Factors associated with high risk of perinatal and neonatal mortality: an interim report on a prospective community-based study in rural Sudan.

In a community-based prospective study, 6275 deliveries resulting in 6084 livebirths, 150 stillbirths (SB) and 167 neonatal deaths (NND) were monitored over a period of 3 years. The risk of an unfavourable outcome (SB or NND) in multiple pregnancies was more than ninefold that of singletons. Teenage mothers and those over 34 years of age ran nearly twice the risk of having an unfavourable outcome of pregnancy compared with mothers aged 20-29 years. First pregnancy and grand-multiparity (greater than eight previous pregnancies) carried a similar risk of an unfavourable outcome compared with mothers with 1-4 previous pregnancies. The most serious risk factor was the adverse outcome of the previous pregnancy. Compared with mothers whose last outcome had resulted in a livebirth surviving at least 30 days, mothers with a previous SB had seven times the risk (adjusted for age and parity) of SB and more than twice the risk of NND in the current pregnancy. Maternal illiteracy was associated with significantly higher risk of NND, and this rate decreased with increasing years of education. Frequency of antenatal visits had a marginally significant effect on the SB rate. Socioeconomic factors, diet and iron supplementation during pregnancy did not seem to affect the outcome.

PIP: Between March 1985 and April 1988 in a rural community in Sudan, a prospective study was conducted to determine the factors linked to perinatal and neonatal mortality. There were 6275 pregnancies and 6150 singleton births, 124 pairs of twins, and 1 set of triplets. The multiple pregnancy rate was 19.9/1000 deliveries. Pregnancy outcomes included 6084 live births surviving more than 30 days, 150 fetal deaths, 124 early neonatal deaths, and 43 late neonatal deaths. When the researcher controlled for age and parity, multiple pregnancies carried a higher risk of still birth, perinatal mortality, and neonatal mortality than did singleton pregnancies (relative risk [RR] = 6.1, 8.9, and 12.3, respectively; p 0.0001). Poor pregnancy outcome was 1.8 times more likely for teenage mothers than for 20-29 year old mothers (p 0.0003). First pregnancy and grandmultiparity ( 8 previous pregnancies) were associated with a higher risk of perinatal mortality when compared to mothers of parity 1-4 (RR = 1.9 [p 0.001] and 1.8 [p 0.01], respectively). A poor outcome of last pregnancy was the most important risk factor for neonatal death of current pregnancy (X2 = 55 when adjusted for multiple pregnancies and 36.5 when adjusted for age, parity, and multiple pregnancies; p 0.0001). The risk was highest when the last pregnancy outcome was stillbirth (RR = 6.9; p 0.001). Mothers with a previous stillbirth faced a 2.4-fold increased risk of neonatal death for the current pregnancy (p 0.001). Perinatal mortality rates fell as the number of years of full-time maternal education increased (p = 0.02 for the trend). Education mainly had an effect on reducing neonatal deaths (X2 for trend = 5.3 [p 0.05] vs. 1.8 for perinatal deaths and 1.1 for stillbirths). The frequency of prenatal visits had only a limited significant effect of reducing stillbirths (p = 0.05) and no effect of reducing perinatal and neonatal deaths. Household income, diet, and iron supplementation during pregnancy did not affect pregnancy outcome.

The role of the village midwife in detection of high risk pregnancies and newborns.

The preliminary findings of a prospective study of perinatal, neonatal and maternal mortality carried out in a rural community of Sudan are reported. Out of 6275 deliveries monitored over a period of 3 years, 150 stillbirths, 167 neonatal deaths and 27 maternal deaths were observed. An intervention program to upgrade the skills of the village midwives started in the middle of the second year. There was a 25% reduction in the risk of unfavorable outcome of pregnancy (i.e. stillbirth and neonatal death) in the third year relative to the first 2 years. Peer review of the 40 village midwives who took part in the study revealed their tremendous potentials in mobilization of mothers as well as participation in primary health care. Their role in detection of high risk pregnancies and newborns cannot be overemphasized.