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Fetal size in a rural melanesian population with minimal risk factors for growth restriction: an observational ultrasound study from Papua New Guinea.

ABSTRACT: We conducted a prospective longitudinal study of fetal size in rural Papua New Guinea (PNG) involving 439 ultrasound-dated singleton pregnancies with no obvious risk factors for growth restriction. Sonographically estimated fetal weights (EFWs; N = 788) and birth weights (N = 376) were included in a second-order polynomial regression model (optimal fit) to generate fetal weight centiles. Means for specific fetal biometric measurements were also estimated. Fetal weight centiles from a healthy PNG cohort were consistently lower than those derived from Caucasian and Congolese populations, which overestimated the proportion of fetuses measuring small for gestational age (SGA; < 10th centile). Tanzanian and global reference centiles (Caucasian weight reference adapted to our PNG cohort) were more similar to those observed in our cohort, but the global reference underestimated SGA. Individual biometric measurements did not differ significantly from other cohorts. In rural PNG, a locally derived nomogram may be most appropriate for detection of SGA fetuses.

SUBMITTER: Unger HW

PROVIDER: S-EPMC4347376 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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Fetal size in a rural melanesian population with minimal risk factors for growth restriction: an observational ultrasound study from Papua New Guinea.

Unger Holger W HW Karl Stephan S Wangnapi Regina A RA Siba Peter P Mola Glen G Walker Jane J Mueller Ivo I Ome Maria M Rogerson Stephen J SJ

The American journal of tropical medicine and hygiene 20141110 1

We conducted a prospective longitudinal study of fetal size in rural Papua New Guinea (PNG) involving 439 ultrasound-dated singleton pregnancies with no obvious risk factors for growth restriction. Sonographically estimated fetal weights (EFWs; N = 788) and birth weights (N = 376) were included in a second-order polynomial regression model (optimal fit) to generate fetal weight centiles. Means for specific fetal biometric measurements were also estimated. Fetal weight centiles from a healthy PNG ...[more]

PMID: 25385863

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Project description:Fetal growth restriction (FGR) is associated with increased infant mortality rates and ill-health in adulthood. Evaluation of fetal growth requires ultrasound. As a result, ultrasound-assisted evaluations of causes of FGR in malaria-endemic developing countries are rare. We aimed to determine factors associated with indicators of abnormal fetal growth in rural lowland Papua New Guinea (PNG).Weights and growth of 671 ultrasound-dated singleton pregnancies (<25 gestational weeks) were prospectively monitored using estimated fetal weights and birthweights. Maternal nutritional status and haemoglobin levels were assessed at enrolment, and participants were screened for malaria on several occasions. FGR was suspected upon detection of an estimated fetal weight or birthweight <10(th) centile (small-for-gestational age) and/or low fetal weight gain, defined as a change in weight z-score in the first quartile. Factors associated with fetal weight and fetal weight gain were additionally assessed by evaluating differences in weight z-scores and change in weight z-scores. Log-binomial and linear mixed effect models were used to determine factors associated with indicators of FGR.SGA and low weight gain were detected in 48.3% and 37.0% of pregnancies, respectively. Of participants, 13.8%, 21.2%, and 22.8% had a low mid-upper arm circumference (MUAC, <22 cms), short stature (<150 cms) and anaemia (haemoglobin <90 g/L) at first antenatal visit. 24.0% (161/671) of women had at least one malaria infection detected in peripheral blood. A low MUAC (adjusted risk ratio [aRR] 1.51, 95% CI 1.29, 1.76, P?<?0.001), short stature (aRR 1.27, 95% CI 1.04, 1.55, P?=?0.009), and anaemia (aRR 1.27, 95% CI 1.06, 1.51, P?=?0.009) were associated with SGA, and a low body mass index was associated with low fetal weight gain (aRR 2.10, 95% CI 1.62, 2.71, P?<?0.001). Additionally, recent receipt of intermittent preventive treatment in pregnancy was associated with increased weight z-scores, and anaemia with reduced change in weight z-scores. Malaria infection was associated with SGA on crude but not adjusted analyses (aRR 1.13, 95% CI 0.95, 1.34, P?=?0.172).Macronutrient undernutrition and anaemia increased the risk of FGR. Antenatal nutritional interventions and malaria prevention could improve fetal growth in PNG.

Project description:BackgroundTo control and eventually eliminate vivax malaria, radical treatment with primaquine (PQ) is essential after completion of blood-stage treatment. Although in many malaria-endemic countries, village health volunteers (VHVs) are engaged in diagnostic treatment of malaria in remote communities, they principally provide blood-stage treatment. In such a situation, access to PQ following blood-stage treatment can be a barrier to complete treatment. However, studies on access to PQ treatment have been scarce and limited in health facility-based settings. This study aimed to identify factors associated with access to PQ treatment in rural Papua New Guinea (PNG) from the community case management perspective.MethodsA community-based, cross-sectional survey was conducted to collect sociodemographic information on children under 15 years of age, their households, and their caretakers in East Sepik Province, PNG. Data collection lasted from February to March, 2015. Information on the diagnoses of potential non-falciparum malaria and prescription of PQ in preceding year (January to December 2014) were obtained from child health-record books. Then, multilevel logistic regression model was used to determine the factors associated with formal health facility visits for PQ treatment among children with potential non-falciparum malaria.ResultsOf 420 episodes diagnosed as potential non-falciparum malaria, 46 (11%) were immediately given PQ. The rest were instructed to visit formal health facilities (HFs) for PQ, and the patients obtained PQ during the second visit to HFs was 44%. Consequently, the overall proportion of PQ prescription was 50%. Logistic regression analysis suggested that among the patients who were instructed to visit HFs for PQ treatment, the initial visit to VHV and higher transportation costs to HF were inversely associated with PQ prescription during the second visit to an HF.ConclusionsFew children received PQ treatment during the second visit to HFs following diagnosis of potential non-falciparum malaria. These findings suggest a need to establish a policy to reduce structural and economic barriers and improve rural inhabitant access to PQ treatment.

Project description:BackgroundKnowledge of accurate gestational age is required for comprehensive pregnancy care and is an essential component of research evaluating causes of preterm birth. In industrialised countries gestational age is determined with the help of fetal biometry in early pregnancy. Lack of ultrasound and late presentation to antenatal clinic limits this practice in low-resource settings. Instead, clinical estimators of gestational age are used, but their accuracy remains a matter of debate.MethodsIn a cohort of 688 singleton pregnancies from rural Papua New Guinea, delivery gestational age was calculated from Ballard score, last menstrual period, symphysis-pubis fundal height at first visit and quickening as well as mid- and late pregnancy fetal biometry. Published models using sequential fundal height measurements and corrected last menstrual period to estimate gestational age were also tested. Novel linear models that combined clinical measurements for gestational age estimation were developed. Predictions were compared with the reference early pregnancy ultrasound (<25 gestational weeks) using correlation, regression and Bland-Altman analyses and ranked for their capability to predict preterm birth using the harmonic mean of recall and precision (F-measure).ResultsAverage bias between reference ultrasound and clinical methods ranged from 0-11 days (95% confidence levels: 14-42 days). Preterm birth was best predicted by mid-pregnancy ultrasound (F-measure: 0.72), and neuromuscular Ballard score provided the least reliable preterm birth prediction (F-measure: 0.17). The best clinical methods to predict gestational age and preterm birth were last menstrual period and fundal height (F-measures 0.35). A linear model combining both measures improved prediction of preterm birth (F-measure: 0.58).ConclusionsEstimation of gestational age without ultrasound is prone to significant error. In the absence of ultrasound facilities, last menstrual period and fundal height are among the more reliable clinical measures. This study underlines the importance of strengthening ultrasound facilities and developing novel ways to estimate gestational age.

Dataset Information

Fetal size in a rural melanesian population with minimal risk factors for growth restriction: an observational ultrasound study from Papua New Guinea.

Publications

Fetal size in a rural melanesian population with minimal risk factors for growth restriction: an observational ultrasound study from Papua New Guinea.

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