Correlates of poor perinatal outcomes in non-hospital births in the context of weak health system: the Nigerian experience.
BMC Pregnancy Childbirth
; 14: 341, 2014 Sep 30.
Article
in En
| MEDLINE
| ID: mdl-25271134
ABSTRACT
BACKGROUND:
Nigeria's high perinatal mortality rate (PNMR) could be most effectively reduced by targeting factors that are associated with increased newborn deaths. Low access to skilled birth attendants (SBAs) and weak health system are recognized factors associated with high PNMR but other socio-demographic and reproductive factors could have significant influences as well. Identification of the major factors associated with high PNMR would be required in designing interventions to improve perinatal outcomes.METHODS:
For this cross-sectional study, data from the Nigeria Demographic and Health Survey 2008 were used to estimate the PNMR of non-hospital births in identified socio-demographic and reproductive situations that are known to influence PNMR. The estimated PNMR were compared using logistic regression analysis.RESULTS:
The PNMR was 36 per 1000 live births. North central region had the lowest PNMR while the south east region had the highest rate (odds ratio 1.59; 95% CI 1.03, 2.45). Other correlates of high PNMR were belonging to the poorest wealth quintile (odds ratio 1.87; 95% CI 1.30, 2.70), maternal age group 15-19 years (odds ratio 1.59; 95% CI 1.05, 2.22), multiple birth (odds ratio 3.12; 95% CI 2.11, 4.59), history of previous perinatal death (odds ratio 3.31; 95% CI 2.73, 4.02), birth interval shorter than 18 months (odds ratio 1.65; 95% CI 1.26, 2.17) and having a small birth size (odds ratio 2.56; 95% CI 1.79, 3.69). Birth attendant, place of birth, parity, maternal education and rural/urban residence had no association with PNMR.CONCLUSIONS:
Reproductive factors that require midwifery skills were found to contribute most to PNMR. We recommend general strengthening of the health system, recruitment of SBAs and retraining of available birth attendants with emphasis on identification and referral of complicated cases. Family planning should be a core MCH activity to address the issues of teenage pregnancy and short pregnancy intervals.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pregnancy Outcome
/
Maternal Mortality
/
Delivery, Obstetric
/
Perinatal Mortality
/
Home Childbirth
/
Medically Underserved Area
Type of study:
Etiology_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Adult
/
Female
/
Humans
/
Newborn
/
Pregnancy
Country/Region as subject:
Africa
Language:
En
Journal:
BMC Pregnancy Childbirth
Journal subject:
OBSTETRICIA
Year:
2014
Type:
Article
Affiliation country:
Nigeria