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An analysis of intra-uterine growth retardation in rural Malawi

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Author: Verhoeff, F.H. · Brabin, B.J. · Buuren, S. van · Chimsuku, L. · Kazembe, P. · Wit, J.M. · Broadhead, R.L.
Type:article
Date:2001
Source:European Journal of Clinical Nutrition, 8, 55, 682-689
Identifier: 236206
doi: doi:10.1038/sj.ejcn.1601200
Keywords: Health · Anaemia · Developing country · Intra-uterine growth · Reference curves · Adult · Africa · Analysis · Anamnesis · Arm · Body height · Calculation · Controlled study · Delivery · Endemic disease · Gender · Gestational age · Growth curve · Hospital · Human immunodeficiency virus · Human immunodeficiency virus infection · Information processing · Intrauterine growth retardation · Low birth weight · Malaria control · Maternal welfare · Monitoring · Mother · Newborn screening · Nutritional status · Parity · Prematurity · Prenatal care · Reference value · Risk assessment · Rural area · Seroprevalence · Anemia, Iron-Deficiency · Antimalarials · Birth Weight · Cross-Sectional Studies · Female · Fetal Growth Retardation · Gestational Age · HIV Infections · Humans · Infant, Newborn · Infant, Premature · Malaria · Malawi · Nutritional Status · Pregnancy · Pregnancy Complications, Infectious · Pregnancy Trimester, Third · Reference Values · Risk Factors · Rural Population · Sex Factors

Abstract

Objective: (1) To describe the sex-specific, birth weight distribution by gestational age of babies born in a malaria endemic, rural area with high maternal HIV prevalence; (2) to assess the contribution of maternal health, nutritional status and obstetric history on intra-uterine growth retardation (IUGR) and prematurity. Methods: Information was collected on all women attending antenatal services in two hospitals in Chikwawa District, Malawi, and at delivery if at the hospital facilities. New-borns were weighed and gestational age was assessed through post-natal examination (modified Ballard). Sex-specific growth curves were calculated using the LMS method and compared with international reference curves. Results: A total of 1423 live-born singleton babies were enrolled; 14.9% had a birth weight < 2500 g, 17.3% were premature (< 37 weeks) and 20.3% had IUGR. A fall-off in Malawian growth percentile values occurred between 34 and 37 weeks gestation. Significantly associated with increased IUGR risk were primiparity relative risk (RR) 1.9; 95% CI 1.4-2.6), short maternal stature (RR 1.6; 95% CI 1.0-2.4), anaemia (Hb < 8 g/dl) at first antenatal visit (RR 1.6; 95% CI 1.2-2.2) and malaria at delivery (RR 1.4; 95% CI 1.0-1.9). Prematurity risk was associated with primiparity (RR 1.7; 95% CI 1.3-2.4), number of antenatal visits (RR 2.2; 95% CI 1.6-2.9) and arm circumference < 23 cm (RR 1.9; 95% CI 1.4-2.5). HIV infection was not associated with IUGR or prematurity. Conclusion: The birth-weight-for-gestational-age, sex-specific growth curves should facilitate improved growth monitoring of new-borns in African areas where low birth weight and IUGR are common. The prevention of IUGR requires improved malaria control, possibly until late in pregnancy, and reduction of anaemia. Chemicals/CAS: Antimalarials