Chronic malnutrition in pregnant adolescents in rural Malawi: an anthropometric study.

BACKGROUND: The anthropometry of adolescent pregnancy has been little described in developing countries. This paper outlines the anthropometry of adolescents living in poor rural communities in southern Malawi. METHODS: A cross-sectional descriptive analysis of 991 women who attended for their first antenatal visit before 18 weeks' gestation at two rural hospitals. Of these, 190 were adolescent (12-19 years). RESULTS: Of adolescent attendees, 82.6% were primigravidae, and 77.9% were illiterate. Adolescents had a higher prevalence of low values for weight for age, mid-upper arm circumference (both p < 0.01), and body mass index (p = 0.06) than nonadolescent women. At all maternal ages illiterate women were shorter than literate women. Percentile values for adolescents for weight, height and upper-arm circumference and body mass index showed consistent evidence of chronic undernutrition during adolescence. The age-specific cross-sectional curves provide evidence for continued linear growth until early adulthood. CONCLUSIONS: Chronic undernutrition and illiteracy were common amongst adolescent pregnant women in these communities where childbearing starts early in adolescence. The nutritional consequences of this for these young mothers and their offspring are considerable. Innovative health and literacy strategies are required to address this problem.

Post-neonatal infant mortality in Malawi: the importance of maternal health.

In a cohort study of mothers and their infants, information was collected from women attending the antenatal services of two hospitals in a rural area of Malawi and 561 of their babies were enrolled in a follow-up study. There were 128 with a low birthweight (LBW, <2500 g), 138 with fetal anaemia (FA, cord haemoglobin <12.5 g/dl), 42 with both and 228 with a normal birthweight and no FA. Infants were seen monthly for 1 year. Risk factors for post-neonatal infant mortality (PNIM) were calculated using Cox regression analysis adjusting for LBW and FA. PNIM was 9.3%. Respiratory infections and diarrhoeal disease were the principal attributable causes of death. PNIM increased with LBW (RR 3.08, 95% CI 1.51-6.23) but not significantly so with FA (RR 1.60, 95% CI 0.78-3.27). An additional effect on PNIM was observed with maternal HIV (RR 3.44, 95% CI 1.63-7.26) and malaria at the first antenatal visit (RR 2.26, 95% CI 1.09-4.73). Illiteracy was not associated with mortality. Placental malaria in HIV-seronegative mothers was significantly associated with increased PNIM. Improving birthweight through effective antimalarial control in pregnancy will lead to a reduction in PNIM. Reduction of HIV prevalence and prevention of mother-to-child transmission of HIV must be a main target for government health policy.