Adverse birth outcomes in United Republic of Tanzania--impact and prevention of maternal risk factors.
OBJECTIVE
To determine risk factors for poor birth outcome and their population attributable fractions.


METHODS
1688 women who attended for antenatal care were recruited into a prospective study of the effectiveness of syphilis screening and treatment. All women were screened and treated for syphilis and other reproductive tract infections (RTIs) during pregnancy and followed to delivery to measure the incidence of stillbirth, intrauterine growth retardation (IUGR), low birth weight (LBW) and preterm live birth.


RESULTS
At delivery, 2.7% of 1536 women experienced a stillbirth, 12% of live births were preterm and 8% were LBW. Stillbirth was independently associated with a past history of stillbirth, short maternal stature and anaemia. LBW was associated with short maternal stature, ethnicity, occupation, gravidity and maternal malaria whereas preterm birth was associated with occupation, age of sexual debut, untreated bacterial vaginosis and maternal malaria. IUGR was associated with gravidity, maternal malaria, short stature, and delivering a female infant. In the women who had been screened and treated for syphilis, in between 20 and 34% of women with each outcome was estimated to be attributable to malaria, and 63% of stillbirths were estimated as being attributable to maternal anaemia. Screening and treatment of RTIs was effective and no association was seen between treated RTIs and adverse pregnancy outcomes.


CONCLUSIONS
Maternal malaria and anaemia continue to be significant causes of adverse pregnancy outcome in sub-Saharan Africa. Providing reproductive health services that include treatment of RTIs and prevention of malaria and maternal anaemia to reduce adverse birth outcomes remains a priority.
Watson-Jones
Deborah
D
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, England.
Weiss
Helen A
HA
Changalucha
John M
JM
Todd
James
J
Gumodoka
Balthazar
B
Bulmer
Judith
J
Balira
Rebecca
R
Ross
David
D
Mugeye
Kokungoza
K
Hayes
Richard
R
Mabey
David
D
D000293:Adolescent; D000328:Adult; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008403:Mass Screening; D008427:Maternal Health Services; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology; D013587:Syphilis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology