SPATIAL MODELLING OF PERINATAL MORTALITY IN MCHINJI, MALAWI

Abstract

The main aim of the study was to quantify small-scale geographical variations in perinatal mortality and estimate risk factors associated with perinatal mortality in Mchinji, Malawi. The study modelled infant mortality in the first 7 days of life, hence logistic regression approach was appropriate to investigate risk factors for the mortality. The Bayesian STAR modelling approach was applied to account for the influence of both individual and contextual factors on perinatal mortality. Socio-demographic and delivery factors were considered in the study. Modelling and inference used the fully and empirical Bayesian approaches. The methodology was applied to analyze the prevalence and risk factors of perinatal mortality, using data from 2005 to 2010 collected by Mai Mwana project in Mchinji district in Malawi. The number of subjects considered for analysis is 7, 627, representing 92 percent of the total number of subjects. The factors that were associated with perinatal mortality are as follows: previous pregnancy compared to none (OR = 0.70, CI: 0.51, 0.99); first ANC visit in first trimester with at least4 visits (OR = 0.29, CI: 0.10, 0.84), second trimester with less than 4 visits (OR = 0.28,CI: 0.10, 0.79), second trimester with at least 4 visits (OR = 0.22, CI: 0.08, 0.61), third trimester with less than 4 visits (OR = 0.18, CI: 0.06, 0.55) and third trimester with at least4 visits (OR = 0.05, CI: 0.01, 0.23) compared to none; blood sample test compared to none(OR = 1.92, CI: 1.44, 2.62); syphilis test compared to none (OR = 0.60, CI: 0.41, 0.85);abdominal examination compared to none (OR = 0.32, CI: 0.21, 0.49); pregnancy danger signs advice compared to none (OR = 0.28, CI: 0.21, 0.37); skilled birth attendant compared to non-skilled birth attendant (OR = 0.73, CI: 0.58, 0.94); normal labour duration comparedv to prolonged labour duration (OR = 0.37, CI: 0.28, 0.49); gestation period of at least 9 months compared to that of 7 to 8 months (OR = 0.11, CI: 0.08, 0.14); and normal delivery compared to other modes (OR = 0.18, CI: 0.12, 0.28). Perinatals from mothers with the age range of 16 to 40 years had reduced prevalence of dying whereas those from mothers with the age of less than 16 years and greater than 40 years were associated with higher prevalence of dying. After accounting for all significant covariates, high perinatal mortality (OR ≥ 1) was observed in zones located on the eastern part whereas low perinatal mortality was observed in zones found on the western part of the district. The findings of the study have shown that perinatal mortality was high on the eastern part and low on the western part of Mchinji district. In the study area, the eastern part should begiven first priority in the provision of targeted interventions. Targeting health interventions to poorer or higher risk areas and ensuring universal coverage are promising approaches for promoting equity and reducing perinatal mortality