Association of type of birth attendant and place of delivery on infant mortality in sub-Saharan Africa.

Whitney A Stanley,Sarah B Laditka,Larissa R Brunner Huber,Elizabeth F Racine

doi:10.4314/ahs.v16i1.1

Abstract

To examine the association between type of birth attendant and place of delivery, and infant mortality (IM). This cross-sectional study used self-reported data from the Demographic Health Surveys for women in Ghana, Kenya, and Sierra Leone. Logistic regression estimated odds ratios (ORs) and95% confidence intervals. In Ghana and Sierra Leone, odds of IM were higher for women who delivered at a health facility versus women who delivered at a household residence (OR=3.18, 95% confidence interval, CI: 1.29-7.83, p=0.01 and OR=1.62, 95% CI: 1.15-2.28, p=0.01, respectively). Compared to the use of health professionals, the use of birth attendants for assistance with delivery was not significantly associated with IM for women in Ghana or Sierra Leone (OR=2.17, 95% CI: 0.83-5.69, p=0.12 and OR=1.25, 95% CI: 0.92-1.70, p=0.15, respectively). In Kenya, odds of IM, though nonsignificant, were lower for women who used birth attendants than those who used health professionals to assist with delivery (OR=0.85, 95% CI: 0.51-1.41, p=0.46), and higher with delivery at a health facility versus a household residence (OR=1.29, 95% CI: 0.81-2.03, p=0.28). Women in Ghana and Sierra Leone who delivered at a health facility had statistically significant increased odds of IM. Birth attendant type-IM associations were not statistically significant.Future research should consider culturally-sensitive interventions to improve maternal health and help reduce IM.

Highlights

Infant mortality (IM), the death of a child occurring in the first year of life, accounted for 6.2 million deaths worldwide in 20101
Women who used health personnel to assist with the delivery of their most recent birth had increased odds of IM compared to women who used a traditional birth attendants (TBAs) or relative to assist with the delivery; this result was not statistically significant (OR=1.66, 95% CI: 0.69-3.99, p=0.26; Table 2)
Women who delivered their most recent child at a health facility had increased odds of IM compared to women who delivered at a household residence; this result was statistically significant (OR=2.26, 95% CI: 1.15-4.44, p=0.02)

Summary

Introduction

Infant mortality (IM), the death of a child occurring in the first year of life, accounted for 6.2 million deaths worldwide in 20101. Substantial progress has been made in reducing the IM rate worldwide, sub-Saharan Africa (SSA) has made little progress towards this goal, reducing child mortality at an annual rate of 1%3. Birth is the time of highest risk for infants, where 6 million stillbirths and neonatal deaths occur every year. Stillbirths, or late fetal deaths, account for half of these deaths and are attributable to poor maternal health, poor prevention and treatment of maternal conditions and infections during pregnancy, and inappropriate management of complications during pregnancy and childbirth[4]. Neonatal deaths are attributable to infections, intrapartum conditions, and preterm birth complications while post-neonatal mortality is most often caused by infectious diseases[5]. Failure to reach the Millennium Development Goal of improving birth outcomes by 2035 will result in approximately 116 million deaths, 99 million survivors with disabilities or lost development potential, and millions more at increased risk of non-communicable diseases after low birth weight[5]

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