MALARIA AND PERINATAL-MORTALITY IN CENTRAL SUDAN

Hospital and community studies were conducted in Central Sudan during 1989 and 1990 to determine the association between maternal malaria an d perinatal mortality. There were 197 cases of stillbirth and 812 cont rols in the hospital study. In the community study, 36 perinatal and 3 1 neonatal deaths were compared with 1,505 and 1,495 survivors of the early neonatal and entire neonatal periods, respectively. There was no overall association between perinatal mortality and malaria. However, the risk of stillbirth (particularly macerated stillbirth) was signif icantly increased among women who reported malaria attacks in the firs t and second trimesters of pregnancy (odds ratio (OR) = 1.4, 95% confi dence interval (CI) 1.1-1.9). A reduced risk was associated with attac ks in the third trimester (OR = 0.4, 95% CI 0.2-0.8), but this probabl y reflects a bias resulting f rom shorter gestation in cases of stillb irth. Increased risk of neonatal mortality was associated with materna l malaria (OR = 2.1, 95% CI 1.0-4.5). In areas where malaria is preval ent, it is recommended that malaria prevention by personal protection, prophylaxis, and treatment be initiated early in pregnancy.