Postnatal care by provider type and neonatal death in sub-Saharan Africa: a multilevel analysis

BMC Public Health

Erica Haney²  Paul Brodish¹  Kavita Singh³ 

[1] Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

关键词: Scale-up;    Unskilled providers;    Skilled providers;    Neonatal mortality;    Infant mortality;   

Others  :  1127094
DOI  :  10.1186/1471-2458-14-941

 received in 2013-11-14, accepted in 2014-09-05,  发布年份 2014

【 摘 要 】

Background

Globally postnatal care (PNC) of the newborn is being promoted as a strategy to reduce neonatal deaths, yet few studies have looked at associations between early PNC and neonatal outcomes in sub-Saharan Africa. In this study we look at the associations of PNC provided on day 1 and by day 7 of life by type of provider – skilled (doctor, midwife or nurse or unskilled (traditional birth attendant or community health worker) on neonatal death on days 2 to 7 and days 2 to 28.

Methods

Data from 10 African countries with recent (from 2009 onwards) Demographic and Health Surveys are pooled and used in a multilevel logistic regression analysis to study associations between the PNC variables with the mortality outcomes after controlling for relevant socioeconomic and maternal factors (including antenatal care, skilled delivery, tetanus immunization and ever breastfed).

Results

Findings indicate that PNC, whether provided by a skilled or unskilled provider, is protective against both neonatal death outcomes. Unskilled PNC on day 1was associated with a 32% decrease in the probability of death (compared to no PNC on day 1) during days 2 to 28 after controlling for other factors (OR: 0.68; 95% CI: 0.48, 0.97). Both skilled and unskilled PNC by day 7 were associated with reduced neonatal death during days 2 to 7 (Skilled: OR: 0.40; 95% CI 0.18, 0.88; Unskilled: OR 0.34; 95% CI 0.23, 0.52) and days 2 to 28 (Skilled: OR: 0.51; 95% CI 0.35, 0.75; Unskilled: OR 0.34; 95% CI 0.30, 0.38). There were also significant associations between four or more antenatal care visits and ever breastfed with both outcomes.

Conclusion

PNC is an important strategy to reduce neonatal death. While postnatal care by a skilled provider is a preferred strategy, PNC provided by unskilled providers can also serve as an intermediate implementation approach as countries strive to reach more newborns and save more lives.

【 授权许可】

   
2014 Singh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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