Trends in pregnancy outcomes in Malawian adolescents receiving antimalarial and hematinic supplements.
OBJECTIVE
To describe pregnancy outcomes of adolescent and adult primigravidae receiving antimalarials and hematinic supplementation and compare findings with a survey in this area a decade earlier.


METHODS
Cross-sectional surveys in intervention and control sites.


METHODS
Community, antenatal and delivery facilities in Chikwawa, Malawi. A rural area with year round malaria transmission.


METHODS
Data on antenatal attendance, uptake of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP), birthweight, malaria, anaemia, for 2,152 primigravidae.


METHODS
Place of delivery, anaemia, malaria, birthweight.


RESULTS
Fewer adolescent than adult primigravidae received >or=2 IPTp-SP doses (66 vs. 77.2%, p < 0.001), although more attended for two or more antenatal visits (92.0 vs. 76.7%, p < 0.001). Only 24.1% of adolescent primigravidae attended for hospital delivery. Women resident in intervention sites receiving IPTp-SP community distribution were more likely to choose a community delivery (p < 0.01), and have higher uptake of IPTp-SP (p = 0.036) than women not resident in these villages. Postnatal malaria prevalence was low and did not differ by age or place of delivery. Postnatal anaemia and low birthweight prevalence were higher in adolescents with community deliveries. Maternal anaemia and low birthweight prevalence were lower amongst adolescents in this study compared to estimates from the same population a decade previously.


CONCLUSIONS
Adolescents had higher anaemia risk, lower IPTp-SP uptake than adults and under a quarter had a hospital delivery. Pregnancy outcomes improved compared to the survey a decade earlier. Monitoring and surveillance is required to reinforce to policy makers the need to improve adolescent coverage for available interventions.
Msyamboza
Kelias
K
Malaria Alert Centre, College of Medicine, Blantyre, Malawi.
Savage
Emma
E
Kalanda
Gertrude
G
Kazembe
Peter
P
Gies
Sabine
S
D'Alessandro
Umberto
U
Brabin
Bernard J
BJ
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology; D000962:Antimalarials / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D004338:Drug Combinations; D005260:Female; D005296:Ferrous Compounds / Q000627:therapeutic use; D005492:Folic Acid / Q000627:therapeutic use; D006306:Health Surveys; D006397:Hematinics / Q000627:therapeutic use*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008288:Malaria / Q000517:prevention & control; D008295:Malawi; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000706:statistics & numerical data; D011739:Pyrimethamine / Q000627:therapeutic use; D019035:Rural Health Services; D012424:Rural Population; D013413:Sulfadoxine / Q000627:therapeutic use
D000962:Antimalarials; D004338:Drug Combinations; D005296:Ferrous Compounds; D006397:Hematinics; C001205:fanasil, pyrimethamine drug combination; C020748:ferrous sulfate; D013413:Sulfadoxine; D005492:Folic Acid; D011739:Pyrimethamine