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An analysis of intra-uterine growth retardation in rural Malawi

European Journal of Clinical Nutrition volume 55, pages 682–689 (2001)Cite this article

Abstract

Objective: (1) To describe the sex-specific, birth weight distribution by gestational age of babies born in a malaria endemic, rural area with high maternal HIV prevalence; (2) to assess the contribution of maternal health, nutritional status and obstetric history on intra-uterine growth retardation (IUGR) and prematurity.

Methods: Information was collected on all women attending antenatal services in two hospitals in Chikwawa District, Malawi, and at delivery if at the hospital facilities. New-borns were weighed and gestational age was assessed through post-natal examination (modified Ballard). Sex-specific growth curves were calculated using the LMS method and compared with international reference curves.

Results: A total of 1423 live-born singleton babies were enrolled; 14.9% had a birth weight <2500 g, 17.3% were premature (<37 weeks) and 20.3% had IUGR. A fall-off in Malawian growth percentile values occurred between 34 and 37 weeks gestation. Significantly associated with increased IUGR risk were primiparity relative risk (RR) 1.9; 95% CI 1.4–2.6), short maternal stature (RR 1.6; 95% CI 1.0–2.4), anaemia (Hb<8 g/dl) at first antenatal visit (RR 1.6; 95% CI 1.2–2.2) and malaria at delivery (RR 1.4; 95% CI 1.0–1.9). Prematurity risk was associated with primiparity (RR 1.7; 95% CI 1.3–2.4), number of antenatal visits (RR 2.2; 95% CI 1.6–2.9) and arm circumference <23 cm (RR 1.9; 95% CI 1.4–2.5). HIV infection was not associated with IUGR or prematurity.

Conclusion: The birth-weight-for-gestational-age, sex-specific growth curves should facilitate improved growth monitoring of new-borns in African areas where low birth weight and IUGR are common. The prevention of IUGR requires improved malaria control, possibly until late in pregnancy, and reduction of anaemia.

European Journal of Clinical Nutrition (2001) 55, 682–689

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Acknowledgements

We would like to thank Ms Makwiza, Ms Mlanga, Ms Nakoma, Ms Gwaza and Mr Banda for their dedication to this project. We are most grateful for the support received from the staff of Chikwawa District Hospital and Montfort Hospital, Nchalo, Malawi. We also thank the laboratory technicians from the Department of Paediatrics, College of Medicine, Blantyre, for technical support and the Health Science Research Committee, Malawi, for allowing us to conduct this study. Financial support for this study was through the European Commission, Program for Life Sciences and Technologies for Developing Countries and Ter Meulen Foundation, Amsterdam (for FV).

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Author notes

  1. L Chimsuku: Deceased.

  2. FH Verhoeff: Guarantor: FH Verhoeff.

  3. FH Verhoeff, BJ Brabin, S van Buuren, L Chimsuku, P Kazembe, JM Wit and RL Broadhead: Contributors: The study was designed and planned by FV and BB, and they wrote the paper together. FV was responsible for data collection and analysis. SvB and JMW were involved in data analysis. PK and RB advised on the study at several stages and on interpretation of data.

Authors and Affiliations

  1. School of Tropical Medicine, Pembroke Place, Liverpool, UK

    FH Verhoeff, BJ Brabin & L Chimsuku

  2. Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands

    FH Verhoeff & JM Wit

  3. Emma Kinderziekenhuis, Academic Medical Center, Amsterdam, The Netherlands

    BJ Brabin

  4. Department of Statistics, TNO Prevention and Health, Leiden, The Netherlands

    S van Buuren

  5. College of Medicine, Blantyre, Malawi

    L Chimsuku & RL Broadhead

  6. Kamuzu Central Hospital, Lilongwe, Malawi

    P Kazembe

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  1. FH Verhoeff
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Correspondence to FH Verhoeff.

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Verhoeff, F., Brabin, B., van Buuren, S. et al. An analysis of intra-uterine growth retardation in rural Malawi. Eur J Clin Nutr 55, 682–689 (2001). https://doi.org/10.1038/sj.ejcn.1601200

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