马拉维农村围产期感染及相关产妇死亡率。

Peripartum infections and associated maternal mortality in rural Malawi.

机构信息

From the Thyolo District Health Office, Ministry of Health, Thyolo, Malawi; Médecins Sans Frontières Operational Center Brussels, Brussels, Belgium; the Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; the Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands; and the Center for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.

出版信息

Obstet Gynecol. 2011 Aug;118(2 Pt 1):266-272. doi: 10.1097/AOG.0b013e3182254d03.

DOI:10.1097/AOG.0b013e3182254d03

PMID:21775841

Abstract

OBJECTIVE

To assess associations between maternal mortality and severe morbidity and human immunodeficiency virus (HIV) infection, uptake of antiretroviral therapy, obstetric infections, and nonobstetric infections in a rural Malawian district, where the estimated HIV prevalence is 21%.

METHODS

We studied the incidence and outcomes of maternal peripartum infections between September 2007 and September 2009 at the district hospital. We used a facility-based prospective cohort study design, including all cases of severe maternal peripartum infection up to 42 days postpartum, and recorded maternal and pregnancy-related characteristics. We assessed the association between mortality and covariates (including nonobstetric infection, HIV prevalence, and uptake of antiretroviral therapy) using univariable and multivariable logistic regression models.

RESULTS

In total, 140 infections occurred: 79 (56%) obstetric and 53 (38%) nonobstetric (eight unknown). Half of the women were HIV-positive. Multivariable analysis showed that nonobstetric infection was the most important explanatory variable for mortality (adjusted odds ratio [OR] 4.23, 95% confidence interval [CI] 1.53-11.73). HIV-positive women not on antiretroviral therapy were at higher risk of mortality (adjusted OR 3.02, 95% CI 1.06-8.60) but there was no significant mortality increase among those on treatment (adjusted OR 0.51, 95% CI 0.10-2.71). The most common infections were puerperal sepsis (obstetric, case fatality rate 7%) and pneumonia (nonobstetric, case fatality rate 41%).

CONCLUSION

Untreated HIV infection and nonobstetric infections are independently associated with maternal mortality. Prompt treatment of HIV and nonobstetric infections in pregnant women must be prioritized to reduce maternal mortality.

LEVEL OF EVIDENCE

II.

摘要

目的

评估在马拉维一个农村地区母婴死亡率和严重发病与人类免疫缺陷病毒（HIV）感染、抗逆转录病毒治疗的采用、产科感染和非产科感染之间的相关性，该地区估计 HIV 流行率为 21%。

方法

我们于 2007 年 9 月至 2009 年 9 月在区医院研究了围产期产妇感染的发生率和结果。我们使用基于机构的前瞻性队列研究设计，包括产后 42 天内所有严重围产期感染的病例，并记录了产妇和妊娠相关特征。我们使用单变量和多变量逻辑回归模型评估死亡率与协变量（包括非产科感染、HIV 流行率和抗逆转录病毒治疗的采用）之间的关联。

结果

共有 140 例感染发生：79 例（56%）为产科感染，53 例（38%）为非产科感染（8 例未知）。一半的妇女 HIV 阳性。多变量分析表明，非产科感染是死亡的最重要解释变量（调整后的优势比[OR]4.23，95%置信区间[CI]1.53-11.73）。未接受抗逆转录病毒治疗的 HIV 阳性妇女死亡风险更高（调整后的 OR 3.02，95% CI 1.06-8.60），但接受治疗的妇女死亡率没有显著增加（调整后的 OR 0.51，95% CI 0.10-2.71）。最常见的感染是产褥期败血症（产科，病死率为 7%）和肺炎（非产科，病死率为 41%）。