Type of delivery attendant, place of delivery and risk of early neonatal mortality: analyses of the 1994-2007 Indonesia Demographic and Health Surveys

ObjectivesTo examine how maternal and sociodemographic factors determine continued care-seeking behaviour from pregnancy to postnatal period in Kenya and Uganda and to determine associated neonatal survival outcomes.DesignA population-based analysis of cross-sectional data using multinomial and binary logistic regressions.SettingCountrywide, Kenya and Uganda.ParticipantsMost recent live births of 24 502 mothers within 1–59 months prior to the 2014–2016 Demographic and Health Surveys.OutcomesCare-seeking continuum and neonatal mortality.ResultsOverall, 57% of the mothers had four or more antenatal care (ANC) contacts, of which 73% and 41% had facility births and postnatal care (PNC), respectively. Maternal/paternal education versus no education was associated with continued care seeking in majority of care-seeking classes; relative risk ratios (RRRs) ranged from 2.1 to 8.0 (95% CI 1.1 to 16.3). Similarly, exposure to mass media was generally associated with continued care seekin; RRRs ranged from 1.8 to 3.2 (95% CI 1.2 to 5.4). Care-seeking tendency reduced if a husband made major maternal care-seeking decisions. Transportation problems and living in rural versus urban were largely associated with lower continued care use; RRR ranged from 0.4 to 0.7 (95% CI 0.3 to 0.9). The two lowest care-seeking categories with no ANC and no PNC indicated the highest odds for neonatal mortality (adjusted OR 4.2, 95% CI 1.6 to 10.9). 23% neonatal deaths were attributable to inadequate maternal care attendance.ConclusionStrategies such as mobile health specifically for promoting continued maternal care use up to postnatal could be integrated in the existing structures. Another strategy would be to develop and employ a brief standard questionnaire to determine a mother’s continued care-seeking level during the first ANC visit and to use the information to close the care-seeking gaps. Strengthening the community health workers system to be an integral part of promoting continued care seeking could enhance care seeking as a stand-alone strategy or as a component of aforementioned suggested strategies.

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Bayesian multilevel model application on determinants of perinatal mortality in Ethiopia using 2011 and 2016 EDHS data

Ethiopian Journal of Science and Technology ◽

10.4314/ejst.v14i1.3 ◽

2021 ◽

Vol 14 (1) ◽

pp. 39-55

Author(s):

Berhanu Bekele Debelu ◽

Denekew Bitew Belay ◽

Nigatu Degu Terye

Keyword(s):

Perinatal Mortality ◽

Health Surveys ◽

Multilevel Model ◽

Wealth Index ◽

Place Of Delivery ◽

Determinant Factors ◽

Early Neonatal Mortality ◽

Great Burden ◽

Index Family ◽

Child Age

Perinatal mortality is the death of a fetus after the age of viability until the 7th day of life. Perinatal mortality is estimated by the addition of stillbirths plus the early neonatal mortality, which represents deaths occurring during the first 7 days after delivery. Perinatal mortality remains a great burden in Ethiopia. The purpose of this study was to assess and compare the demographic and socio-economic determinant factors of perinatal mortality in Ethiopia using the 2011 and 2016 Ethiopian Demographic Health Surveys (EDHS). For data analysis, the Bayesian multilevel Model was used in this study. The study revealed that there is a regional variation in perinatal mortality and this variation was high in 2011 EDHS than in 2016 EDHS data. Factors like sex of the child, age of mother, wealth index, family size, birth order, source of drinking water, place of residence, place of delivery, and child twin were found to be the determinant factors of perinatal mortality in both 2011 and 2016 EDHS. In this study, we found that perinatal mortality variation across regions has decreased from 2011 to 2016 surveys which shows the promising progress of health intervention in the country.

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Can an Enhanced Iron-Folic Acid Supplementation Program Reduce Neonatal Mortality? Analysis of Pooled Nepal Demographic and Health Surveys

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_028 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 823-823

Author(s):

Michael Dibley ◽

Yasir Nisar ◽

Shahreen Raihana ◽

Patrick Kelly

Keyword(s):

Folic Acid ◽

Neonatal Mortality ◽

Health Surveys ◽

Neonatal Period ◽

Cox Proportional Hazards ◽

Cluster Sampling ◽

Demographic And Health Surveys ◽

Risk Of Death ◽

Iron Folic Acid ◽

The Impact

Abstract Objectives Nepal has improved the national antenatal iron-folic acid (IFA) supplementation program through the ‘Iron Intensification Project’ (IIP) between 2003 and 2011. This study assesses the effect of this enhanced IFA supplementation on the risk of neonatal mortality over a 20-year period in Nepal. Methods For the impact evaluation, we used a non-randomized stepped wedge study design, using survival information from 16,159 most recent live births from the pooled data from four Nepal Demographic and Health Surveys (2001, 2006, 2011 and 2016). The primary outcomes were neonatal mortality indicators. The use of any antenatal care (ANC) services and antenatal IFA supplements were the secondary outcomes. The main exposure variable was the status of the IIP in the district of the mother's residence at the time of birth. Analyses used multivariate Cox proportional hazards regression, adjusted for up to 22 potential confounders, and the cluster sampling design. Results After the IIP, the risk of death on the first day of life was significantly reduced by 35% [adjusted hazard ratio (aHR) 0.65, 95% confidence interval (95% CI) 0.43 to 0.97], in the early neonatal period by 32% (aHR 0.68, 95% CI 0.48 to 0.96), and in the neonatal period by 29% (aHR 0.71, 95% CI 0.51 to 0.99). After the IIP, there was a significant reduction of the odds of non-use of ANC services and IFA supplements. Conclusions An enhanced IFA supplementation program was associated with a significant reduction in neonatal mortality in Nepal. Funding Sources Ph.D. scholarship from the University of Sydney.

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Is newborn survival influenced by place of delivery? A comparison of home, public sector and private sector deliveries in India

Journal of Biosocial Science ◽

10.1017/s0021932021000080 ◽

2021 ◽

pp. 1-15

Author(s):

Asmita Verma ◽

John Cleland

Keyword(s):

Public Sector ◽

Private Sector ◽

Neonatal Mortality ◽

Neonatal Period ◽

Uttar Pradesh ◽

Health Facilities ◽

Place Of Delivery ◽

Early Neonatal Mortality ◽

Early Neonatal Period ◽

Home Deliveries

Abstract In 2005 and again in 2011, the Government of India launched schemes to encourage institutional delivery among poor women, with the aim of improving maternal and newborn health outcomes. Partly as a result of these initiatives, the proportion of children born in a health facility rose steeply from 42% in 2000–2005 to 81% a decade later. In this context, the objective of this paper was to determine the association between place of delivery (public sector, private sector, home) and early neonatal mortality, defined as death in the first 7 days after birth. The focus was on early neonatal mortality because over half of all under-five deaths occur in his period and because the protective effect of an institutional place of birth should be strongest in those few early days. Both bivariate methods and multivariate logistic regression analysis were applied to data from the fourth round of the National Family Health Survey conducted in 2015–16. For the country as a whole, it was found that the adjusted odds of death in the early neonatal period were lower for deliveries in public health facilities than for home deliveries (OR 0.833 p<0.01), but no significant difference was found between deliveries in private health facilities and at home. Adjusted odds of death were higher for deliveries in private than public sector facilities (OR 1.41 p<0.01). On further investigation, for the poor in Bihar and Uttar Pradesh, it was found that the risks of dying in the early neonatal period were even higher for babies delivered in private health facilities than for home deliveries with adjusted odds of over 2.0. These results raise serious questions about quality of care in the private sector in India. In the context of increased emphasis on public–private partnerships in health services provision in the country, it becomes imperative to enforce better inspection, licensing and quality control of private sector facilities, especially in the states of Bihar and Uttar Pradesh.

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Rising trends and persisting inequalities in cesarean section rates in Nepal: evidence from demographic and health surveys 2006-2016

10.21203/rs.3.rs-15560/v1 ◽

2020 ◽

Author(s):

Kiran Acharya ◽

Yuba Raj Paudel ◽

Chandra Mani Dhungana

Keyword(s):

Higher Education ◽

Cesarean Section ◽

Maternal Mortality ◽

Health Surveys ◽

Maternal Mortality Ratio ◽

Mountain Region ◽

Income Quintile ◽

Maternal And Newborn Health ◽

Demographic And Health Surveys ◽

Place Of Delivery

Abstract BackgroundSustainable development goals require member countries to reduce maternal mortality below 70 per 100,000 live births by 2030. Addressing inequalities in access to emergency obstetric care is crucial for reducing the maternal mortality ratio. This study was done to examine the time trends and socio-demographic inequalities in the utilization of cesarean section (CS) in Nepal during 2006-2016.MethodsWe used data from the Nepal Demographic and Health Surveys (NDHS) conducted during 2006-2016. Women who had a live birth in the last five years of the survey (most recent birth if there were two or more child birth) were the unit of analysis for this study. Absolute and relative inequalities in CS rates by different characteristics were measured in-terms of rate difference and rate ratios, respectively. Bivariate analyses and multivariate logistic regression models were used to assess the rate of cesarean sections by background socio-demographic characteristics of women. ResultsAge and parity adjusted CS rates were found to have increased almost three-fold (from 3.2%,95% CI:2.1-4.3 in 2006 to 10.5%;95% CI:8.9-11.9 in 2016) over the decade. In 2016, women from Mountain region (3.0%;95% CI:1.1-4.9), those from poorest wealth quintile (2.4%,95% CI:(1.2-3.7) and those living in province 6(2.4%,95% CI:1.3-3.5) had CS rate below 5%. Whereas, women from the richest income quintile (25.1%,95% CI :20.2-30.1), with higher education (21.2%,95% CI:14.7-27.8) and those delivering in private facilities (37.1%,95% CI:30.5-43.7) had CS rate above 15%. The absolute inequality in CS rate increased for maternal educational status, income quintiles, ecological region, province and place of delivery over the period. Relative inequality increased for provinces and place of delivery. Women from the richest income quintile (OR-3.3,95% CI: 1.6-7.0) and those delivered in private/NGO-run facilities (OR-3.6;95% CI:2.7-4.9) were more than three times more likely to deliver by CS compared to women from the poorest income quintile and those delivering in public facilities, respectively. ConclusionTo improve maternal and newborn health, strategies need to be revised to address the underuse of C-section in poor, mountain region and province 6. Simultaneously, policies and guidelines are needed to reduce overuse in rich women, women with higher education and those delivered in private facilities.

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