Annual distribution of births and deaths outcomes at Harare Maternity Hospital, Zimbabwe.

Abstract

Objectives: To assess socio-demographic and reproductive/obstetric risk factors for stillbirth, preterm births and low birth weight (LBW). To explore the probability of death at birth by antenatal care attendance, and by delivery with a Caesarean section.

Design: Using information available in obstetric records, we conducted a retrospective analysis of data, covering a twelve month period.

Setting: Harare Maternity Hospital, Zimbabwe

Subjects: All deliveries (17,174 births) occurring from October 1997 to September 1998

Main outcome measures: Stillbirth, preterm births and LBW.

Results: The annual stillbirth rate was 57 per 1000, preterm birth 215 per 1000 and LBW was 243 per 1000 total births. Women delivering stillbirths, preterm births and LBW infants were less likely to attend antenatal care (adjusted relative risk [RR] = 2.56 95% confidence intervals [CI]: 2.18 to 3.00, RR= 3.02 95% CI: 2,77 to 3.29, and RR = 2.38; 95% CI: 1.58-3.60), or to be deliveredby Caesarean section (RR= 0.61; 95% CI: 0.49 to 0.76, RR = 0.68; 95% CI: 0.61 to 0.76 and RR = 0.82; 95% CI: 0.75 to 0.90), but more likely to deliver a breech (RR = 3.17; 95% CI: 2.62 to 3.85, RR = 4.16; 95% CI: 3.72 to 4.64 and RR = 5.34; 95% CI: 4.88 to 5.85), respectively. Stillbirths were more likely to be a preterm birth (RR = 6.53; 95% CI: 5.65 to 7.79) or a LBW infant (RR= 6.42; 95% CI: 5.49 to 7.52).

Conclusion: The annual frequency of poor birth outcomes at Harare Maternity Hospital, which is a referral hospital, also catering for a proportion of patients coming from distant health centers and from rural areas, is high. This high prevalence of birth outcomes is associated with lack of prenatal care, and breech delivery. Infants born too early or small have an increased risk of mortality. Early prenatal care, improved obstetric care, accessibility to care, use of emergency care services, and early access to Caesarean section, could save life, and could assist in reducing the frequency of poor birth outcomes in this population.