title: Post-neonatal infant mortality in Malawi: the importance of maternal health.
abstract: In a cohort study of mothers and their infants, information was collected from women attending the antenatal services of two hospitals in a rural area of Malawi and 561 of their babies were enrolled in a follow-up study. There were 128 with a low birthweight (LBW, <2500 g), 138 with fetal anaemia (FA, cord haemoglobin <12.5 g/dl), 42 with both and 228 with a normal birthweight and no FA. Infants were seen monthly for 1 year. Risk factors for post-neonatal infant mortality (PNIM) were calculated using Cox regression analysis adjusting for LBW and FA. PNIM was 9.3%. Respiratory infections and diarrhoeal disease were the principal attributable causes of death. PNIM increased with LBW (RR 3.08, 95% CI 1.51-6.23) but not significantly so with FA (RR 1.60, 95% CI 0.78-3.27). An additional effect on PNIM was observed with maternal HIV (RR 3.44, 95% CI 1.63-7.26) and malaria at the first antenatal visit (RR 2.26, 95% CI 1.09-4.73). Illiteracy was not associated with mortality. Placental malaria in HIV-seronegative mothers was significantly associated with increased PNIM. Improving birthweight through effective antimalarial control in pregnancy will lead to a reduction in PNIM. Reduction of HIV prevalence and prevention of mother-to-child transmission of HIV must be a main target for government health policy.
authors.affiliation: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. verhoeff@liverpool.ac.uk
authors.forename: Francine H
authors.initials: FH
authors.lastname: Verhoeff
authors.forename: Saskia
authors.initials: S
authors.lastname: Le Cessie
authors.forename: Boniface F
authors.initials: BF
authors.lastname: Kalanda
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kazembe
authors.forename: Robin L
authors.initials: RL
authors.lastname: Broadhead
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Brabin
mesh_terms: D000740:Anemia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D012307:Risk Factors; D012424:Rural Population