Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial

BMC Pregnancy and Childbirth

Research

Christie Noble¹  James A. Church²  Andrew J. Prendergast³  Ciaran Mooney⁴  Naume V. Tavengwa⁵  Robert Ntozini⁵  Florence D. Majo⁵  Rachel Makasi⁵  Jean H. Humphrey⁶ 

[1] Blizard Institute, Queen Mary University of London, London, UK;Blizard Institute, Queen Mary University of London, London, UK;Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe;Blizard Institute, Queen Mary University of London, London, UK;Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe;Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Northern Ireland Medical and Dental Training Agency (NIMDTA), Beechill House, 42 Beechill Rd, BT8 7RL, Belfast, UK;Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe;Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe;Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;

关键词: Global health;    Neonatal health;    Neonatal mortality;    Home delivery;    Institutional delivery;    Birth outcomes;    Maternal health;   

DOI  :  10.1186/s12884-022-05282-x

 received in 2022-02-23, accepted in 2022-12-05,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundDespite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions.MethodsThis study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes.ResultsAmong 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference.ConclusionsPreterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe.Trial registrationThe trial is registered with ClinicalTrials.gov, number NCT01824940.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 5