|Efforts to alter the trajectory of neonatal mortality in Malawi: evaluating relative effects of access to maternal care services and birth history risk factors|
||Bareng AS Nonyane, and Emmanuel Chimbalanga
||Journal of Global Health, 8(2): 1-8; DOI: 10.7189/jogh.08.020419
Health care utilization
||Background The neonatal mortality rate (NMR) in Malawi has remained
stagnant at around 27 per 1000 live births over the last 15 years, despite
an increase in the uptake of targeted health care interventions. We used
the nationally representative 2015/16 Demographic Health Survey data set
to evaluate the effect of two types of maternal exposures, namely, lack of
access to maternal or intra-partum care services and birth history factors,
on the risk of neonatal mortality.
Methods A causal inference approach was used to estimate a population
attributable risk parameter for each exposure, adjusting for co-exposures
and household, maternal and child-specific covariates. The maternal exposures
evaluated were unmet family planning needs, less than 4+ antenatal
care visits, lack of institutional delivery or skilled birth attendance, having
prior neonatal mortality, short (8-24 months) birth interval preceding the
index birth, first pregnancy, and two or more pregnancy outcomes within
the preceding five years of the survey interview.
Results We included 9553 women and their most recent live birth within
3 years of the survey. The sample’s overall neonatal mortality rate was 18.5
per 1000 live births. The adjusted population attributable risk for first pregnancies
was 3.9/1000 (P < 0.001), while non-institutional deliveries and the
shortest preceding birth interval (8-24 months) each had an attributable
risk of 1.3/1000 (Ps = 0.01). Having 2 or more pregnancy outcomes within
the last 5 years had an attributable risk of 3/1000 (P = 0.006). Attending
less than 4 ANC visits had, a relatively large attributable risk (2.1/1,000),
and it was not statistically significant at alpha level 0.05.
Conclusions Our analysis addresses the gap in the literature on evaluating
the effect of these exposures on neonatal mortality in Malawi. It also
helps inform programs and current efforts such as the Every Newborn
Action 2020 Plan. Increasing access to maternal care interventions has an
important role to play in changing the trajectory of neonatal mortality, and
women who are at an increased risk may not be receiving adequate care.
Recent studies indicate an urgent need to assess gaps in service readiness
and quality of care at the antenatal and obstetric care facilities.