title: The importance of preterm births for peri- and neonatal mortality in rural Malawi.
abstract: 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.
authors.affiliation: Medical School, University of Tampere, Department of Paediatrics, Tampere University Hospital, Finland. teija.kulmala@uta.f
authors.forename: T
authors.initials: T
authors.lastname: Kulmala
authors.forename: M
authors.initials: M
authors.lastname: Vaahtera
authors.forename: M
authors.initials: M
authors.lastname: Ndekha
authors.forename: A M
authors.initials: AM
authors.lastname: Koivisto
authors.forename: T
authors.initials: T
authors.lastname: Cullinan
authors.forename: M L
authors.initials: ML
authors.lastname: Salin
authors.forename: P
authors.initials: P
authors.lastname: Ashorn
mesh_terms: D003906:Developing Countries; D005260:Female; D005313:Fetal Death; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008295:Malawi / Q000453:epidemiology; D008297:Male; D007752:Obstetric Labor, Premature / Q000453:epidemiology*; D011159:Population Surveillance; D011247:Pregnancy; D012424:Rural Population