Mortality in women of reproductive age in rural South Africa

Figures & data

Table 1 Sociodemographic characteristics of women of reproductive age during the study period, ACDIS

Variable	Women alive (0) (n)%	Women dead (1) (n)%	P-value
Overall (n = 42,703)	(n = 39,605) 92.75	(n = 3,098) 7.25
Age in years at entry			<0.001
15–19	(18,220) 46.0	(491) 15.85
20–24	(6,174) 15.59	(615) 19.85
25–29	(4,722) 11.92	(655) 21.14
30–34	(3,579) 9.04	(534) 17.24
35–39	(2,895) 7.31	(402) 12.98
40–44	(2,346) 5.92	(293) 9.46
45–49	(1,669) 4.21	(108) 3.49
Area of residence			<0.001
Rural	(22,737) 57.4	(1,802) 58.17
Urban	(4,023) 10.16	(142) 4.58
Peri-urban	(12,753) 32.20	(1,154) 37.25
Migration status			<0.001
Never moved	(11,495) 29.02	(1,314) 42.41
Internal only	(3,982) 10.05	(273) 8.81
External only	(7,237) 18.27	(606) 19.56
Internal and external	(16,891) 42.65	(905) 29.21
Minimum HSE class index			<0.001
Upper 20%	(4,568) 12.73	(225) 7.59
Middle 40%	(12,064) 33.61	(1,007) 33.96
Lower 40%	(19,263) 53.66	(1,733) 58.45
Ever married			0.015
No	(32,752) 82.7	(2,615) 84.41
Yes	(6,853) 17.3	(483) 15.59
Ever employed			0.353
No	(29,701) 74.99	(2,300) 74.24
Yes	(9,904) 25.01	(798) 25.76
Highest level of education			<0.001
More than 8 years	(24,647) 71.88	(1,469) 62.25
Less than 8 years	(8,083) 23.57	(742) 31.44
No school	(1,559) 4.55	(149) 6.31
Self-reported minimum general health			<0.001
Good	(17,095) 79.68	(770) 69.43
Fair	(3,808) 17.75	(253) 22.81
Poor	(5,51) 2.57	(86) 7.75
Woman HIV status			<0.001
HIV tested and negative	(9,532) 24.07	(117) 3.78
HIV tested and positive	(4,645) 11.73	(532) 17.17
Never tested	(25,428) 64.20	(2,449) 79.05
Maximum parity (M, SD)	1.79, 2.13	2.28, 2.06	<0.001
Pregnancy outcome summarized from maternity history			<0.001
All live births	(22,005) 55.56	(1,917) 61.88
≥ 1 pregnancy was a still birth	(29,68) 7.49	(317) 10.23
No outcome reported	(14,632) 36.94	(864) 27.89

Table 2 Causes of death in women of reproductive age, 2000–2009, ACDIS

				95% confidence intervals
Causes of death	Cause-specific numbers	Mortality fraction (%)	Mortality rate /1,000 person-years	Lower	Upper
HIV/TB	2,266	73.14	10.64	10.21	11.08
*Pregnancy	14	0.45	0.07	0.04	0.11
Other communicable	266	8.59	1.25	1.11	1.41
Injuries	109	3.52	0.51	0.42	0.62
Non communicable	261	8.42	1.22	1.08	1.38
Unknown	182	5.87	0.86	0.74	0.99

Fig. 1 All-cause and cause-specific mortality rates for women of reproductive age from 2000 to 2009, ACDIS.

Fig. 2 All-cause and cause-specific mortality rates by age group from 2000 to 2009, ACDIS.

Table 3 Univariable and multivariable hazard ratios (95% CI) for risk factors associated with all-cause mortality, 2000–2009, ACDIS

		Univariable analysis			Multivariable analysis
Explanatory variables	Categories of explanatory variables	Crude hazards ratio	95% CI	P value	Adjusted hazards ratio	95% CI	P value
Women age	15–19	1.000
	20–24	4.267	3.506, 5.194	<0.001	2.186	1.435, 3.330	<0.001
	25–29	9.336	7.742, 11.257	<0.001	3.457	1.980, 6.036	<0.001
	30–34	11.910	9.873, 14.367	<0.001	3.615	1.726, 7.573	0.001
	35–39	10.309	8.491, 12.516	<0.001	2.857	1.123, 7.269	0.028
	40–44	9.205	7.541, 11.237	<0.001	1.528	0.489, 4.775	0.465
	45–49	9.908	8.083, 12.145	<0.001	1.563	0.411, 5.946	0.512
Self-reported minimum general health	Good	1.000			1.000
	Fair	1.293	1.122, 1.491	<0.001	2.302	1.215, 4.358	0.010
	Poor	2.927	2.343, 3.658	<0.001	8.256	2.944, 23.151	<0.001
Ever employed	No	1.000			1.000
	Yes	0.622	0.574, 0.675	<0.001	0.779	0.681, 0.891	<0.001
Ever married	No	1.000			1.000
	Yes	0.665	0.604, 0.733	<0.001	0.500	0.419, 0.598	<0.001
Migration status	Never moved	1.000			1.000
	Internal only	0.451	0.396, 0.514	<0.001	0.647	0.527, 0.796	<0.001
	External only	1.549	1.405, 1.709	<0.001	1.698	1.408, 2.046	<0.001
	Both internal and external	0.377	0.346, 0.410	<0.001	0.476	0.406, 0.557	<0.001
Minimum household index class	Upper 20%	1.000			1.000
	Middle 40%	1.505	1.302, 1.739	<0.001	1.077	0.809, 1.433	0.611
	Lower 40%	1.527	1.329, 1.754	<0.001	1.167	0.872, 1.563	0.298
Highest education level	More than 8 years	1.000			1.000
	Less than 8 years	1.855	1.698, 2.026	<0.001	1.338	1.139, 1.572	<0.001
	Never gone to school	1.618	1.367, 1.915	<0.001	1.334	1.023, 1.739	0.033
Ever used contraception	No	1.000			1.000
	Yes	1.211	1.128, 1.301	<0.001	1.201	1.039, 1.387	0.013
Pregnancy outcome history	All live births	1.000			1.000
	>1 pregnancy a still birth/Abortion	1.202	1.068,1.354	0.002	1.082	0.895, 1.308	0.417
	No outcome reported	1.239	1.142,1.344	<0.001	1.306	1.046, 1.629	0.018
Maximum parity		1.021	1.005, 1.037	0.009	0.486	0.395, 0.597	<0.001
Area of residence	Rural	1.000			1.000
	Urban	0.635	0.535, 0.753	<0.001	0.808	0.554, 1.178	0.269
	Peri-urban	1.281	1.189, 1.379	<0.001	1.194	1.037, 1.374	0.014
HIV status	HIV tested and negative	1.000			1.000
	HIV tested and positive	11.425	9.348, 13.963	<0.001	7.842	6.261, 9.823	<0.001
	Never tested	5.421	4.485, 6.551	<0.001	3.275	2.615, 4.103	<0.001

Table 4 Risk factors associated with HIV and /or TB-related mortality, ACDIS

		Univariable analysis			Multivariable analysis
Explanatory variables	Categories of explanatory variables	Crude hazards ratio	95% CI	P value	Adjusted Hazards ratio	95% CI	P value
Women age	15–19	1.000	,		1.000
	20–24	6.127	4.705, 7.980	<0.001	2.668	1.522, 4.678	0.001
	25–29	14.863	11.545, 19.137	<0.001	4.682	2.294, 9.559	<0.001
	30–34	18.910	14.683, 24.355	<0.001	5.342	2.117, 13.481	<0.001
	35–39	16.172	12.476, 2.963	<0.001	4.114	1.294, 13.074	0.017
	40–44	13.823	10.594, 18.036	<0.001	2.362	0.582, 9.592	0.229
	45–49	14.056	10.705, 18.459	<0.001	2.416	0.469, 12.425	0.291
Self-reported minimum general health	Good	1.000			1.000
	Fair	1.519	1.285,1.797	<0.001	3.485	1.635,7.428,	0.001
	Poor	3.675	2.857,4.729	<0.001	9.928	3.063, 32.184	<0.001
Ever employed	No	1.000			1.000
	Yes	0.553	0.501, 0.610	<0.001	0.710	0.604, 0.836	<0.001
Ever married	No	1.000			1.000
	Yes	0.625	0.556, 0.702	<0.001	0.482	0.387, 0.600	<0.001
Migration status	Never moved	1.000			1.000
	Internal only	0.475	0.409, 0.553	<0.001	0.665	0.517, 0.857	0.002
	External only	1.602	1.432, 1.793	<0.001	1.711	1.363, 2.148	<0.001
	Both internal and external	0.377	0.341, 0.417	<0.001	0.541	0.448, 0.654	<0.001
Minimum household index class	Upper 20%	1.000			1.000
	Middle 40%	1.904	1.579, 2.294	<0.001	1.425	0.967, 2.099	0.073
	Lower 40%	1.999	1.669, 2.394	<0.001	1.505	1.014, 2.234	0.042
Highest education level	More than 8 years	1.000			1.000
	Less than 8 years	1.972	1.778, 2.187	<0.001	1.378	1.137, 1.669	0.001
	Never gone to school	1.645	1.347, 2.009	<0.001	1.372	1.000, 1.884,	0.050
Ever used contraception	No	1.000			1.000
	Yes	1.316	1.211, 1.431	<0.001	1.314	1.099, 1.569	<0.003
Pregnancy outcome history	All live births	1.000			1.000
	>1 pregnancy a still birth/abortion	1.124	0.976, 1.295	0.091	1.066	0.847, 1.341	0.587
	No outcome reported	1.144	1.039, 1.259	0.008	1.346	1.022,1.774	0.035
Maximum parity		1.036	1.018, 1.055	<0.001	0.505	0.394, 0.649	<0.001
Area of residence	Rural	1.000			1.000
	Urban	0.517	0.415, 0.643	<0.001	0.733	0.438, 1.227	0.237
	Peri-urban	1.296	1.189, 1.412	<0.001	1.252	1.058, 1.482	0.009
HIV status	HIV tested and negative	1.000			1.000
	HIV tested and positive	25.567	18.606,35.134	<0.001	17.767	12.290, 25.685	<0.001
	Never tested	10.232	7.509, 13.942	<0.001	6.49	4.479, 9.425	<0.001

Table 5 Risk factors associated with other causes (Combined) other than HIV and /or TB, ACDIS

		Univariable analysis			Multivariable analysis
Explanatory variables	Categories of explanatory variables	Crude hazards ratio	95% CI	P value	Adjusted hazards ratio	95% CI	P value
Women age	15–19	1.000			1.000
	20–24	2.111	1.513, 2.945	<0.001	1.761	0.965, 3.211	0.065
	25–29	3.429	2.484, 4.733	<0.001	3.649	1.974, 6.744	<0.001
	30–34	4.050	2.919, 5.620	<0.001	3.344	1.739, 6.429	<0.001
	35–39	3.644	2.576, 5.155	<0.001	3.277	1.647, 6.520	0.001
	40–44	4.318	3.063, 6.086	<0.001	1.937	0.895, 4.189	0.093
	45–49	5.388	3.824, 7.591	<0.001	2.184	0.909, 5.247	0.081
Self-reported minimum general health	Good	1.000			1.000
	Fair	0.836	0.608, 1.149	0.269	0.564	0.399, 0.797	0.001
	Poor	1.694	0.986, 2.908	0.056	0.815	0.437, 1.520	0.521
Ever employed	No	1.000			1.000
	Yes	0.814	0.689, 0.961	0.015	1.040	0.796, 1.360	0.769
Ever married	No	1.000			1.000
	Yes	0.794	0.651, 0.969	0.023	0.572	0.408, 0.804	0.001
Migration status	Never moved	1.000			1.000
	Internal only	0.405	0.306, 0.536	<0.001	0.575	0.388, 0.853	0.006
	External only	1.255	1.008, 1.568	0.045	1.621	1.121, 2.343	0.010
	Both internal and external	0.312	0.259, 0.375	<0.001	0.329	0.239, 0.453	<0.001
Minimum household index class	Upper 20%	1.000
	Middle 40%	1.116	0.846, 1.473	0.437
	Lower 40%	1.055	0.809, 1.375	0.690
Highest education level	More than 8 years	1.000			1.000
	Less than 8 years	1.636	1.351, 1.982	<0.001	1.248	0.899, 1.730	0.184
	Never gone to school	1.547	1.082, 2.211	0.017	1.364	0.812, 2.303	0.240
Ever used contraception	No	1.000
	Yes	0.976	0.833, 1.143	0.762
Pregnancy outcome history	All live births	1.000			1.000
	>1 pregnancy a still birth/abortion	1.554	1.219, 1.982	0.002	1.311	0.915, 1.876	0.140
	No outcome reported	1.586	1.332, 1.888	<0.001	1.143	0.756,1.728	0.526
Maximum parity		0.985	0.949, 1.021	0.415	0.363	0.240,0.549	<0.001
Area of residence	Rural	1.000			1.000
	Urban	0.701	0.488, 1.006	0.067	0.608	0.316,1.172	0.137
	Peri-urban	1.287	1.095, 1.513	0.025	1.215	0.939, 1.573	0.139
HIV status	HIV tested and negative	1.000			1.000
	HIV tested and positive	3.315	2.387, 4.604	<0.001	2.590	1.790, 3.750	<0.001
	Never tested	2.399	1.822, 3.159	<0.001	1.703	1.218, 2.382	0.002