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- - - DISTANCE TO CARE, FACILITY DELIVERY AND EARLY NEONATAL MORTALITY IN MALAWI AND ZAMBIA

Wednesday, 17th of April 2013

 

• DISTANCE TO CARE, FACILITY DELIVERY AND EARLY NEONATAL MORTALITY IN MALAWI AND ZAMBIA

Terhi J. Lohela,

Affiliations: Department of Anaesthesiology and Intensive Care Medicine, Jorvi Hospital, Helsinki University Hospital, Espoo, Finland, University of Heidelberg, Institute of Public Health, Heidelberg, Germany

Oona M. R. Campbell,

Affiliation: London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom

Sabine Gabrysch mail

* E-mail: sabine.gabrysch@uni-heidelberg.de

Affiliation: University of Heidelberg, Institute of Public Health, Heidelberg, Germany

Abstract below; full text, with tables, is at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0052110

Background

Globally, approximately 3 million babies die annually within their first month. Access to adequate care at birth is needed to reduce newborn as well as maternal deaths. We explore the influence of distance to delivery care and of level of care on early neonatal mortality in rural Zambia and Malawi, the influence of distance (and level of care) on facility delivery, and the influence of facility delivery on early neonatal mortality.

Methods and Findings

National Health Facility Censuses were used to classify the level of obstetric care for 1131 Zambian and 446 Malawian delivery facilities. Straight-line distances to facilities were calculated for 3771 newborns in the 2007 Zambia DHS and 8842 newborns in the 2004 Malawi DHS. There was no association between distance to care and early neonatal mortality in Malawi (OR 0.97, 95%CI 0.58–1.60), while in Zambia, further distance (per 10 km) was associated with lower mortality (OR 0.55, 95%CI 0.35–0.87). The level of care provided in the closest facility showed no association with early neonatal mortality in either Malawi (OR 1.02, 95%CI 0.90–1.16) or Zambia (OR 1.02, 95%CI 0.82–1.26). In both countries, distance to care was strongly associated with facility use for delivery (Malawi: OR 0.35 per 10km, 95%CI 0.26–0.46). All results are adjusted for available confounders. Early neonatal mortality did not differ by frequency of facility delivery in the community.

Conclusions

While better geographic access and higher level of care were associated with more frequent facility delivery, there was no association with lower early neonatal mortality. This could be due to low quality of care for newborns at health facilities, but differential underreporting of early neonatal deaths in the DHS is an alternative explanation. Improved data sources are needed to monitor progress in the provision of obstetric and newborn care and its impact on mortality.

Citation: Lohela TJ, Campbell OMR, Gabrysch S (2012) Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia. PLoS ONE 7(12): e52110. doi:10.1371/journal.pone.0052110

Editor: C. Mary Schooling, CUNY, United States of America

Received: April 17, 2012; Accepted: November 15, 2012; Published: December 27, 2012

Copyright: © 2012 Lohela et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: SG is paid by the University of Heidelberg through a Margarete von Wrangell Fellowship supported by the European Social Fund and by the Ministry of Science, Research and the Arts Baden-Württemberg, omega replica and has received salary support from the Medical Faculty’s Rahel Goitein-Straus Programme. TJL did this work as part of her MSc thesis and was subsequently employed by SG through Heidelberg University funds. OMRC is supported by the London School of Hygiene and Tropical Medicine. No funders had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.