IJE Advance Access originally published online on November 2, 2004
International Journal of Epidemiology 2004 33(6):1194-1201; doi:10.1093/ije/dyh120
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IJE vol.33 no.6 © International Epidemiological Association 2004; all rights reserved.
Special Theme: Perinatal and Paediatric Epidemiology |
Risk factors for prematurity at Harare Maternity Hospital, Zimbabwe
1 Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor Michigan, USA
2 Department of Community Medicine, Medical School, University of Zimbabwe, Harare, Zimbabwe
Correspondence: Dr Shingairai A. Feresu, c/o Dr SD Harlow, University of Michigan, Department of Epidemiology, School of Public Health, 611 Church Street, Ann Arbor, MI 48104–3028, USA. E-mail: sferesu{at}umich.edu
Background Prematurity remains the main cause of mortality and morbidity in infants and a problem in the care of pregnant women world-wide. This preliminary study describes the socio-demographic, reproductive, medical, and obstetrical risk factors for having a live pre-term delivery (PTD) in Zimbabwe.
Methods This case-control study examined risk factors for PTD, at Harare Maternity Hospital between March and June 1999.
Results The frequency of PTD among live birth was 16.4%. Prior history of stillbirth or abortion was associated with PTD (adjusted relative risk [ARR] 1.50; 95% CI: 1.06, 2.11). Nutritional factors, including drinking a local non-alcoholic beverage (mahewu) during pregnancy and mother's increasing mid-arm circumference reduced the risk of PTD (ARR = 0.75; 95% CI: 0.60, 0.93 and ARR = 0.95; 95% CI: 0.92, 0.99 per cm of circumference, respectively). Obstetric conditions including eclampsia, anaemia, ante-partum haemorrhage, and placenta praevia were infrequent, but when present, were strongly associated with PTD (ARR = 3.57; 95% CI: 1.67, 7.63; ARR = 4.12; 95% CI: 1.80, 9.43; ARR = 3.05; 95% CI: 1.86, 5.00 and ARR = 3.30; 95% CI: 1.34, 8.14, respectively). Malaria, although less frequent, nonetheless was associated with an increased risk of PTD (ARR = 2.93; 95% CI: 1.70, 5.04). These results suggest that in addition to established obstetric risk factors, nutrition and malarial infection are important. About 43% of the mothers initiated prenatal care after 28 weeks of gestation.
Conclusion Addressing prematurity in this population will require earlier initiation of prenatal care to allow for early detection and management of complications of pregnancy, and improving nutritional status of reproductive age with locally available foods. Further exploration of the potential benefits of mahewu, is warranted.
Keywords Prematurity, pre-term delivery, pre-term birth, prenatal care, malaria
Accepted 19 January 2004
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