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)