title: Correlates of poor perinatal outcomes in non-hospital births in the context of weak health system: the Nigerian experience.
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.
authors.affiliation: Department of Obstetrics & Gynecology, University of Nigeria Teaching Hospital Ituku-Ozalla Enugu Nigeria, Ozalla, Nigeria. drponkwo@yahoo.com.
authors.forename: Peter Onubiwe
authors.initials: PO
authors.lastname: Nkwo
authors.forename: Lucky Osaheni
authors.initials: LO
authors.lastname: Lawani
authors.forename: Euzebus Chinonye
authors.initials: EC
authors.lastname: Ezugwu
authors.forename: Chukwuemeka Anthony
authors.initials: CA
authors.lastname: Iyoke
authors.forename: Agozie C
authors.initials: AC
authors.lastname: Ubesie
authors.forename: Robinson Chukwudi
authors.initials: RC
authors.lastname: Onoh
mesh_terms: D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods; D036861:Delivery, Obstetric / Q000379:methods*; D003906:Developing Countries; D005260:Female; D006301:Health Services Needs and Demand; D006700:Home Childbirth / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D008428:Maternal Mortality; D008429:Maternal Welfare; D008507:Medically Underserved Area; D009549:Nigeria; D016017:Odds Ratio; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment; D012959:Socioeconomic Factors; D055815:Young Adult