title: Prenatal care associated with reduction of neonatal mortality in Sub-Saharan Africa: evidence from Demographic and Health Surveys.
abstract: OBJECTIVE
  To determine whether prenatal care by a skilled provider (physician, nurse or midwife) and specific prenatal interventions were associated with decreased neonatal mortality.
  
  
  METHODS
  Mothers' reports in nationally representative surveys (conducted 2003-2009) about their most recent delivery were analyzed. Setting. Sub-Saharan Africa, 17 least developed countries (UN designation).
  
  
  METHODS
  89 655 women aged 15-49 years with a singleton birth within 3 years prior to survey. Methods. Logistic regression models were used to measure the associations between having a skilled prenatal provider, as well as specific interventions, and neonatal mortality.
  
  
  METHODS
  Neonatal mortality, defined as a live birth ending in death at less than one month of age.
  
  
  RESULTS
  Overall, 70.7% of women saw a skilled prenatal provider during their previous pregnancy. Prenatal care from a skilled provider was associated with a decreased neonatal mortality risk compared with no provider [adjusted odds ratio (AOR) 0.70, 95% confidence interval (CI) 0.62-0.80] and compared with an unskilled provider (AOR 0.81, 95% CI 0.68-0.96). The most effective prenatal interventions were weight (AOR 0.71, 95% CI 0.64-0.80) and blood pressure measurements (AOR 0.77, 95% CI 0.69-0.86), and two or more tetanus immunizations (AOR 0.78, 95% CI 0.70-0.86). Four or more prenatal visits compared with none were associated with decreased neonatal mortality risk (AOR 0.68, 95% CI 0.59-0.79).
  
  
  CONCLUSIONS
  Prenatal care provided by skilled providers, at least four prenatal visits, weight and blood pressure assessment, and two or more tetanus immunizations were associated with decreased neonatal mortality in Sub-Saharan African countries.
authors.affiliation: Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania 17033, USA.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: McCurdy
authors.forename: Kristen H
authors.initials: KH
authors.lastname: Kjerulff
authors.forename: Junjia
authors.initials: J
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D050498:Live Birth; D016015:Logistic Models; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014944:World Health Organization; D055815:Young Adult