The importance of preterm births for peri- and neonatal mortality in ruralMalawi

Peri- and neonatal mortality remain high in developing countries, especiall y in sub-Saharan Africa. In the present study, we quantified and identified the most important predictors of early mortality in rural Malawi. Data wer e obtained from a community-based cohort of 795 pregnant women and their 81 3 fetuses, followed prospectively from mid-pregnancy In this group, peri- a nd neonatal mortality rates were 65.3 deaths per 1000 births and 37.0 death s per 1000 live births respectively. When controlled for month of birth, ma ternal age and selected socio-economic variables, preterm birth was the str ongest independent predictor of both peri- and neonatal mortality (adjusted odds ratios 9.6 for perinatal and 11.0 for neonatal mortality; 95% confide nce intervals: [4.4, 21.0] and [3.7, 32.7] respectively). Weaker risk facto rs for mortality included a maternal history of stillbirth and abnormal del ivery. Preterm delivery was associated with primiparity and peripheral mala ria parasitaemia of the mother, and it accounted for 65% of the population- attributable risk for perinatal and 68% of the neonatal mortality. Successf ul intervention programmes to reduce peri- and neonatal mortality in Malawi have to include strategies to predict and prevent prematurity.