Factors associated with and causes of perinatal mortality in northeastern Tanzania.
OBJECTIVE
To identify factors associated with perinatal mortality in northeastern Tanzania.


METHODS
Prospective cohort study.


METHODS
Northeastern Tanzania. Population. 872 mothers and their newborns.


METHODS
Pregnant women were screened for factors possibly associated with perinatal mortality, including preeclampsia, small-for-gestational age, preterm delivery, anemia, and health-seeking behavior. Fetal growth was monitored using ultrasound. Finally, the specific causes of the perinatal deaths were evaluated.


METHODS
Perinatal mortality.


RESULTS
Forty-six deaths occurred. Key factors associated with perinatal mortality were preterm delivery (adjusted odds ratio (OR) 14.47, 95% confidence interval (CI) 3.23-64.86, p < 0.001), small-for-gestational age (adjusted OR 3.54, 95%CI 1.18-10.61, p = 0.02), and maternal anemia (adjusted OR 10.34, 95%CI 1.89-56.52, p = 0.007). Adherence to the antenatal care program (adjusted OR 0.027, 95%CI 0.003-0.26, p = 0.002) protected against perinatal mortality. The cause of death in 43% of cases was attributed to complications related to labor and specifically to intrapartum asphyxia (30%) and neonatal infection (13%). Among the remaining deaths, 27% (7/26) were attributed to preeclampsia and 23% (6/26) to small-for-gestational age. Of these, 54% (14/26) were preterm.


CONCLUSIONS
Preeclampsia, small-for-gestational age and preterm delivery were key risk factors and causes of perinatal mortality in this area of Tanzania. Maternal anemia was also strongly associated with perinatal mortality. Furthermore, asphyxia accounted for a large proportion of the perinatal deaths. Interventions should target the prevention and handling of these conditions in order to reduce perinatal mortality.
Centre for Medical Parasitology, Institute of International Health, Immunology, and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Øster Farimagsgade 5, Copenhagen, Denmark. christentzes@yahoo.dk
Christentze
C
Schmiegelow
Daniel
D
Minja
Mayke
M
Oesterholt
Caroline
C
Pehrson
Hannah Elena
HE
Suhrs
Stéphanie
S
Boström
Martha
M
Lemnge
Pamela
P
Magistrado
Vibeke
V
Rasch
John
J
Lusingu
Thor G
TG
Theander
Birgitte
B
Bruun Nielsen
D000328:Adult; D000747:Anemia, Hypochromic / Q000150:complications; D001238:Asphyxia Neonatorum / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007744:Obstetric Labor Complications / Q000401:mortality; D054238:Perinatal Mortality; D011225:Pre-Eclampsia; D011247:Pregnancy; D047928:Premature Birth / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology