{"id":{"repo_id":"cape-town","oai_identifier":"oai:open.uct.ac.za:11427/42343"},"canonical_url":"https://search.dev.ndltd.org/etd/cape-town/oai:open.uct.ac.za:11427/42343","repository":{"repo_id":"cape-town","name":"University of Cape Town","base_url":"https://open.uct.ac.za/oai/request"},"display":{"title":"The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21)","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","abstract_html":"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","abstract_has_math":false,"creators":["Hunter, Mehreen Bhorat"],"institution":"Department of Public Health and Family Medicine","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Kalk, Emma","Hannan, Luke","Matjila, Mushi"],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025","date_published":"2025","updated_at":"2026-07-22T22:23:36Z","subjects":["COVID-19","Pandemic","South Africa","Maternal mortality"],"languages":["en"],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/11427/42343","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Kalk, Emma","Hannan, Luke","Matjila, Mushi"]},{"key":"dc:creator","label":"Author","values":["Hunter, Mehreen Bhorat"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2025-11-26T08:34:16Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2025-11-26T08:34:16Z"]},{"key":"dc:date.issued","label":"Date","values":["2025"]},{"key":"dc:publisher.department","label":"Dc Publisher Department","values":["Department of Public Health and Family Medicine"]},{"key":"dc:publisher.institution","label":"Dc Publisher Institution","values":["University of Cape Town"]},{"key":"dc:type","label":"Dc Type","values":["Thesis / Dissertation"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Masters","MMed"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["COVID-19","Pandemic","South Africa","Maternal mortality"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/11427/42343"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["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"]},{"key":"dc:title","label":"Title","values":["The impact of the SARS-COV-2 pandemic on maternal mortality in a South African Metropole (2020-21)"]}]}],"canonical_facts":{"dc:contributor.advisor":["Kalk, Emma","Hannan, Luke","Matjila, Mushi"],"dc:creator":["Hunter, Mehreen Bhorat"],"dc:date.accessioned":["2025-11-26T08:34:16Z"],"dc:date.available":["2025-11-26T08:34:16Z"],"dc:date.issued":["2025"],"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.uri":["http://hdl.handle.net/11427/42343"],"dc:language.iso":["en"],"dc:publisher.department":["Department of Public Health and Family Medicine"],"dc:publisher.institution":["University of Cape Town"],"dc:subject":["COVID-19","Pandemic","South Africa","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","MMed"]},"updated_at":"2026-07-22T22:23:36Z"}