title: Weekly miscarriage rates in a community-based prospective cohort study in rural western Kenya.
abstract: OBJECTIVE
  Information on adverse pregnancy outcomes is important to monitor the impact of public health interventions. Miscarriage is a challenging end point to ascertain and there is scarce information on its rate in low-income countries. The objective was to estimate the background rate and cumulative probability of miscarriage in rural western Kenya.
  
  
  METHODS
  This was a population-based prospective cohort.
  
  
  METHODS
  Women of childbearing age were followed prospectively to identify pregnancies and ascertain their outcomes in Siaya County, western Kenya. The cohort study was carried out in 33 adjacent villages under health and demographic surveillance.
  
  
  METHODS
  Miscarriage.
  
  
  RESULTS
  Between 2011 and 2013, among 5536 women of childbearing age, 1453 pregnancies were detected and 1134 were included in the analysis. The cumulative probability was 18.9%. The weekly miscarriage rate declined steadily with increasing gestation until approximately 20 weeks. Known risk factors for miscarriage such as maternal age, gravidity, occupation, household wealth and HIV infection were confirmed.
  
  
  CONCLUSIONS
  This is the first report of weekly miscarriage rates in a rural African setting in the context of high HIV and malaria prevalence. Future studies should consider the involvement of community health workers to identify the pregnancy cohort of early gestation for better data on the actual number of pregnancies and the assessment of miscarriage.
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dellicour
authors.affiliation: Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya.
authors.forename: George
authors.initials: G
authors.lastname: Aol
authors.affiliation: Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Ouma
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Nicole
authors.initials: N
authors.lastname: Yan
authors.affiliation: Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Bigogo
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Hamel
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Deron C
authors.initials: DC
authors.lastname: Burton
authors.affiliation: Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya.
authors.forename: Martina
authors.initials: M
authors.lastname: Oneko
authors.affiliation: Global Health Institute, Emory University, Atlanta, Georgia, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Feikin
authors.affiliation: Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya.
authors.forename: Simon
authors.initials: S
authors.lastname: Kariuki
authors.affiliation: Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya.
authors.forename: Frank
authors.initials: F
authors.lastname: Odhiambo
authors.affiliation: Pharmacy Systems, Outcomes and Policy Department, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Gregory
authors.identifier: http://orcid.org/0000-0002-7744-3518
authors.initials: G
authors.lastname: Calip
authors.affiliation: Departments of Pharmacy and Global Health, Schools of Pharmacy and Public Health, University of Washington, Seattle, Washington, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stergachis
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Feiko O
authors.initials: FO
authors.lastname: ter Kuile
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Meghna
authors.initials: M
authors.lastname: Desai
mesh_terms: D000022:Abortion, Spontaneous; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003906:Developing Countries; D005260:Female; D020073:Gravidity; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Kenya; Miscarriage; prospective cohort; rate; sub-Saharan Africa