Abstract
BackgroundFew studies have shown how the move toward institutional delivery in low and middle-income countries (LMIC) impacts stillbirth and newborn mortality.ObjectivesThe study evaluated trends in institutional delivery in research sites in Belagavi and Nagpur India, Guatemala, Kenya, Pakistan, and Zambia from 2010 to 2018 and compared them to changes in the rates of neonatal mortality and stillbirth.MethodsWe analyzed data from a nine-year interval captured in the Global Network (GN) Maternal Newborn Health Registry (MNHR). Mortality rates were estimated from generalized estimating equations controlling for within-cluster correlation. Cluster-level analyses were performed to assess the association between institutional delivery and mortality rates.ResultsFrom 2010 to 2018, a total of 413,377 deliveries in 80 clusters across 6 sites in 5 countries were included in these analyses. An increase in the proportion of institutional deliveries occurred in all sites, with a range in 2018 from 57.7 to 99.8%. In 2010, the stillbirth rates ranged from 19.3 per 1000 births in the Kenyan site to 46.2 per 1000 births in the Pakistani site and by 2018, ranged from 9.7 per 1000 births in the Belagavi, India site to 40.8 per 1000 births in the Pakistani site. The 2010 neonatal mortality rates ranged from 19.0 per 1000 live births in the Kenyan site to 51.3 per 1000 live births in the Pakistani site with the 2018 neonatal mortality rates ranging from 9.2 per 1000 live births in the Zambian site to 50.2 per 1000 live births in the Pakistani site. In multivariate modeling, in some but not all sites, the reductions in stillbirth and neonatal death were significantly associated with an increase in the institutional deliveries.ConclusionsThere was an increase in institutional delivery rates in all sites and a reduction in stillbirth and neonatal mortality rates in some of the GN sites over the past decade. The relationship between institutional delivery and a decrease in mortality was significant in some but not all sites. However, the stillbirth and neonatal mortality rates remain at high levels. Understanding the relationship between institutional delivery and stillbirth and neonatal deaths in resource-limited environments will enable development of targeted interventions for reducing the mortality burden.Trial registrationThe study is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475.
Highlights
Few studies have shown how the move toward institutional delivery in low and middle-income countries (LMIC) impacts stillbirth and newborn mortality
There was an increase in institutional delivery rates in all sites and a reduction in stillbirth and neonatal mortality rates in some of the Global Network (GN) sites over the past decade
The stillbirth and neonatal mortality rates remain at high levels
Summary
Few studies have shown how the move toward institutional delivery in low and middle-income countries (LMIC) impacts stillbirth and newborn mortality. By 2015, the global underfive mortality rate was reduced by 53%, from 91 per 1000 live births to 43 per 1000. The burden of death remains unequally distributed, as both sub-Saharan Africa and south Asia recorded a neonatal mortality rate of 29 per 1000 live births, combining for an estimated 2.1 million neonatal deaths recorded in 2015. The burden of stillbirths is similar to that of neonatal mortality and these regions account for a similar proportion of all stillbirths. Most of both neonatal deaths and stillbirths in these regions occur among term or near-term fetuses/neonates. One recent study from Ghana observed that facility delivery was not associated with decreased risk of maternal or neonatal mortality [13]
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