Human immunodeficiency virus and postpartum haemorrhage in a lower-middle-income setting: a retrospective cross-sectional study in Dar Es Salaam, Tanzania
Thomas Brown, Belinda Balandya, Gilles de WildtIntroduction/Aims
Maternal mortality remains a significant public health issue, with approximately 300 000 women dying during pregnancy and childbirth annually, the majority of whom are from low- and middle-income countries. Postpartum haemorrhage is the leading cause of maternal death, while human immunodeficiency virus disproportionately affects young women, particularly in sub-Saharan Africa. This study's aim was to explore the intersection of human immunodeficiency virus and postpartum haemorrhage in a lower-middle-income setting, focusing on their combined impact on maternal mortality.
Methods
This retrospective cross-sectional study took place at Muhimbili National Hospital, in Tanzania. The medical records of 1105 births that took place at the hospital between 1 November 2021 and 31 January 2022 were accessed. Demographic statistics were compared between those positive and negative for human immunodeficiency virus using unpaired two sample t -tests and Chi-squared tests. Incidence of postpartum haemorrhage was compared between groups via an odds ratio calculation, adjusted for confounding factors using multivariable logistic regression.
Results
There was no statistically significant difference in the odds of experiencing postpartum haemorrhage between women testing positive and negative for human immunodeficiency virus (adjusted odds ratio: 0.68, P =0.354). Demographic and obstetric characteristics were similar across groups.
Conclusions
This study found no evidence of a significant association between human immunodeficiency virus status and the risk of postpartum haemorrhage, which may reflect the impact of national interventions to reduce the burden of human immunodeficiency virus. However, the findings are limited by the study setting, a tertiary centre, which may not reflect outcomes in community or primary care settings, and by the lack of data on human immunodeficiency virus treatment adherence.
Implications for practice
Further Research with larger heterogenous samples and additional clinical variables is recommended to definitively assess the relationship between human immunodeficiency virus and postpartum haemorrhage in maternal health.