|Skilled attendant at birth and newborn survival
in Sub–Saharan Africa|
||Agbessi Amouzou, Meng Ziqi, Liliana Carvajal, and John Quinley
||Journal of Global Health, 7(2): 020504; DOI: 10.7189/jogh.07.020504
Multiple African Countries
||Background Recent studies have shown higher neonatal mortality
among births delivered by a skilled attendant at birth (SAB) compared
to those who were not in sub–Saharan African countries. Deaths during
the neonatal period are concentrated in the first 7 days of life, with
about one third of these deaths occurring during the first day of life.
We reassessed the relationship between SAB and neonatal mortality by
distinguishing deaths on the first day of life from those on days 2–27.
Methods We used data on births in the past five years from recent demographic
and health survey (DHS) between 2010 and 2014 in 20
countries in sub–Saharan Africa. The main categorical outcome was 1)
newborns who died within the first day of birth (day 0–1), 2) newborns
who died between days 2–27, and 3) newborns who survived
the neonatal period. We ran generalized linear mixed model with multinomial
distribution and random effect for country on pooled data.
Additionally, we ran a separate model restricted to births with SAB and
assessed the association of receipt of seven antenatal care (ANC) and
two immediate postnatal care interventions on risk of death on days
0–1 and days 2–27. These variables were assessed as proxy of quality
of antenatal and postnatal care.
Results We found no statistically significant difference in risk of death
on first day of life between newborns with SAB compared to those
without. However, after the first day of life, newborns delivered with
SAB were 16% less likely to die within 2–27 days than those without
SAB (OR = 0.84, 95% CI = 0.71–0.99). Among births with skilled attendant,
those who were weighed at birth and those who were initiated
early on breastfeeding were significantly less likely to die on days
0–1 (respectively OR = 0.42 95% CI = 0.29–0.62 and OR = 0.24, 95%
CI 0.18–0.31) or on days 2–27 (OR = 0.60, 95% CI = 0.45–0.81 and
OR = 0.59, 95% CI = 47–0.74, respectively). Newborns whose mothers
received an additional ANC intervention had no improved survival
chances during days 0–1 of life. However, there was significant association
on days 2–27 where newborns whose mothers received an additional
ANC interventions had higher survival chances (OR = 0.95,
95% CI = 0.93–0.98).
Conclusion Findings demonstrate the vulnerability of newborns immediately
after birth, compounded with insufficient quality of care.
Improving the quality of care around the time of birth will significantly
improve survival and therefore accelerate reduction in neonatal mortality
in sub–Saharan African countries. Improved approaches for measuring
skilled attendant at birth are also needed.