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Background. Much of the data on still births and early neonatal deaths from resource-limited settings are obtained via maternal recall from national or community level surveys. While this approach results in useful information to be obtained, often such data suffer from significant recall bias and misclassification. In order to determine the prevalence of stillbirths (SB), early hospital neonatal death (EHND) and associated factors in Blantyre, Malawi, a prospective study of pregnant and post-natal women was conducted at the Queen Elizabeth Central Hospital (QECH), Malawi. Methods. A prospective observational study was conducted between February 1, 2004 and October 30, 2005. Consecutive women attending the hospital for delivery were recruited. Data were collected on the health status of the fetus on admission to labor ward and immediately after delivery, whether alive or dead. Gestational age (GA) and birth weight (BW) and sex of the newborn were also noted. Similar data were also collected on the live births that died in the delivery room or nursery. Data were analyzed using SPSS (Statistical Package for the Social Sciences) statistical package. Results. A total of 10,700 deliveries were conducted during the 12 months study period and of these deliveries, 845 (7.9%) were SB and EHND. Stillbirths comprised 3.4% of all deliveries; 20.2% of the ante-partum deaths occurred before the mother was admitted to the labor ward while a slightly higher proportion (22.7%) of fetal loss occurred during the process of labor and delivery. Fifty-sex percent of the perinatal deaths (PD) were EHND. The mean gestational age for the perinatal deaths was 34.7 weeks and mean birth weight was 2,155 g (standard deviation = 938 g). The majority, 468 (57.8%) of the perinatal deaths were males and 350 (43.2%) were females. Many of the perinatal deaths (57.9%) were deliveries between gestational ages of 20 and 37 weeks. Most (62.7%) of the mothers with a perinatal death had experienced a previous similar incident. Conclusion. About 3.4% of all pregnant mothers past 20 weeks of gestation ended up in delivering a stillbirth; another 4.4% of the live births died before discharge from hospital, thus, 7.9% of pregnancy loss after 20 weeks (or 500 g estimated weight) of gestation. This is a higher loss when compared to international and regional data. We recommend attention be given to these unfavorable outcomes and preventive measures or intervention for preventable causes be considered seriously. These measures could include the provision of emergency obstetric care, improving access to deliveries by health professionals and resourcing of health facilities such that neonatal viability is promoted. © 2009 Metaferia and Muula.
This was a prospective observational study conducted at the Gogo Chatinkha Maternity Unit and the Pediatrics and Child Health Departments at the QECH in Malawi between February 1, 2004 and October 30, 2005. The QECH is a public health facility serving as the referral facility for the southern region of Malawi (population estimated at 5 million), as well as a district hospital for Blantyre (population estimated at 650,000). The Department of Obstetrics and Gynecology at the hospital has often had between 3 and 6 specialist physicians, two to three registrars and 3 to 5 intern medical doctors. There are between two and fours nurse midwives for each shift. There are about six pediatricians at the hospital. The objectives of the study were to estimate the incidence of SB and ENND and assess the gestational age, birth weight and sex distribution of the perinatal deaths observed. During the 12 months study period a total of 10,700 deliveries were conducted at the study center. Consecutive women presenting for labor and delivery care were enrolled. Data were collected on SB and in hospital ENNDs using a standardized and pre-tested data capture sheet. Maternal and fetal variables of interest including GA, BW, sex of fetus or baby, vital status (dead or alive) were collected by a trained research midwife. Information on live births, but who might have died at home after discharge from the hospital, was unknown. No effort was made to follow-up women in the community who did not present for a postnatal visit. Data were analyzed using SPSS statistical software. Results are presented as frequencies, proportions and graphs where appropriate. The study protocol was reviewed and approved by the University of Malawi’s, College of Medicine Research and Ethics Committee (COMREC). All women who participated in the study gave informed consent.
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