size of 25,061 women who were pregnant was identified. Logistic regression was used in ascertaining which factors were associated with maternal death. Results: Seventy maternal deaths were identified. There was an increasing risk of maternal death with increasing maternal age and parity. The maternal mortality ratio for the 14-year period was 287/100,000 live births and the trend was statistically significant. HIV/AIDS, respiratory tuberculosis and other ill-defined conditions were the major causes of death across the age groups with over 70% of all deaths of women of reproductive age related to HIV/TB. Conclusion: Maternal mortality ratio increased per year from 1993 to 2006. Communicable diseases (largely HIV/AIDS) have emerged as the most common causes of death of women of reproductive age in the Agincourt sub-district, with major risk factors being increasing maternal age, complication during delivery, antenatal care visits and mother’s socio-economi