Improving perinatal outcomes in Zimbabwe: A new focus on prematurity.

Abstract

Data on birth outcomes are essential for planning maternal and child health care services in developing countries. No study has jointly examined the spectrum of poor birth outcomes across demographic subgroups in Zimbabwe. This dissertation is based on three studies conducted in Zimbabwe, October 1997 to December 1999. Chapter 2 assesses delivery patterns and birth outcomes over a one-year period at Harare Maternity Hospital (HMH). The annual rate of stillbirth was 61/1000 live births, pre-term birth was 168/1000 and low birthweight (LBW) was 199/1000. Lack of antenatal care increased the risk of all three outcomes. Pre-term and LBW births were more likely to be stillborn, delivered breech, but less likely to be delivered by Caesarian section as were stillbirths. Chapter 3 evaluates the Dubowitz and Ballard methods of estimating gestational age in 364 African newborn infants at HMH. Both methods were good predictors of gestational age and can differentiate term from pre-term infants. The Dubowitz method was a relatively better predictor, while the Ballard method took a shorter time and was easier to administer. Addition of birthweight to the regression models improved prediction of gestational age. Chapter 4 assesses risk factors for pre-term birth, pre-term labor and premature rupture of membranes (PROM). The frequency of pre-term birth was 164/1000, pre-term labor 89/1000 and PROM was 119/1000 live births. Lack of antenatal care increased and maternal mid-arm circumference decreased the odds of each outcome. History of abortion or stillbirth, anemia, placenta previa, ante-partum hemorrhage, malaria and HIV infection increased the odds of pre term birth, while drinking a non-alcoholic traditional beverage was protective. The rate of stillbirth in Zimbabwe remains high and prematurity is an important yet poorly evaluated risk factor. Addressing prematurity will require improved quality of antenatal and obstetric care, promotion of early antenatal care and programs to identify and treat obstetrical complications related to prematurity. Such efforts could reduce frequency of poor birth outcomes and perinatal mortality in Zimbabwe. We also recommend the use of new birthweight-sensitive maturity scales.