@article{fdi:010060397,
  title = {{P}rotective effect of pregnancy in rural {S}outh {A}frica : questioning the concept of "indirect cause' of maternal death},
  author = {{G}arenne, {M}ichel and {K}ahn, {K}. and {C}ollinson, {M}. and {G}omez-{O}live, {X}. and {T}ollman, {S}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {M}easurement of the level and composition of maternal mortality depends on the definition used, with inconsistencies leading to inflated rates and invalid comparisons across settings. {T}his study investigates the differences in risk of death for women in their reproductive years during and outside the maternal risk period (pregnancy, delivery, puerperium), focusing on specific causes of infectious, non-communicable and external causes of death after separating out direct obstetrical causes. {M}ethods: {D}ata on all deaths of women aged 15-49 years that occurred in the {A}gincourt sub-district between 1992 and 2010 were obtained from the {A}gincourt health and socio-demographic surveillance system ({HDSS}) located in rural {S}outh {A}frica. {C}auses of death were assessed using a validated verbal autopsy instrument. {A}nalysis included 2170 deaths, of which 137 occurred during the maternal risk period. {F}indings: {O}verall, women had significantly lower mortality during the maternal risk period than outside it (age-standardized {RR} = 0.75; 95% {CI} = 0.63-0.89). {T}his was true in most age groups with the exception of adolescents aged 15-19 years where the risk of death was higher. {M}ortality from most causes, other than obstetric causes, was lower during the maternal risk period except for malaria, cardiovascular diseases and violence where there were no differences. {L}ower mortality was significant for {HIV}/{AIDS} ({RR} = 0.29, {P}<0.0001), cancers ({RR} = 0.10, {P}<0.023), and accidents ({RR} = 0, {P}<0.0001). {I}nterpretation: {I}n this rural setting typical of much of {S}outhern {A}frica, pregnancy was largely protective against the risk of death, most likely because of a strong selection effect amongst those women who conceived successfully. {T}he concept of indirect cause of maternal death needs to be re-examined.},
  keywords = {{AFRIQUE} {DU} {SUD}},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {8},
  numero = {5},
  pages = {e64414},
  ISSN = {1932-6203},
  year = {2013},
  DOI = {10.1371/journal.pone.0064414},
  URL = {https://www.documentation.ird.fr/hor/fdi:010060397},
}