@article{fdi:010073753,
  title = {{C}oncordance of three alternative gestational age assessments for pregnant women from four {A}frican countries : a secondary analysis of the {MIPPAD} trial},
  author = {{R}ada, {S}. and {G}amper, {J}. and {G}onzalez, {R}. and {M}ombo-{N}goma, {G}. and {O}uedraogo, {S}. and {K}akolwa, {M}. {A}. and {Z}oleko-{M}anego, {R}. and {S}evene, {E}. and {K}abanywanyi, {A}. {M}. and {A}ccrombessi, {M}. and {B}riand, {V}al{\'e}rie and {C}ot, {M}ichel and {V}ala, {A}. and {K}remsner, {P}. {G}. and {A}bdulla, {S}. and {M}assougbodgi, {A}. and {N}hacolo, {A}. and {A}ponte, {J}. {J}. and {M}acete, {E}. and {M}enendez, {C}. and {R}amharter, {M}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {A}t times, ultrasound is not readily available in low resource countries in {A}frica for accurate determination of gestational age, so using alternative methods is pivotal during pregnancy. {T}hese assessments are used to aid the risk analysis for an infant and management strategies for premature delivery, if necessary. {C}urrently, date of last menstrual period, fundal height measurements, and the {N}ew {B}allard {S}core are commonly used in resource-limited settings. {H}owever, concordance of these measures is unknown for sub-{S}aharan {A}frica. {W}e obtained data from an open-label randomized controlled trial, to assess the concordance of these alternative assessment methods. {T}he purpose of our study was to determine the agreement between these alternative methods when used in sub-{S}aharan {A}frican populations. {M}ethods {A} total of 4,390 pregnant women from {B}enin, {G}abon, {M}ozambique and {T}anzania were included in our analysis. {T}he assessment methods compared were: 1) reported last menstrual period, 2) symphysis-fundal height measurement, and 3) the {N}ew {B}allard {S}core. {T}he {B}land-{A}ltman method and intraclass correlation coefficient ({ICC}) were used to test the degree of agreement. {S}urvival range gestational age, used as an inclusion criterion for further analysis, was from 22 to 44 weeks. {F}indings {P}lots showed a lack of agreement between methods and the 95% limits of agreement too wide to be clinically useful. {ICC} = 0.25 indicated poor agreement. {A} post-hoc analysis, restricted from 32 to 42 weeks, was done to check for better agreement in this near-term population. {T}he plots and {ICC} = 0.16 still confirmed poor agreement. {C}onclusion {T}he alternative assessments do not result in comparable outcomes and discrepancies are far beyond the clinically acceptable range. {L}ast menstrual period should not be used as the only estimator of gestational age. {I}n the absence of reliable early ultrasound, symphysis-fundal height measurements may be most useful during pregnancy for fetal risk assessment and the {N}ew {B}allard {S}core after delivery as a confirmation of these estimations and for further neonatal management. {H}owever, promotion of portable ultrasound devices is required for accurate assessment of gestational age in sub-{S}ahara {A}frica.},
  keywords = {{AFRIQUE} {SUBSAHARIENNE} ; {BENIN} ; {GABON} ; {MOZAMBIQUE} ; {TANZANIE}},
  booktitle = {},
  journal = {{PL}o{S} {O}ne},
  volume = {13},
  numero = {8},
  pages = {e0199243 [13 p.]},
  ISSN = {1932-6203},
  year = {2018},
  DOI = {10.1371/journal.pone.0199243},
  URL = {https://www.documentation.ird.fr/hor/fdi:010073753},
}