Preterm Labour in Malawi. Prevention, treatment, complications. A literature study.

Abstract

Background: Malawi has the highest estimated preterm birth rate in the world, estimated at 18.1%. Preterm birth represent a major, largely unrecognized, public health problem contributing to the high rates of neonatal mortality in Malawi. Objectives: This thesis gives an overview of the causes, prevention, treatment and complications of preterm birth. Special emphasis is on Malawi, and a presentation of the most relevant studies on preterm labour, conducted in Malawi, is included. With the articles from Malawi as a basis, I will discuss what they can do in this low-income country to reduce the rate of preterm birth. Method: This is a literature study. The articles used for the chapters regarding causes, prevention, treatment and complications of preterm birth, are chosen through non-systematic searches on Pub Med, and articles were picked out from the criteria of being of recent date, updated and of good quality. The literature from Malawi is chosen through a systematic search on Pub Med using the search-words “preterm” AND “Malawi”, and 25 articles were picked out. Discussion: Studies investigating risk factors associated with preterm birth in Malawi have identified several factors that can be modified. Focus on maternal health and nutrition in the preconception- and antenatal period can reduce the incidence of preterm birth. Increasing the coverage of prevention in adolescence, promoting family planning, and changing Malawi’s guidelines for prevention of malaria in pregnancy can contribute to reduction of the preterm birth rate. Conclusion: Attacking risk factors found to be associated with preterm birth in Malawi, in studies where ultrasound were used to determine gestational age, will be important if Malawi’s preterm birth rate shall improve. Focus on pre-pregnancy- and antenatal care will be essential.