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The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21)
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 protec...
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| Format: | Thesis |
| Language: | English English |
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Department of Public Health and Family Medicine
2025
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| _version_ | 1867613819625275392 |
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| access_status_str | Open Access |
| author | Hunter, Mehreen Bhorat |
| author2 | Kalk, Emma |
| author_browse | Hunter, Mehreen Bhorat Kalk, Emma |
| author_facet | Kalk, Emma Hunter, Mehreen Bhorat |
| author_sort | Hunter, Mehreen Bhorat |
| collection | Thesis |
| description | 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 |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/42343 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:42:12.742Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/42343 The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21) Hunter, Mehreen Bhorat Kalk, Emma Hannan, Luke Matjila, Mushi COVID-19 Pandemic South Africa Maternal mortality 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 2025-11-26T08:34:16Z 2025-11-26T08:34:16Z 2025 2025-11-26T08:31:35Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/42343 en eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | COVID-19 Pandemic South Africa Maternal mortality Hunter, Mehreen Bhorat The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21) |
| thesis_degree_str | Master's |
| title | The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21) |
| title_full | The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21) |
| title_fullStr | The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21) |
| title_full_unstemmed | The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21) |
| title_short | The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21) |
| title_sort | impact of the sars cov 2 pandemic on maternal mortality in a south african metropole 2020 21 |
| topic | COVID-19 Pandemic South Africa Maternal mortality |
| url | http://hdl.handle.net/11427/42343 |
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