Background
The concept of continuum of care has recently been highlighted as a core principle of
maternal, newborn and child health initiatives, and as a means to save lives. However,
evidence has consistently revealed that access to care during and post delivery (intra and
postpartum) remains a challenge in the continuum of care framework. In places where skilled
delivery assistance is exclusively available in health facilities, access to health facilities is
critical to the survival of the mother and her newborn. However, little is known about the
association of place of delivery and survival of neonates. This paper uses longitudinal data
generated in a Health and Demographic Surveillance System in rural Southern Tanzania to
assess associations of neonatal mortality and place of delivery.
Methods
Three cohorts of singleton births (born 2005, 2006 and 2007) were each followed up from
birth to 28 days. Place of birth was classified as either “health facility” or “community”.
Neonatal mortality rates were produced for each year and by place of birth. Poisson
regression was used to estimate crude relative risks of neonatal death by place of birth.
Adjusted ratios were derived by controlling for maternal age, birth order, maternal schooling,
sex of the child and wealth status of the maternal household.
Results
Neonatal mortality for health facility singleton deliveries in 2005 was 32.3 per 1000 live
births while for those born in the community it was 29.7 per 1000 live births. In 2006,
neonatal mortality rates were 28.9 and 26.9 per 1,000 live births for deliveries in health
facilities and in the community respectively. In 2007 neonatal mortality rates were 33.2 and
27.0 per 1,000 live births for those born in health facilities and in the community
respectively. Neonates born in a health facility had similar chances of dying as those born in
the community in all the three years of study. Adjusted relative risks (ARR) for neonatal
death born in a health facility in 2005, 2006 and 2007 were 0.99 (95%CI: 0.58 - 1.70), 0.98
(95%CI: 0.62 - 1.54) and 1.18 (95% CI: 0.76 - 1.85) respectively.
Conclusions
We found no evidence to suggest that delivery in health facilities was associated with better
survival chances of the neonates.