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Letter From Mtendeli
January 19, 2000

An Evaluation of Poor Pregnancy Outcomes Among Burundian Refugees in Tanzania

Author Affiliations

Author Affiliations: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (Drs Jamieson, Meikle, Hillis, and Duerr), and Epidemic Intelligence Service, Epidemiology Program Office (Dr Jamieson), Centers for Disease Control and Prevention, Atlanta, Ga; and International Rescue Committee, New York, NY (Mss Mtsuko and Mawji).


Section Editor: Annette Flanagin, RN, MA, Managing Senior Editor.

JAMA. 2000;283(3):397-402. doi:10.1001/jama.283.3.397

Context Little is known about pregnancy outcomes among the approximately 11 million refugees worldwide, 25% of whom are women of reproductive age.

Objective To estimate incidence of and determine risk factors for poor pregnancy outcomes and to calculate the contribution of mortality from neonatal and maternal deaths to overall mortality in a refugee camp.

Design Cross-sectional review of records and survey, conducted in February and March 1998.

Setting Mtendeli refugee camp, Tanzania.

Participants For the overall assessment, 664 Burundi women who had a pregnancy outcome during a recent 5-month period (September 1, 1997–January 31, 1998) and their 679 infants; 538 women (81%) completed the survey.

Main Outcome Measures Incidence of fetal death (fetus born ≥500 g or ≥22 weeks' gestation with no signs of life), low birth weight (<2500 g), neonatal death (death <28 days of life), and maternal death (deaths during or within 42 days of pregnancy from any cause related to or aggravated by the pregnancy or its management).

Results The fetal death rate was 45.6 per 1000 births, the neonatal mortality rate was 29.3 per 1000 live births, and 22.4% of all live births were low birth weight. Compared with women without poor pregnancy outcome, those with poor pregnancy outcome were more likely to report prior high socioeconomic status (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4), having a first or second pregnancy (OR, 2.2; 95% CI, 1.4-3.4), and having 3 or more episodes of malaria during pregnancy (OR, 2.0; 95% CI, 1.4-3.1). Neonatal and maternal deaths accounted for 16% of all deaths during the period studied.

Conclusions Poor pregnancy outcomes were common in this refugee setting, and neonatal and maternal deaths, 2 important components of reproductive health–related deaths, contributed substantially to overall mortality.