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. 2014 Jan;28(1):23-31.
doi: 10.1111/ppe.12085. Epub 2013 Oct 10.

The contribution of preterm birth and intrauterine growth restriction to infant mortality in Tanzania

Ayesha Sania  1 , Donna Spiegelman, Janet Rich-Edwards, James Okuma, Rodrick Kisenge, Gernard Msamanga, Willy Urassa, Wafaie W Fawzi
Affiliations

The contribution of preterm birth and intrauterine growth restriction to infant mortality in Tanzania

Ayesha Sania et al. Paediatr Perinat Epidemiol. 2014 Jan.

Abstract

Background: Our objectives were to examine the associations of neonatal and infant mortality with preterm birth and intrauterine growth restriction (IUGR), and to estimate the partial population attributable risk per cent (pPAR%) of neonatal and infant mortality due to preterm birth and IUGR.

Methods: Participants were HIV-negative pregnant women and their infants enrolled in Dar es Salaam, Tanzania. Gestational age calculated from date of last menstrual period was used to define preterm, and small for gestational age (SGA) was used as proxy for IUGR. Survival of infants was ascertained at monthly follow-up visits. Cox proportional hazard models were used to estimate the associations of preterm and SGA with neonatal and infant mortality.

Results: Study included 7225 singletons, of whom 15% were preterm and 21% were SGA; majority of preterm or SGA babies had birthweight ≥2500 g. Compared to term and appropriately sized babies (AGA), relative risks (RR) of neonatal mortality among preterm-AGA was 2.6 [95% CI 1.8, 3.9], RR among term-SGA was 2.3 [95% CI 1.6, 3.3], and the highest risk was among the preterm-SGA babies (RR 15.1 [95% CI 8.2, 27.7]). Risk associated with preterm was elevated throughout the infancy, and risk associated with SGA was elevated during the neonatal period only. The pPAR% of neonatal mortality for preterm was 22% [95% CI 17%, 26%] and for SGA it was 26% [95% CI 16%, 36%].

Conclusions: Preterm and SGA birth substantially increased the risk of mortality. Interventions for prevention and management of these conditions are likely to reduce of infant mortality in Tanzania.

Keywords: IUGR; birthweight; infant mortality; neonatal mortality; preterm.

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Conflict of interest statement

Conflict of interest

Authors do not have any conflict of interest to disclose.

Figures

Figure 1.
Figure 1.
Distribution of gestational age and size at gestational age category by birth weight. (Area approximates the number of infants in each category).
Figure 2.
Figure 2.
(a) Risk of infant mortality by gestational age and size at gestational age category. (b) Risk of infant mortality by birthweight categories.
See this image and copyright information in PMC

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