Malaria and perinatal mortality in central Sudan.

Hospital and community studies were conducted in Central Sudan during 1989 and 1990 to determine the association between maternal malaria and perinatal mortality. There were 197 cases of stillbirth and 812 controls in the hospital study. In the community study, 36 perinatal and 31 neonatal deaths were compared with 1,505 and 1,495 survivors of the early neonatal and entire neonatal periods, respectively. There was no overall association between perinatal mortality and malaria. However, the risk of stillbirth (particularly macerated stillbirth) was significantly increased among women who reported malaria attacks in the first and second trimesters of pregnancy (odds ratio (OR) = 1.4, 95% confidence interval (CI) 1.1-1.9). A reduced risk was associated with attacks in the third trimester (OR = 0.4, 95% CI 0.2-0.8), but this probably reflects a bias resulting from shorter gestation in cases of stillbirth. Increased risk of neonatal mortality was associated with maternal malaria (OR = 2.1, 95% CI 1.0-4.5). In areas where malaria is prevalent, it is recommended that malaria prevention by personal protection, prophylaxis, and treatment be initiated early in pregnancy.