Perinatal mortality in rural Malawi

Abstract

Reported are the results of a study to assess the prevalence and risk factors for perinatal death among pregnant women in Malawi over the period 1987-90. There were 264 perinatal deaths among the 3866 women with singleton pregnancies (perinatal mortality rate, 68.3 per 1000 births). Among the risk factors for perinatal mortality were the following: reactive syphilis serology, nulliparity, a late fetal or neonatal death in the most recent previous birth, maternal height < 150 cm, home delivery, and low socioeconomic status. Although unexplained perinatal deaths will continue to occur, perinatal mortality can be reduced if its causes and risk factors in a community are given priority in antenatal and intrapartum care programmes. The following interventions could potentially reduce the perinatal mortality in the study population: screening and treating women with reactive syphilis serology; and management from early labour, by competent personnel in a health facility, of nulliparous women and multiparous women who are short or have a history of a perinatal death.

PIP: During 1987-90, in rural Mangochi District, Malawi, 4052 pregnant women were enrolled at their first prenatal visit to one of four prenatal care clinics in a study designed to examine the prevalence and risk factors for perinatal death. They were followed through delivery and at bimonthly visits for at least 12 months after delivery. The infant survival status at day 7 was known for 3866 women. There were 148 late fetal deaths and 116 early neonatal deaths for a perinatal mortality rate of 68.3/1000 births. The researchers had a complete set of data available for 3184 women with which to determine risk factors for perinatal death. The multivariate analysis identified independent risk factors for perinatal death to include reactive syphilis serology (odds ratio [OR] = 3.39), a history of late fetal or neonatal death in the most recent previous birth among multiparous women (OR = 3.27), nulliparity (OR = 2.38), short maternal stature (150 cm) (OR = 1.74), home delivery (OR = 1.47), and low socioeconomic status (SES) (OR = 1.41). Syphilis, nulliparity, and low SES each contributed 22-25% of perinatal deaths. Home delivery, history of late fetal or neonatal death in most recent previous birth, and short stature each contributed 10-16% of perinatal deaths. These findings suggest that screening and treating pregnant women with positive syphilis serology would reduce current perinatal mortality by at least 25%. Maternity services should offer clinical management by competent personnel in a health facility from early labor of nulliparous women and multiparous women of short stature or multiparous women with a history of late fetal or neonatal death in the most recent previous birth to further reduce perinatal mortality.