title: Infant mortality and morbidity associated with preterm and small-for-gestational-age births in Southern Mozambique: A retrospective cohort study.
abstract: BACKGROUND
  Preterm and small for gestational age (SGA) births have been associated with adverse outcomes during the first stages of life. We evaluated the morbidity and mortality associated with preterm and SGA births during the first year of life in a rural area of Southern Mozambique.
  
  
  METHODS
  This is a retrospective cohort study using previously collected data from children born at the Manhiça District Hospital in two different periods (2003-2005 and 2010-2012). Newborns were classified as being preterm and/or SGA or as babies not fulfilling any of the previous conditions (term non-SGA). All children were followed up for a year for morbidity and mortality outcomes.
  
  
  RESULTS
  A total of 5574 live babies were included in the analysis. The prevalence of preterm delivery was 6.2% (345/5574); the prevalence of SGA was 14.0% (776/5542) and 2.2% (114/5542) of the children presented both conditions. During the neonatal period, preterm delivery and SGA were associated with 13 (HR: 13.0, 95% CI 4.0-42.2) and 5 times (HR: 4.5, 95% CI: 1.6-12.6) higher mortality compared to term non SGA babies. Risk of hospitalization was only increased when both conditions were present (IRR: 3.5, 95%CI: 1.5-8.1). Mortality is also increased during the entire first year, although at a lower rate.
  
  
  CONCLUSIONS
  Neonatal and infant mortality rates are remarkably high among preterm and SGA babies in southern Mozambique. These increased rates are concentrated within the neonatal period. Prompt identification of these conditions is needed to implement interventions aimed at increasing survival of these high-risk newborns.
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.|ISGlobal, Barcelona Ctr. Int. Health Res. Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.|Amsterdam Institute for Global Health and Development, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Alberto L
authors.initials: AL
authors.lastname: García-Basteiro
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quintó
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.
authors.forename: Eusebio
authors.initials: E
authors.lastname: Macete
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.|ISGlobal, Barcelona Ctr. Int. Health Res. Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Azucena
authors.initials: A
authors.lastname: Bardají
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.|ISGlobal, Barcelona Ctr. Int. Health Res. Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: González
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.
authors.forename: Arsenio
authors.initials: A
authors.lastname: Nhacolo
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.
authors.forename: Betuel
authors.initials: B
authors.lastname: Sigauque
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.
authors.forename: Charfudin
authors.initials: C
authors.lastname: Sacoor
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.|ISGlobal, Barcelona Ctr. Int. Health Res. Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.|Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Rupérez
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.|ISGlobal, Barcelona Ctr. Int. Health Res. Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.|School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Elisa
authors.initials: E
authors.lastname: Sicuri
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.|ISGlobal, Barcelona Ctr. Int. Health Res. Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.
authors.forename: Esperança
authors.initials: E
authors.lastname: Sevene
authors.affiliation: Centro de Investigação em Saude de Manhiça, Manhiça, Maputo Province, Mozambique.|ISGlobal, Barcelona Ctr. Int. Health Res. Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.|Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D008423:Maternal Age; D009017:Morbidity; D009073:Mozambique / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies