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Research Article

An Autopsy Study of Maternal Mortality in Mozambique: The Contribution of Infectious Diseases

  • Clara Menéndez mail,

    To whom correspondence should be addressed. E-mail: menendez@clinic.ub.es

    Affiliations: Barcelona Center for International Health Research (CRESIB) and Department of Pathology, Hospital Clinic, Institut d'Investigaçions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain, Centro de Investigaçao em Saude de Manhiça (CISM), Maputo, Mozambique

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  • Cleofé Romagosa,

    Affiliations: Barcelona Center for International Health Research (CRESIB) and Department of Pathology, Hospital Clinic, Institut d'Investigaçions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain, Centro de Investigaçao em Saude de Manhiça (CISM), Maputo, Mozambique

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  • Mamudo R Ismail,

    Affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique

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  • Carla Carrilho,

    Affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique

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  • Francisco Saute,

    Affiliation: National Malaria Control Program, Ministry of Health, Mozambique

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  • Nafissa Osman,

    Affiliation: Department of Gynaecology, Maputo Central Hospital, Universidad Eduardo Mondlane, Maputo, Mozambique

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  • Fernanda Machungo,

    Affiliation: Department of Gynaecology, Maputo Central Hospital, Universidad Eduardo Mondlane, Maputo, Mozambique

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  • Azucena Bardaji,

    Affiliations: Barcelona Center for International Health Research (CRESIB) and Department of Pathology, Hospital Clinic, Institut d'Investigaçions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain, Centro de Investigaçao em Saude de Manhiça (CISM), Maputo, Mozambique

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  • Llorenç Quintó,

    Affiliation: Barcelona Center for International Health Research (CRESIB) and Department of Pathology, Hospital Clinic, Institut d'Investigaçions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain

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  • Alfredo Mayor,

    Affiliation: Barcelona Center for International Health Research (CRESIB) and Department of Pathology, Hospital Clinic, Institut d'Investigaçions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain

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  • Denise Naniche,

    Affiliation: Barcelona Center for International Health Research (CRESIB) and Department of Pathology, Hospital Clinic, Institut d'Investigaçions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain

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  • Carlota Dobaño,

    Affiliation: Barcelona Center for International Health Research (CRESIB) and Department of Pathology, Hospital Clinic, Institut d'Investigaçions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain

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  • Pedro L Alonso,

    Affiliations: Barcelona Center for International Health Research (CRESIB) and Department of Pathology, Hospital Clinic, Institut d'Investigaçions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain, Centro de Investigaçao em Saude de Manhiça (CISM), Maputo, Mozambique

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  • Jaume Ordi

    Affiliation: Barcelona Center for International Health Research (CRESIB) and Department of Pathology, Hospital Clinic, Institut d'Investigaçions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain

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  • Published: February 19, 2008
  • DOI: 10.1371/journal.pmed.0050044

Reader Comments (5)

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Response to Dr Fottrell's comment ("Clinical perceptions of infectious causes of maternal death")

Posted by plosmedicine on 31 Mar 2009 at 00:26 GMT

Author: Clara Menendez
Position: Research Professor
Institution: Barcelona Center for International Health Research (CRESIB)
E-mail: MENENDEZ@clinic.ub.es
Submitted Date: May 13, 2008
Published Date: May 14, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Although, as stressed by Dr. Fottrell, the prominence of infectious diseases observed in our recently published report [1] differs considerably from Global estimates, the data of our analysis are strikingly similar to those of a recent report from Zambia indicating a dramatic increase in non-obstetric causes of death, particularly infectious diseases such as malaria, AIDS-related tuberculosis and respiratory illnesses. [2]

The analysis of clinico-pathological correlations in our series (manuscript in preparation) has detected a large number of discrepancies, particularly due to under-identification of infectious diseases, strongly suggesting that infectious causes are being missed in clinical decision making.

We absolutely agree with Dr. Fottrell that an urgent clarification of the impact of infectious diseases in maternal mortality may have major public health implications in terms of priority setting and prevention. In these regard, both accurate studies on the causes of maternal death such as autopsy studies, as well as analysis of cause of death in verbal autopsies based on refined algorithms, [3] may contribute to draw the attention to current causes of death and may help reduce the intolerable burden of maternal death in resource-poor regions.

References

1. Menendez C, Romagosa C, Ismail MR et al. An autopsy study of maternal mortality in Mozambique: the contribution of infectious diseases. PLoS Med 2008; 5(2):e44.

2. Ahmed Y, Mwaba P, Chintu C, Grange JM, Ustianowski A, Zumla A. A study of maternal mortality at the University Teaching Hospital, Lusaka, Zambia: the emergence of tuberculosis as a major non-obstetric cause of maternal death. Int J Tuberc Lung Dis 1999; 3(8):675-680.

3. Fottrell E, Byass P, Ouedraogo TW et al. Revealing the burden of maternal mortality: a probabilistic model for determining pregnancy-related causes of death from verbal autopsies. Popul Health Metr 2007; 5:1.

Competing interests declared: I am the first and corresponding author of this paper.