Adverse birth outcomes related to the length of gestation (preterm birth) and fetal growth (SGA birth) are recognized as 2 of the most significant disorders in maternal-child health on a global scale.
Worldwide, more than 20 million infants are born each year with low birth weight, with more than 95% of these being delivered in developing nations. Of the 4 million newborn deaths annually, nearly 1/3 (27%) are directly attributable to prematurity with another 36% secondary to prematurity-related infections (sepsis, pneumonia, gastrointestinal such as necrotizing entercolitis. Seventy-five percent of the 4 million deaths occur within the first week of life, with the vast majority occurring in the first 48 hours. In poor rural communities, infant mortality related to preterm and low birth rate exceeds that in urban communities, and is not solely attributed to limited access to secondary and tertiary care. The link between periodontal disease and risk of preterm and SGA birth is demonstrated.
Malawi is said to have the highest preterm birth rate in the world. Prior estimates suggest that 18-22% of all infants born in Malawi are born <37 weeks. Starting in 2011, Drs. Kjersti Aagaard and Judy Levison initiated work in Malawi with funding from USAID, the Gates Foundation, the Norwegian MOH, the World Bank, and Grand Challenges Canada. We have partnered with our colleagues in Malawi, and have made a number of important observations. First, our most recent in-depth data collection from the village to the city center suggests a likely clinically meaningful (26 to 34 weeks) preterm birth rate of 26.1%. Second, there is a high rate of poor oral health (periodontal disease and caries) which accompanies this high preterm birth rate. Third, the care providers and the people of Malawi are engaged and invested in understanding ways to prevent preterm birth.
We are currently engaged through our team of community health workers, nurses, and clinicians in efforts aimed at the primary prevention of preterm birth. Read more.
Obstetric fistula is a condition that occurs when the baby is too big to pass through the women’s birth canal and obstructed labor ensues. Without access to a timely cesarean delivery, prolonged obstructed labor usually leads to the death of the baby and eventually formation of a fistula or hole between the bladder and the vagina and/or the rectum and the vagina. This condition only occurs in parts of the world where resources are scarce and women do not have access to high quality obstetrics care. Dr. Wilkinson and his team are working with the Freedom from Fistula Foundation in Lilongwe on ground breaking clinical and research programs on obstetric fistula. They manage a database of over 1000 fistula patients and are looking at complex issues such as prevention of post-repair incontinence, vaginal reconstruction and urinary diversions in fistula patients.
In 2015 the risk of dying in childbirth in Malawi hovered at 634 maternal deaths per 100,000 live births, almost 25 times higher than in the United States. Over the past ten years efforts have been made to reduce Malawi’s mortality rate from maternal hemorrhage but have been largely unsuccessful. Texas Children’s Hospital and Baylor College of Medicine collaborated with the American College of Obstetricians and Gynecologists (ACOG) to implement a one year program that trained health care workers on the prevention, rapid identification and prompt treatment of obstetric hemorrhage. The Alliance for Innovation in Maternal Health (AIM) program has had proven success in the United States, and was adapted to the limited resources in Malawi to determine if the program could be successfully implemented in sub-Saharan Africa. The AIM program combines training in teamwork and communication skills with clinical training in the management of obstetric hemorrhage to improve emergency response times and avert maternal deaths when serious obstetric hemorrhage occurs. After successful implementation of the AIM Malawi program, we found an increased use of procedural interventions, a decreased rate of maternal mortality and an increase in safety scores. The AIM Malawi proved an effective framework for adaptation to improve maternal mortality in a low-resource setting.