{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T14:34:58Z","timestamp":1769092498377,"version":"3.49.0"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,9,12]],"date-time":"2014-09-12T00:00:00Z","timestamp":1410480000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Anova Health Institute"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2015,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To estimate maternal mortality ratio (<jats:styled-content style=\"fixed-case\">MMR<\/jats:styled-content>) and determine maternal death causes and trends in Greater Soweto, Johannesburg, South Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Chris Hani Baragwanath Maternity Hospital (<jats:styled-content style=\"fixed-case\">CHBMH<\/jats:styled-content>) in Greater Soweto.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Maternal deaths at <jats:styled-content style=\"fixed-case\">CHBMH<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Record review of maternal deaths from 1997 to 2012, using hospital death records, with denominator data from the district health information system and the hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Maternal mortality ratio per 100\u00a0000 live births, and causes of death classified as in the South African confidential enquiries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 479 deaths, with a peak <jats:styled-content style=\"fixed-case\">MMR<\/jats:styled-content> of 139 in 2004 and a decline to 86 in 2012. Of 332 women tested, 245 (74%) were <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010infected. Nonpregnancy\u2010related infection (40%) was the most frequent cause of death, followed by hypertension (16%) and obstetric haemorrhage (13%). <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> infection rates in these groups were 92%, 30% and 61%, respectively. Previous caesarean section was associated with obstetric haemorrhage death (odds ratio [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>] 3.2, 95% confidence interval [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] 1.7\u20136.0), maternal age \u226535\u00a0years with hypertension death (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.2, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.2\u20133.7) and antenatal anaemia with nonpregnancy\u2010related infection death (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 4.0, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.3\u20136.9), compared with other causes of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is evidence of a decline in <jats:styled-content style=\"fixed-case\">MMR<\/jats:styled-content> since <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> treatment for pregnant women was introduced in 2004. Previous caesarean section, advanced maternal age, and anaemia were associated with death from obstetric haemorrhage, hypertensive disorders of pregnancy and nonpregnancy\u2010related infections, respectively. <jats:styled-content style=\"fixed-case\">MMR<\/jats:styled-content> may be further reduced with accelerated initiation of <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> treatment during pregnancy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13064","type":"journal-article","created":{"date-parts":[[2014,9,12]],"date-time":"2014-09-12T05:31:39Z","timestamp":1410499899000},"page":"220-227","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Declining maternal mortality in the face of persistently high <scp>HIV<\/scp> prevalence in a middle\u2010income country"],"prefix":"10.1111","volume":"122","author":[{"given":"EJ","family":"Buchmann","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CN","family":"Mnyani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"KA","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"MF","family":"Chersich","sequence":"additional","affiliation":[{"name":"Centre for Health Policy MRC Health Policy Research Group School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"},{"name":"Wits Reproductive Health and HIV Institute University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JA","family":"McIntyre","sequence":"additional","affiliation":[{"name":"Anova Health Institute Johannesburg South Africa"},{"name":"School of Public Health and Family Medicine University of Cape Town Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,9,12]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2013.05.011"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60518-1"},{"key":"e_1_2_6_4_1","volume-title":"Saving Mothers 2008\u20132010: Fifth Report on the Confidential Enquiries into Maternal Deaths in South Africa","author":"National Committee for Confidential Enquiry into Maternal Deaths","year":"2012"},{"key":"e_1_2_6_5_1","volume-title":"South Africa Demographic and Health Survey 1998","author":"Department of Health","year":"2002"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0073864"},{"key":"e_1_2_6_7_1","volume-title":"Saving Mothers. 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