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  • The study protocol was approved by the Ethics Committee of the International Foundation for the Albert Schweitzer Hospital in Lambaréné. Written informed consent was sought from the mother and the guardian accompanying the patient to the hospital. Study design, study site, participants: From May 2005 to September 2006 a cross-sectional study in women delivering at the obstetric departments of local hospitals in the cities of Libreville (Centre Hospitalier de Libreville) and Lambaréné (Hôpital Régional de Lambaréné and Albert Schweitzer Hospital) was conducted in the Central African country Gabon. The region is characterized by perennial high transmission of Plasmodium falciparum malaria [17], [18]. Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine and the use of insecticide treated bednets have been adopted as national policy for the prevention of malaria in pregnancy since 2005. HIV prevalence among pregnant women is estimated to be between 5% and 10%. Libreville – the capital of Gabon –is a typical Central African city whereas Lambaréné – situated approximately 300 km inland – is characterized by a semi-urban environment and is located in a predominantly rural province. Women in labour attending the hospital for delivery were eligible for participation in this survey. Information on maternal age, last date of menstruation, parity, number of antenatal consultations, use of bednets during pregnancy and intake of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria were collected in structured interviews and from mother-child health booklets. A thick blood smear for the diagnosis of malaria was performed as well as maternal haemoglobin measurements (CellDyn 3000, Abbott Laboratories, Santa Clara, CA). All newborns were weighed immediately after birth and birth outcome was evaluated by the midwife in charge of the delivering women. Only women giving birth to live singletons were considered for analysis. Data were captured on paper record forms and reviewed manually before analysis. Outcome variables, definitions and statistical analysis: The aim of the statistical analysis was to evaluate differences in pregnancy characteristics and birth outcomes of adolescent versus adult women. Adolescent status was defined as an age of or below 16 years at delivery. The number of antenatal consultations, use of bednet during pregnancy, intake of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria, maternal haemoglobin at delivery, and peripheral parasitaemia at delivery were specified as main pregnancy characteristics. Continuous and categorical measures of birth weight and gestational age at delivery were defined as main birth outcome variables. Gestational age was calculated based on the last date of menses as reported by the pregnant women. Birth weight below 2500g was defined as low birth weight and deliveries before 37 weeks of gestation were classified as preterm deliveries. Univariable analysis of epidemiological data for the two groups (adolescent and adult pregnant women) was performed by Student's t-test at a two-sided significance level of α = 0.05 for continuous variables and odds ratios for categorical variables. Since parity is a known risk factor for low birth weight an analysis of nulliparous adolescent and adult mothers was performed to correct for differences in parity between the two groups. In addition a separate analysis of differences in birth weight was carried out in the subset of term-newborns in order to account for the strong influence of preterm delivery on the occurrence of low birth weight. Finally, a comparative graphical analysis of birth weight for each completed week of gestation was performed in the subset of term-newborns to appreciate potential differences of growth retardation in adolescent and adult mothers over time. To further analyse the impact of adolescent pregnancy on low birth weight multivariable logistic regression analysis was performed. For this purpose statistical significance of variables associated with low birth weight was computed. Known risk factors for low birth weight and variables showing a statistically significant association with low birth weight in our study population were included as dichotomized variables in the logistic regression analysis. Data are displayed as mean (±standard deviation) or median (±interquartile range). Statistical analysis was performed using JMP (JMP 7.0, SAS Institute Inc., NC, USA).
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