Abstract:
Gert Sibande District is a predominantly rural district in Mpumalanga Province, South Africa (SA), with a population of just over
1.1 million. It has a high prevalence of HIV infection and pregnancy-related hypertensive disease. In 2010 the district was one of the
worst-performing health districts in SA, with a maternal mortality ratio of 328.0 per 100 000 births. Various programmes were introduced
between 2010 and 2017 to address major causes of maternal and perinatal morbidity and mortality in the district. The focus has been on
HIV-related morbidity, the direct obstetric causes of maternal and perinatal morbidity and mortality, and health systems strengthening.
During the period 2010 - 2017, there was a steady decline in institutional maternal mortality with a drop of 71% in maternal deaths over a
period of 6 years, from 328.0 per 100 000 births to 95.0. However, the ratio levelled off in 2016 and 2017, mainly as a result of a changing
disease profile. The stillbirth rate showed a decline of 24.4% over a period of 8 years. With perseverance, rapid response and evidence-based
strategies it was possible to more than halve the institutional maternal mortality ratio within 6 years. However, with the changing disease
profile, conditions such as hypertensive disease in pregnancy should be prioritised and new strategies developed to further reduce maternal
and perinatal mortality and morbidity.
