Potential use of birthweight indicators in rural Tanzania for monitoring malaria control in pregnancy

Abstract

Objective: Birthweight outcomes in rural Tanzania were determined in relation to place of delivery (hospital, dispensary or home), parity and maternal age (adolescent or non-adolescent) in order to evaluate the usefulness of birthweight data for monitoring malaria control in pregnancy.

Study design: Retrospective descriptive study.

Methods: Birthweight data for the years 1997-2001 were obtained from Kilosa district hospital (n=6269), nine dispensaries (n=3688) and for home deliveries (n=677).

Results: The prevalence of low birthweight in singletons was highest in hospital births (primigravidae, 23.4%; multigravidae, 10.0%). Adolescent primigravidae with home deliveries had the lowest mean birthweight (2.611 kg; 95% confidence interval 2.546-2.676 kg). An excess risk of low birthweight in primigravidae compared with multigravidae was seen with increasing distance from the district hospital. The population attributable risk percent for low birthweight in primigravidae associated with malaria increased with distance from the hospital, from 30% for Kilosa town to 45.7% at distances >50 km. Young adolescent primigravidae were at highest risk of poor birthweight outcomes. Dispensary birthweight data were considered to provide the most representative sample for routine birthweight surveillance.

Conclusions: Birthweight indicators show that malaria control in pregnancy is poor in this population, deteriorates with distance of place of birth from the main hospital location, and is worst in adolescent primigravidae. Greater attention should be given to the use of birthweight indicators in rural areas of Tanzania for monitoring malaria control in pregnancy.