Systematic review of the proportion of pregnancy-related deaths attributed to HIV in population-based studies in sub-Saharan Africa

ObjectivesTo estimate the proportion of pregnancy-related deaths attributed to HIV in population-based studies in sub-Saharan Africa, and to document the methods used to make such attribution. MethodsFour databases were searched for studies on causes of maternal and pregnancy-related mortality published from 2003 to June 2013. Data were extracted, and meta-analysis of proportions with random effects was used to obtain summary estimates. ResultsIn the 19 studies found, the proportion of deaths attributed to HIV ranged from 0.0% to 27.0%. The summary proportion was 3.4% (95% confidence interval: 1.8-6.3), with high heterogeneity. Subregionally, the summary proportions were 1.1% (0.4-3.3%) in West Africa, 4.5% (1.7-11.2%) in East Africa and 26.1% (21.9-30.7%) in Southern Africa. Criteria for assigning HIV as a cause of maternal death were rarely reported, and overall, methods were poor. ConclusionsThe proportion of pregnancy-related/maternal deaths attributed to HIV is substantially lower than modelled estimates, but comparisons are hampered by the absence of standard approaches. Clear guidelines on how to classify pregnancy-related deaths as attributable to HIV are urgently needed, so that the effect of the HIV epidemic on pregnancy-related mortality can be monitored and action taken accordingly.