Hum. Reprod. Advance Access originally published online on July 21, 2005
Human Reproduction 2005 20(11):3235-3237; doi:10.1093/humrep/dei208
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Preterm birth in rural Malawi: high incidence in ultrasound-dated population
1 Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, 2 Malawi–Liverpool–Wellcome Programme and 3 School of Reproductive & Developmental Medicine, University of Liverpool, UK
4 To whom correspondence should be addressed. E-mail: vdbroek{at}liv.ac.uk
BACKGROUND: Preterm birth is the major cause of neonatal death, and has an incidence in industrialized countries of 7%. We have found a high incidence (25–30%) previously in a population of anaemic, pregnant women in southern Malawi, studied with ultrasound dating. METHODS: Cohort study of 512 unselected pregnant women in rural communities in Malawi. All had ultrasound fetal measurements before 24 weeks. RESULTS: 20.3% of women delivered before 37 completed weeks of pregnancy. Babies born before 37 completed weeks but after 32 weeks (16%) were twice as likely to die as babies born at term (6.9 versus 3.4%) but this difference did not achieve statistical significance. For those born between 24 and 33 weeks gestation (4.4%) there was a highly significant increase in perinatal mortality (75%) (p <0 .000001). CONCLUSIONS: This population has a very high rate of preterm birth, which is probably infection-related. It may be representative of many rural populations in sub-Saharan Africa. Tackling the problem of neonatal mortality in low income countries will require effective methods to prevent preterm birth.
Key words: infection/Malawi/neonatal mortality/preterm birth/ultrasound