RATES AND RISK-FACTORS FOR MORTALITY DURING THE FIRST 2 YEARS OF LIFEIN RURAL MALAWI

Developing nations in sub-Saharan Africa experience childhood mortalit y rates that are much higher than any other region of the world. In a rural Malawian community we investigated risk factors for deaths occur ring during the neonatal (birth-28 days), postneonatal (29-365 days), infant (birth-365 days), and second-year (366-730 days) periods among a cohort of 3,724 infants monitored from birth. The neonatal mortality rate in this cohort was 48.6 per 1,000 live births (LB); the postneon atal mortality rate was 108.7/1,000 LB. The overall infant mortality r ate was 157.3 deaths/1,000 LB and the mortality rate for the first two years of life was 223.7 deaths/1,000 LB. The predominate risk factors for neonatal deaths identified in multivariate analysis were low (haz ard ratio [HR] = 2.3) and very low birth weight (HR = 12.7), first pre gnancy (HR = 1.8) and maternal syphilis infection (HR = 2.4). Maternal infection with human immunodeficiency virus (HIV) (HR = 1.5) predomin ated for postneonatal deaths. Low (HR = 1.4) and very low (HR = 5.0) b irth weight, first pregnancy (HR = 1.6), maternal HIV infection (HR = 2.4), and the combination of low education and low socioeconomic statu s (SES) of the mother (HR = 2.0) were the most important factors durin g the infant period. Maternal HIV infection (HR = 3.3) and the combina tion of low education and low SES of the mother (HR = 2.6) were the pr edominate risk factors for mortality occurring during the second year. Factors that were significant in univariate analysis but not signific ant in the final multivariate models included prematurity, previous ad verse reproductive outcome, dying during high malaria transmission sea son, and being born at home. Interventions to prevent maternal HIV inf ection and low birth weight and treatment of syphilis infection would have a great impact on reducing early childhood deaths. Improving the delivery of health care and education to women during their first preg nancy and to the most socially disadvantaged women may also help reduc e the burden of early childhood mortality in communities such as the o ne studied in Malawi.