Infant mortality and morbidity associated with preterm and small-for-gestational-age births in Southern Mozambique: A retrospective cohort study

PLOS ONE, Dec 2019

Background Preterm and small for gestational age (SGA) births have been associated with adverse outcomes during the first stages of life. We evaluated the morbidity and mortality associated with preterm and SGA births during the first year of life in a rural area of Southern Mozambique. Methods This is a retrospective cohort study using previously collected data from children born at the Manhiça District Hospital in two different periods (2003–2005 and 2010–2012). Newborns were classified as being preterm and/or SGA or as babies not fulfilling any of the previous conditions (term non-SGA). All children were followed up for a year for morbidity and mortality outcomes. Results A total of 5574 live babies were included in the analysis. The prevalence of preterm delivery was 6.2% (345/5574); the prevalence of SGA was 14.0% (776/5542) and 2.2% (114/5542) of the children presented both conditions. During the neonatal period, preterm delivery and SGA were associated with 13 (HR: 13.0, 95% CI 4.0–42.2) and 5 times (HR: 4.5, 95% CI: 1.6–12.6) higher mortality compared to term non SGA babies. Risk of hospitalization was only increased when both conditions were present (IRR: 3.5, 95%CI: 1.5–8.1). Mortality is also increased during the entire first year, although at a lower rate. Conclusions Neonatal and infant mortality rates are remarkably high among preterm and SGA babies in southern Mozambique. These increased rates are concentrated within the neonatal period. Prompt identification of these conditions is needed to implement interventions aimed at increasing survival of these high-risk newborns.

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Infant mortality and morbidity associated with preterm and small-for-gestational-age births in Southern Mozambique: A retrospective cohort study

February Infant mortality and morbidity associated with preterm and small-for-gestational-age births in Southern Mozambique: A retrospective cohort study Alberto L. GarcÂõa-Basteiro 0 1 LlorencË Quinto 0 Eusebio Macete 0 1 Azucena BardajÂõ 0 1 Raquel Gonza lez 0 1 Arsenio Nhacolo 0 1 Betuel Sigauque 0 1 Charfudin Sacoor 0 1 MarÂõa Rupe rez 0 1 3 Elisa Sicuri 0 1 2 Quique Bassat 0 1 EsperancË a Sevene 0 1 Clara Mene ndez 0 1 3 0 Editor: Umberto Simeoni, Centre Hospitalier Universitaire Vaudois , FRANCE 1 Centro de InvestigacËão em Saude de ManhicËa , ManhicËa, Maputo Province, Mozambique, 2 ISGlobal , Barcelona Ctr. Int. Health Res. Hospital ClÂõnicÐUniversitat de Barcelona , Barcelona , Spain , 3 Amsterdam Institute for Global Health and Development, Academic Medical Centre , Amsterdam , The Netherlands 2 School of Public Health, Imperial College London , London , United Kingdom 3 Consorcio de Investigacio n Biome dica en Red de EpidemiologÂõa y Salud Pu blica , Barcelona , Spain - Data Availability Statement: The data used in our study comes from routine data collected in ManhicËa District Hospital. Many individuals (mothers and children participated in two big studies about preventive tools for malaria among pregnant women and infants: TIMNET and MIPPAD). All data from any study conducted at our site needs to be formally requested to the Internal Scientific Committee of ManhicËa Health Research Center (). We do not foresee any issue if indeed data is requested, given that all Background Mozambique. Methods ity outcomes. Results A total of 5574 live babies were included in the analysis. The prevalence of preterm delivery was 6.2% (345/5574); the prevalence of SGA was 14.0% (776/5542) and 2.2% (114/5542) of the children presented both conditions. During the neonatal period, preterm delivery and SGA were associated with 13 (HR: 13.0, 95% CI 4.0±42.2) and 5 times (HR: 4.5, 95% CI: 1.6±12.6) higher mortality compared to term non SGA babies. Risk of hospitalization was only increased when both conditions were present (IRR: 3.5, 95%CI: 1.5±8.1). Mortality is also increased during the entire first year, although at a lower rate. information would be shared in an anonymized fashion. Funding: Salary fellowship (ALGB) from the Spanish program Rio Hortega of the ISCIII (grant number: CM12/00246) and Spanish Epidemiology Society. No further specific funding was needed for the conduct for this work. Competing interests: The authors have declared that no competing interests exist. Conclusions Neonatal and infant mortality rates are remarkably high among preterm and SGA babies in southern Mozambique. These increased rates are concentrated within the neonatal period. Prompt identification of these conditions is needed to implement interventions aimed at increasing survival of these high-risk newborns. Introduction Preterm birth is the world's leading cause of death in children under five years[ 1 ]. It has been estimated that each year, 11% of all deliveries in the world are premature, and one million out of six million child deaths are due to complications of prematurity[ 2,3 ]. Small for gestational age (SGA) births, are also a prevalent condition among newborns from low and middle income countries (up to 27% of all deliveries are SGA), with higher prevalence in South East Asia and Sahelian countries[4]. Preterm and SGA births are associated with adverse health consequences, including increased neonatal and infant mortality, childhood malnutrition, visual and hearing problems, and adulthood metabolic disease[ 5,6 ]. Both preterm birth and SGA are intrinsically associated with low birth weight and are not mutually exclusive. On the one hand, preterm birth is associated with multiple maternal and/or foetal conditions, including maternal and neonatal infections, vascular disease, uterine overdistension, pre-eclampsia/eclampsia or intrauterine growth restriction (IUGR)[ 7 ]. On the other hand, SGA is frequently associated with disorders such as foetal genetic/chromosomal defects or also to IUGR[ 8 ]. The latter is associated with factors that prevent normal circulation across the placenta causing poor nutrient and oxygen supply to the foetus, including maternal undernutrition, anemia, malaria, HIV and other acute or chronic infections[ 9 ]. Alternatively, SGA can result from an incorrect assessment of gestational age or a constitutionally±albeit not necessarily pathological- small size. However, since preterm and SGA babies are at risk of presenting different health problems they are associated with different morbidity and mortality risks[ 10 ]. Compared to SGA, preterm babies have been associated with higher risk of death during infancy, but lower risk of morbidity and better growth patterns during the first two years of life[ 10 ]. Despite the relative high prevalence and adverse outcomes associated with preterm births and SGA in low-income settings, very few stud (...truncated)


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Alberto L. García-Basteiro, Llorenç Quintó, Eusebio Macete, Azucena Bardají, Raquel González, Arsenio Nhacolo, Betuel Sigauque, Charfudin Sacoor, María Rupérez, Elisa Sicuri, Quique Bassat, Esperança Sevene, Clara Menéndez. Infant mortality and morbidity associated with preterm and small-for-gestational-age births in Southern Mozambique: A retrospective cohort study, PLOS ONE, 2017, Volume 12, Issue 2, DOI: 10.1371/journal.pone.0172533