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Education and health care quality affect pregnancy outcomes in Malawi

Of 585 000 maternal deaths worldwide each year, 99% are in developing countries. What factors underlie this striking imbalance? Research involving the Malawi College of Medicine and the Liverpool School of Tropical Medicine studied this issue in a rural community in southern Malawi. Maternal education and access to healthcare facilities influence pregnancy outcomes, it showed.

Researchers interviewed women in 20 649 households. They found that:

40% of women have received no education at all and 26% completed primary school only. For men, the corresponding figures are 18% and 41%.
There is a link between education level and the average number of pregnancies for each age group. Women who finish primary school start childbearing later than women with less education.
69.4% of pregnancies have resulted in a currently living child. This percentage increases at higher levels of maternal education.
95% of women attend antenatal clinics, with an average of 5.2 visits. These generally start late – between four and five months of gestation. Attendance is not linked to level of education or type of household.
Births are supervised by doctors (7% of cases), nurse-midwives (56%), traditional birth attendants (TBAs - 19%) and female relatives (16%). 2.5% of women receive no birth assistance.
Presence of a trained midwife is more common among women with higher levels of education and those living nearer to a health centre.

Traditional birth attendants here receive no extra training or equipment. But perinatal mortality is similar for births attended by TBAs (22 deaths per 1000 deliveries) and nurse-midwives (21 per 1000). By contrast, there are 47 perinatal deaths per 1000 deliveries attended by female relatives. Trained staff cannot achieve better results than untrained TBAs without adequate facilities. Services at the health centre are clean but very basic and do not meet all the requirements for essential obstetric care.

The researchers point out that even well-attended antenatal clinics may not lead to improved pregnancy outcomes if they are not coupled to adequate delivery of care. Essential and effective components of antenatal care, such as syphilis screening and detection and treatment of severe anaemia and malaria, are not readily available to rural populations like this one.

Recommendations for policy-makers aiming to improve pregnancy outcomes and reduce overall fertility and health risks to mothers and babies include:

better education for girls
skilled assistance at delivery
effective and timely referral to a suitably-equipped health centre or hospital.

Source(s):
‘Reproductive health in rural Malawi: a population-based survey’, British Journal of Obstetrics and Gynaecology 110: 902-908, by N. van den Broek et al, 2003

Funded by: Wellcome Trust

id21 Research Highlight: 4 March 2004

Further Information:
Nynke van den Broek
Liverpool School of Tropical Medicine
Pembroke Place
Liverpool L3 5QA
UK

Contact the contributor: vdbroek@liverpool.ac.uk

Malawi College of Medicine

Liverpool School of Tropical Medicine (LSTM), UK

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