Introduction
The fourth Millennium Development Goal (MDG) calls for a reduction in newborn
mortality but newborn mortality is one of the world’s most neglected health problems.
While there has been significant progress in reducing deaths among children under age
five over the past decade, the proportion of under five mortality that occur in the
neonatal period, an estimated 38% in 2000, is increasing. Therefore the Millennium
Development Goal for child survival cannot be met without substantial reductions in
neonatal mortality. It is therefore extremely important to make available the much
needed epidemiological information regarding the time, place and causes of neonatal
deaths which will enable greater attention to policies aimed at reducing levels of
mortality and programme planning.
Objectives
The objective of this study was to investigate the relationship between neonatal
mortality and place of delivery in Rufiji in rural Tanzania. The specific objectives were:
1.to measure and compare the neonatal mortality rates among neonates born in and
outside health facilities, 2. to compare the maternal characteristics of those who deliver
in and outside health facilities, 3. to compare cause-specific neonatal mortality among
neonates born in and outside health facilities and 4.to measure the association between
place of delivery and neonatal mortality.
Methods
Data from the Rufiji Demographic Surveillance System (RDSS), Tanzania, was used for
the analysis. A total of 5124 live births and 166 neonatal deaths were recorded from 1st
January, 2005 to 31st December, 2006.
Place of delivery and place of death were categorized as either health facility or outside
health facility. Neonatal mortality rates were calculated by dividing the number of
neonatal deaths to the total number of live births and multiplied by 1000.
Data on causes of death were collected using verbal autopsies. Cause specific mortality
was determined by using physician coding according to a list of causes of death based
on the 10th revision of International Classification of Diseases. Household
characteristics and assets ownership of the mothers of the neonates were used to
construct a wealth index as proposed by Filmer and Pritchett in 20011. The index was
calculated using Principal Component Analysis (PCA) in Stata version 10 software. A
chi-square (x2) test at 5% significant level was also used to compare the maternal
characteristics by place of delivery and neonatal characteristics and place of delivery.
Univariate and multivariate logistic regression models were also used to assess the
association between neonatal mortality and place of delivery as well as between
neonatal mortality and maternal risk factors, while adjusting for potential confounders.
Results
The highest number of neonatal deaths occurred during the first week of life 111(67%),
the remainder occurred from the second week to the fourth weeks of life 55(33%). The
overall neonatal mortality rate was 32/1000 live births. Neonatal mortality rate was
higher in children born outside heath facilities 43/1000 live births compared with those
born in health facilities 27/1000 live births. The two major causes of deaths in both
health facility deliveries and outside health facility deliveries were birth injury or
asphyxia n=29 (26%) and prematurity/low birth weight n=25 (22%). Mothers who
delivered out-side a health facility were 1.6 times more likely to have experienced
neonatal death [unadjusted OR=1.6, p-value = 0.002, 95% CI 1.2, 2.2] compared to
mothers who delivered in health facility and this was statistically significant. After
adjusting for maternal risk factors, mothers who delivered outside a health facility were
1.7 times more likely to have experienced neonatal death [adjusted OR=1.7, p-value =
0.002, 95% CI 1.2, 2.4] compared to mothers who delivered in a health facility and this
was statistically significant. Maternal household socio-economic status and parity were
the only other factors that were found to be statistically significantly associated with
neonatal mortality in the multivariate analysis. For instance, least poor mothers were
found to be 40% less likely to have experienced neonatal death [adjusted OR = 0.6, pvalue
= 0.046, 95% CI 0.4, 1.1] compared to the poorest mothers and this was
statistically significant. Less poor mothers were also found to be 50% less likely to
experience neonatal mortality [adjusted OR =0.5, p-value = 0.002, 95% CI 0.3, 0.8]
compared to the poorest mothers. Mothers who had parity of three to four (3-4) were
found to be 40% less likely to have experienced neonatal death compared to mothers
who had parity of one to two (1-2). Mothers who had parity of five (5) and above were
also found to be 50% less likely to have experienced neonatal death compared to those
who had parity of one to two (1-2).
Conclusion
Place of delivery has a very important role in neonatal survival in this rural setting. In
order to reduce neonatal mortality, pregnant women should be encouraged and
supported to give birth to their newborns in a health facility while discouraging
deliveries that occurred outside health facility. Infrastructure, such as emergency
transport, to facilitate health facility deliveries requires attention.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/6913 |
| Date | 29 April 2009 |
| Creators | Ajaari, Justice |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
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