ArticlePloS one2025
Maternal deaths before and during COVID-19 pandemic: Causes and avoidable factors in a tertiary hospital in South Africa, 2018‒2022.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed.
- Experiences of Health Professionals Regarding Existing Guidelines Used to Manage Obstetric Emergencies in a Rural Area of South Africa: A Qualitative Explorative Study.International journal of environmental research and public health · 2026Article
- Health system stress: Assessing the impact of the COVID-19 pandemic on obstetric haemorrhage-related mortality in South Africa using confidential enquiry into maternal deaths data.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2026Article
- A setback for Sustainable Development Goal 3.1: Documenting the coronavirus disease 2019 pandemic's impact on maternal mortality through a National Confidential Enquiry in South Africa.African journal of primary health care & family medicine · 2026Article
- Impact of maternal HIV infection on pregnancy and labor complication and perinatal health outcomes: a South African retrospective study.Archives of gynecology and obstetrics · 2026Article
- Strategies to improve outcomes of obstetric emergencies in sub-Saharan Africa: A scoping review.PloS one · 2026Article
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Abstract
aimTo determine the institutional maternal mortality ratio (iMMR) and avoidable factors (AVFs) before and during the COVID-19 pandemic in a tertiary hospital in South Africa.
methodsThis was a retrospective cross-sectional study. We reviewed medical records to compare iMMR and associated AVFs two years before (March 2018 - February 2020) and two years during (March 2020 - February 2022) COVID-19 pandemic.
resultsFifty-eight maternal deaths were recorded but available data was 57 (35 before and 22 during COVID-19 pandemic). The highest iMMR per 100,000 live births over a 12-month period was 329.1 before and 201.8 during COVID-19 pandemic. The mean ages were 31.0 ± 6.9 and 31 ± 6.2 years, p = 0.822 before and during COVID-19 pandemic, respectively. During COVID-19 pandemic, 40.9% (9/22) were diagnosed with COVID-19. Before and during the pandemic, 71.4% (25/35) and 68.2% (15/22) p = 1.0 were admitted into an intensive care unit (ICU), respectively, with corresponding 74.3% (26/35) and 50% (11/22), p = 0.026 requiring mechanical ventilation. There was a significant difference in the primary causes of death (p = 0.009) for the two periods, with preeclampsia with severe features (22.9%, 8/35) being the leading cause before COVID-19 pandemic compared to COVID-19 (31.8%, 7/22) during the pandemic. AVFs related to healthcare professionals were the most common occurring in 22/35 and 12/22 of the deceased before and during COVID-19 pandemic, respectively. Before COVID-19 pandemic, the most frequent patient-, healthcare professional-, and administrative-related AVFs were failure to book for antenatal care, administration of wrong treatment, and lack of ICU/high care bed spaces, respectively. During COVID-19 pandemic, the most common patient-, healthcare professional- and administrative-related AVFs were delay in seeking medical treatment, lack of critical care skills, and unavailability of ICU/high-care bed spaces, respectively.
conclusioniMMR was lower during than before the COVID-19 pandemic. AVFs related to healthcare professionals were the most common.
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