In:
PLOS Medicine, Public Library of Science (PLoS), Vol. 18, No. 12 ( 2021-12-1), p. e1003843-
Abstract:
Widespread increases in facility delivery have not substantially reduced neonatal mortality in sub-Saharan Africa and South Asia over the past 2 decades. This may be due to poor quality care available in widely used primary care clinics. In this study, we examine the association between hospital delivery and neonatal mortality. Methods and findings We used an ecological study design to assess cross-sectional associations between the share of hospital delivery and neonatal mortality across country regions. Data were from the Demographic and Health Surveys from 2009 to 2018, covering 682,239 births across all regions. We assess the association between the share of facility births in a region that occurred in hospitals (versus lower-level clinics) and early (0 to 7 days) neonatal mortality per 1,000 births, controlling for potential confounders including the share of facility births, small at birth, maternal age, maternal education, urbanicity, antenatal care visits, income, region, and survey year. We examined changes in this association in different contexts of country income, global region, and urbanicity using interaction models. Across the 1,143 regions from 37 countries in sub-Saharan Africa and South Asia, 42%, 29%, and 28% of births took place in a hospital, clinic, and at home, respectively. A 10-percentage point higher share of facility deliveries occurring in hospitals was associated with 1.2 per 1,000 fewer deaths ( p -value 〈 0.01; 95% CI: 0.82 to 1.60), relative to mean mortality of 22. Associations were strongest in South Asian countries, middle-income countries, and urban regions. The study’s limitations include the inability to control for all confounding factors given the ecological and cross-sectional design and potential misclassification of facility levels in our data. Conclusions Regions with more hospital deliveries than clinic deliveries have reduced neonatal mortality. Increasing delivery in hospitals while improving quality across the health system may help to reduce high neonatal mortality.
Type of Medium:
Online Resource
ISSN:
1549-1676
DOI:
10.1371/journal.pmed.1003843
DOI:
10.1371/journal.pmed.1003843.g001
DOI:
10.1371/journal.pmed.1003843.t001
DOI:
10.1371/journal.pmed.1003843.t002
DOI:
10.1371/journal.pmed.1003843.t003
DOI:
10.1371/journal.pmed.1003843.t004
DOI:
10.1371/journal.pmed.1003843.s001
DOI:
10.1371/journal.pmed.1003843.s002
DOI:
10.1371/journal.pmed.1003843.s003
DOI:
10.1371/journal.pmed.1003843.s004
DOI:
10.1371/journal.pmed.1003843.s005
DOI:
10.1371/journal.pmed.1003843.s006
DOI:
10.1371/journal.pmed.1003843.s007
DOI:
10.1371/journal.pmed.1003843.s008
DOI:
10.1371/journal.pmed.1003843.s009
DOI:
10.1371/journal.pmed.1003843.s010
DOI:
10.1371/journal.pmed.1003843.s011
DOI:
10.1371/journal.pmed.1003843.s012
DOI:
10.1371/journal.pmed.1003843.s013
DOI:
10.1371/journal.pmed.1003843.s014
DOI:
10.1371/journal.pmed.1003843.s015
DOI:
10.1371/journal.pmed.1003843.s016
DOI:
10.1371/journal.pmed.1003843.s017
DOI:
10.1371/journal.pmed.1003843.r001
DOI:
10.1371/journal.pmed.1003843.r002
DOI:
10.1371/journal.pmed.1003843.r003
DOI:
10.1371/journal.pmed.1003843.r004
DOI:
10.1371/journal.pmed.1003843.r005
DOI:
10.1371/journal.pmed.1003843.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2021
detail.hit.zdb_id:
2164823-2
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