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Title: Improving antenatal care for pregnant adolescents in southern Malawi.
Author: Brabin L, Verhoeff FH, Kazembe P, Brabin BJ, Chimsuku L, Broadhead R.
Journal: Acta Obstet Gynecol Scand; 1998 Apr; 77(4):402-9. PubMed ID: 9598948.
Abstract:
BACKGROUND: This paper considers why antenatal care (ANC) programs for adolescents may need to be improved in areas where a high proportion of first pregnancies are to young girls. DESIGN: Descriptive data on the characteristics of 615 adolescents (aged 10-19 years) who attended for a first antenatal care visit at two rural hospitals in southern Malawi are given. For the 41.5% who came for a supervised delivery, details of their pregnancy care and delivery outcome are provided. The Chi-square test is used for determining significant differences between age and parity groups and logistic regression for an analysis of low birthweight. RESULTS: Fifty-two percent of girls were nulliparous, 24.5% were < or =16 years and 73.3% were illiterate. Prevalence of anemia, malaria and HIV infection was high. Girls who were nulliparous, illiterate, made early antenatal care visits or gave a history of stillbirth or abortion were less likely to attend for delivery. Few primiparae required an assisted vaginal delivery or cesarean section but primiparae had more adverse birth outcomes. Forty percent of primiparae <17 years gave birth to low birthweight babies as did 28.3% of multiparae. In a logistic regression (all adolescents) low birthweight was correlated with literacy (p=0.03) and number of antenatal care visits (p=0.01). CONCLUSIONS: Pregnancy morbidity and adverse birth outcomes were common in spite of antenatal care attendance. This partly reflects poor management of malaria during pregnancy. In areas like Malawi, where childbearing starts early, girls in their first pregnancy need good quality care and careful monitoring if problems are not to be perpetuated to a second pregnancy. Many girls start pregnancy with HIV and schistosomal infections which indicates the need for programs before girls become pregnant. A descriptive study of 615 girls 10-19 years of age attending their first prenatal visit at 2 rural hospitals in southern Malawi revealed a need to improve the quality of antenatal care for this high-risk group. 52% of teens were nulliparous and 73.3% were illiterate. Most nulliparae first attended for antenatal care at 20-23 weeks of gestation, while multiparae tended to report at 24-27 weeks. The mean number of antenatal visits was high: 5.3. 26.6% of pregnant adolescents were HIV-infected, 34.4% had malaria, and 92.6% were anemic. Details of pregnancy outcome were available only for the 251 girls (41.5%) who presented for supervised delivery. Girls who were nulliparous, illiterate, made early antenatal care visits, or gave a history of stillbirth or abortion were less likely to attend for delivery. 40% of primiparae under 17 years of age and 28.3% of multiparae had a low-birth-weight infant. Logistic regression analysis indicated that low birth weight was significantly inversely associated with literacy and number of antenatal care visits. The prevalence of peripheral parasitemia was as high at delivery as at first antenatal visit, indicating that malaria control during pregnancy was not performed or was not effective. These findings indicate that, when adolescent pregnancy begins at an early age, girls in their first and second pregnancies require intensive monitoring. On the other hand, in settings such as Malawi, where many young girls are anemic and HIV-infected when they become pregnant and have infections such as schistosomiasis that cannot be treated during pregnancy, programs must be initiated to improve the health status and literacy of young girls before they reach childbearing age.

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