Antenatal and perinatal predictors of infant mortality in rural Malawi
Merimaaria Vaahteraa, Teija Kulmalaa, MacDonald Ndekhac, Anna-Maija Koivistod, Timothy Cullinanc, Marja-Leena Saline, Per Ashornb
a Medical
School, University of Tampere, PO Box 607, FIN-33101 Tampere, Finland, b Department
of Paediatrics, Tampere University Hospital, PO Box 2000, FIN-33521
Tampere, Finland, c College of
Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre,
Malawi, d School of
Public Health, University of Tampere, FIN-33014 Tampere, Finland, e Mannerheim League for Child
Welfare, PO Box 230, Mangochi, Malawi
Correspondence to: Dr Vaahtera email: merimaaria.vaahtera{at}kolumbus.fi
Accepted 22 October
1999
BACKGROUND
The slow
pace in the reduction of infant mortality in sub-Saharan Africa has
partially been attributed to the epidemic of human immunodeficiency
virus (HIV) infection. To facilitate early interventions, antenatal and
perinatal predictors of 1st year mortality were identified in a rural
community in southern Malawi.
METHODSA cohort of
733 live born infants was studied prospectively from approximately 24 gestation weeks onwards. Univariate analysis was used to determine
relative risks for infant mortality after selected antenatal and
perinatal exposures. Multivariate modelling was used to control for
potential confounders.
FINDINGSThe infant
mortality rate was 136 deaths/1000 live births. Among singleton
newborns, the strongest antenatal and perinatal predictors of mortality
were birth between May and July, maternal primiparity, birth before
38th gestation week, and maternal HIV infection. Theoretically,
exposure to these variables accounted for 22%, 22%, 17%, and 15% of
the population attributable risk for infant mortality, respectively.
INTERPRETATIONThe HIV
epidemic was an important but not the main determinant of infant
mortality. Interventions targetting the offspring of primiparous women
or infants born between May and July or prevention of prematurity would
all have considerable impact on infant survival.
Keywords: infant mortality; antenatal predictors; human immunodeficiency virus; sub-Saharan Africa
© 2000 by Archives of Disease in Childhood
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