The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21)
| dc.contributor.advisor | Kalk, Emma | |
| dc.contributor.advisor | Hannan, Luke | |
| dc.contributor.advisor | Matjila, Mushi | |
| dc.contributor.author | Hunter, Mehreen Bhorat | |
| dc.date.accessioned | 2025-11-26T08:34:16Z | |
| dc.date.available | 2025-11-26T08:34:16Z | |
| dc.date.issued | 2025 | |
| dc.date.updated | 2025-11-26T08:31:35Z | |
| dc.description.abstract | Background: During the COVID-19 pandemic there was a notable increase in maternal deaths across South Africa. Pre-pandemic, the Western Cape Province had made significant strides towards reducing maternal mortality. However, this progress was reversed in the pandemic period despite a relative protection of maternal care services. The biological impact of SARS-CoV-2 may not be the sole reason for the increase in mortality. Therefore, we aimed to evaluate the relative change in the maternal death rate for non-SARS-CoV-2-related deaths intra-pandemic versus pre-pandemic in 2019. Methods: We conducted a retrospective cohort study involving all pregnant women with a pregnancy outcome enumerated in the Provincial Health Data Centre, in the Metro-West region of Cape Town from 1 January 2019 – 31 January 2022. Cause of in- facility maternal death and relationship to SARS-CoV-2 infection was determined by folder review. We used Interrupted Time Series (ITS) analysis to assess the impact of the pandemic period on non-SARS-CoV-2 causes of maternal mortality. Maternal characteristics reviewed included HIV status and the proportion of maternal deaths occurring in persons living with HIV were also explored. Results: Over 98 000 women were included with 68 deaths reviewed. The ITS model (p =0.01) revealed that the pandemic was associated with a step increase of 3.12 (-1.66;7.9) in maternal mortality rate for non-SARS-CoV-2 related deaths following the start of the pandemic. This impact was sustained with an attenuation in the maternal mortality rate reduction over time from -0.56 pre-pandemic to -0.12 intra-pandemic. Folder review of deaths revealed an increase in opportunistic infections as a cause of death relative to pre-pandemic. Conclusion: Whilst maternal healthcare services were largely protected from service disruptions during the COVID-19 pandemic, there was a reversal of some of the progress made in reducing non-SARS-CoV-2 maternal deaths in prior years. An increase in opportunistic infections and an attenuation of the decline in maternal death rate suggest that optimising maternal health requires the well-functioning of the entire healthcare ecosystem. The indirect impact of health threats, and our responses thereto, need to be strongly considered in future management strategies | |
| dc.identifier.apacitation | Hunter, M. B. (2025). <i>The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21)</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/42343 | en_ZA |
| dc.identifier.chicagocitation | Hunter, Mehreen Bhorat. <i>"The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21)."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025. http://hdl.handle.net/11427/42343 | en_ZA |
| dc.identifier.citation | Hunter, M.B. 2025. The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21). . University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. http://hdl.handle.net/11427/42343 | en_ZA |
| dc.identifier.ris | TY - Thesis / Dissertation AU - Hunter, Mehreen Bhorat AB - Background: During the COVID-19 pandemic there was a notable increase in maternal deaths across South Africa. Pre-pandemic, the Western Cape Province had made significant strides towards reducing maternal mortality. However, this progress was reversed in the pandemic period despite a relative protection of maternal care services. The biological impact of SARS-CoV-2 may not be the sole reason for the increase in mortality. Therefore, we aimed to evaluate the relative change in the maternal death rate for non-SARS-CoV-2-related deaths intra-pandemic versus pre-pandemic in 2019. Methods: We conducted a retrospective cohort study involving all pregnant women with a pregnancy outcome enumerated in the Provincial Health Data Centre, in the Metro-West region of Cape Town from 1 January 2019 – 31 January 2022. Cause of in- facility maternal death and relationship to SARS-CoV-2 infection was determined by folder review. We used Interrupted Time Series (ITS) analysis to assess the impact of the pandemic period on non-SARS-CoV-2 causes of maternal mortality. Maternal characteristics reviewed included HIV status and the proportion of maternal deaths occurring in persons living with HIV were also explored. Results: Over 98 000 women were included with 68 deaths reviewed. The ITS model (p =0.01) revealed that the pandemic was associated with a step increase of 3.12 (-1.66;7.9) in maternal mortality rate for non-SARS-CoV-2 related deaths following the start of the pandemic. This impact was sustained with an attenuation in the maternal mortality rate reduction over time from -0.56 pre-pandemic to -0.12 intra-pandemic. Folder review of deaths revealed an increase in opportunistic infections as a cause of death relative to pre-pandemic. Conclusion: Whilst maternal healthcare services were largely protected from service disruptions during the COVID-19 pandemic, there was a reversal of some of the progress made in reducing non-SARS-CoV-2 maternal deaths in prior years. An increase in opportunistic infections and an attenuation of the decline in maternal death rate suggest that optimising maternal health requires the well-functioning of the entire healthcare ecosystem. The indirect impact of health threats, and our responses thereto, need to be strongly considered in future management strategies DA - 2025 DB - OpenUCT DP - University of Cape Town KW - COVID-19 KW - Pandemic KW - South Africa KW - Maternal mortality LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21) TI - The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21) UR - http://hdl.handle.net/11427/42343 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/42343 | |
| dc.identifier.vancouvercitation | Hunter MB. The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21). []. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/42343 | en_ZA |
| dc.language.iso | en | |
| dc.language.rfc3066 | eng | |
| dc.publisher.department | Department of Public Health and Family Medicine | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.publisher.institution | University of Cape Town | |
| dc.subject | COVID-19 | |
| dc.subject | Pandemic | |
| dc.subject | South Africa | |
| dc.subject | Maternal mortality | |
| dc.title | The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21) | |
| dc.type | Thesis / Dissertation | |
| dc.type.qualificationlevel | Masters | |
| dc.type.qualificationlevel | MMed |