title: Born too small: who survives in the public hospitals in Lilongwe, Malawi?
abstract: OBJECTIVE
  Malawi has the highest estimated preterm birth rate in the world. The survival rate of these babies is not known. The main objective of this study was to demonstrate the short-term survival of infants with birth weight below 2500 g nursed in Bwaila Hospital, a district hospital, and the tertiary level Kamuzu Central Hospital (KCH) in Lilongwe. The specific objectives were to calculate birth weight specific survival rates, compare the two hospitals regarding the chances of survival and review the use of antenatal corticosteroids.
  
  
  METHODS
  1496 babies were included prospectively in the study between June and November 2012. Survival was defined as discharge from the nursery or postnatal ward.
  
  
  RESULTS
  Survival was 7% for extremely low birth weight infants, 52% for very low birth weight and 90% for low birth weight (1500-2499 g). There was a marked increase in survival from 1100 g. Survival was significantly higher in KCH only for babies weighing below 1200 g. The majority of deaths occurred within the first 3 days of life. Only 98 of the babies had a mother who had received antenatal corticosteroids.
  
  
  CONCLUSIONS
  With the current resources, we suggest focusing efforts on preventing early neonatal deaths in low birth weight infants above 1100 g in the hospitals in Lilongwe. The coverage of antenatal steroids for mothers at risk of preterm delivery can be improved. Further studies are needed on the quality of the obstetric and neonatal care at the hospitals and how to reduce the high rate of preterm birth in Malawi.
authors.affiliation: Department of Obstetrics and Gynaecology, Södertälje Sjukhus, Södertälje, Sweden Department of Obstetrics and Gynaecology, Kamuzu Central Hospital, Lilongwe, Malawi Department of International Collaborations, Oslo University Hospital, Oslo, Norway.
authors.forename: Anna Karin
authors.initials: AK
authors.lastname: Ahlsén
authors.affiliation: Motala Hospital, Motala, Sweden.
authors.forename: Elinor
authors.initials: E
authors.lastname: Spong
authors.affiliation: Department of Obstetrics and Gynaecology, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Nomsa
authors.initials: N
authors.lastname: Kafumba
authors.affiliation: Department of Obstetrics and Gynaecology, Queen Elisabeth Central Hospital, Blantyre, Malawi.
authors.forename: Francis
authors.initials: F
authors.lastname: Kamwendo
authors.affiliation: Department of Obstetrics and Gynaecology, Södertälje Sjukhus, Södertälje, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Wolff
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001724:Birth Weight; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008295:Malawi / Q000453:epidemiology; D008297:Male; D047928:Premature Birth / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: Premature; low birth weight; mortality; neonatology; survival