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Hum. Reprod. Advance Access published online on July 21, 2005
Human Reproduction, doi:10.1093/humrep/dei208
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
Received December 9, 2004
Revised June 1, 2005
Accepted June 8, 2005

Article

Preterm birth in rural Malawi: high incidence in ultrasounddated population

Nynke van den Broek 1*, Chikonde Ntonya 2, Edith Kayira 2, Sarah White 2, and James P. Neilson 3

1 Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA
2 Malawi-Liverpool-Wellcome Programme, University of Liverpool, UK
3 School of Reproductive & Developmental Medicine, University of Liverpool, UK

* To whom correspondence should be addressed.
Nynke van den Broek, E-mail: vdbroek{at}liv.ac.uk


  Abstract

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.

Keywords: infection/Malawi/neonatal mortality/preterm birth/ultrasound.
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