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The importance of preterm births for peri‐ and neonatal mortality in rural Malawi
Author(s) -
Kulmala T.,
Vaahtera M.,
Ndekha M.,
Koivisto AM.,
Cullinan T.,
Salin ML.,
Ashorn P.
Publication year - 2000
Publication title -
paediatric and perinatal epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 88
eISSN - 1365-3016
pISSN - 0269-5022
DOI - 10.1046/j.1365-3016.2000.00270.x
Subject(s) - medicine , odds ratio , obstetrics , neonatal mortality , population , infant mortality , pregnancy , confidence interval , cohort study , pediatrics , demography , environmental health , sociology , biology , genetics , pathology
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.