The importance of preterm births for peri- and neonatal mortality in rural Malawi

• Published in: Paediatric and perinatal epidemiology 2000-07, Vol.14 (3), p.219-226
• Main Authors: Kulmala, T., Vaahtera, M., Ndekha, M., Koivisto, A-M., Cullinan, T., Salin, M-L., Ashorn, P.
• Format: Article
• Language: English
• Subjects: Developing Countries; Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Malawi - epidemiology; Male; Obstetric Labor, Premature - epidemiology; Population Surveillance; Pregnancy; Rural Population
• ISSN: 0269-5022; 1365-3016
• DOI: 10.1046/j.1365-3016.2000.00270.x

Peri‐ and neonatal mortality remain high in developing countries, especially in sub‐Saharan Africa. In the present study, we quantified and identified the most important predictors of early mortality in rural Malawi. Data were obtained from a community‐based cohort of 795 pregnant women and their 813 fetuses, followed prospectively from mid‐pregnancy. In this group, peri‐ and neonatal mortality rates were 65.3 deaths per 1000 births and 37.0 deaths per 1000 live births respectively. When controlled for month of birth, maternal age and selected socio‐economic variables, preterm birth was the strongest independent predictor of both peri‐ and neonatal mortality (adjusted odds ratios 9.6 for perinatal and 11.0 for neonatal mortality; 95% confidence intervals: [4.4, 21.0] and [3.7, 32.7] respectively). Weaker risk factors for mortality included a maternal history of stillbirth and abnormal delivery. Preterm delivery was associated with primiparity and peripheral malaria parasitaemia of the mother, and it accounted for 65% of the population‐attributable risk for perinatal and 68% of the neonatal mortality. Successful intervention programmes to reduce peri‐ and neonatal mortality in Malawi have to include strategies to predict and prevent prematurity.