title: Association of type of birth attendant and place of delivery on infant mortality in sub-Saharan Africa.
abstract: OBJECTIVE
  To examine the association between type of birth attendant and place of delivery, and infant mortality (IM).
  
  
  METHODS
  This cross-sectional study used self-reported data from the Demographic Health Surveys for women in Ghana, Kenya, and Sierra Leone. Logistic regression estimated odds ratios (ORs) and95% confidence intervals.
  
  
  RESULTS
  In Ghana and Sierra Leone, odds of IM were higher for women who delivered at a health facility versus women who delivered at a household residence (OR=3.18, 95% confidence interval, CI: 1.29-7.83, p=0.01 and OR=1.62, 95% CI: 1.15-2.28, p=0.01, respectively). Compared to the use of health professionals, the use of birth attendants for assistance with delivery was not significantly associated with IM for women in Ghana or Sierra Leone (OR=2.17, 95% CI: 0.83-5.69, p=0.12 and OR=1.25, 95% CI: 0.92-1.70, p=0.15, respectively). In Kenya, odds of IM, though nonsignificant, were lower for women who used birth attendants than those who used health professionals to assist with delivery (OR=0.85, 95% CI: 0.51-1.41, p=0.46), and higher with delivery at a health facility versus a household residence (OR=1.29, 95% CI: 0.81-2.03, p=0.28).
  
  
  CONCLUSIONS
  Women in Ghana and Sierra Leone who delivered at a health facility had statistically significant increased odds of IM. Birth attendant type-IM associations were not statistically significant.Future research should consider culturally-sensitive interventions to improve maternal health and help reduce IM.
authors.affiliation: Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223; phone: 704-687-8719; fax: 704-687-1644.
authors.forename: Whitney A
authors.initials: WA
authors.lastname: Stanley
authors.affiliation: Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223; phone: 704-687-8719; fax: 704-687-1644.
authors.forename: Larissa R
authors.initials: LR
authors.lastname: Brunner Huber
authors.affiliation: Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223; phone: 704-687-8719; fax: 704-687-1644.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Laditka
authors.affiliation: Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223; phone: 704-687-8719; fax: 704-687-1644.
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Racine
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D005191:Family Characteristics; D005260:Female; D005869:Ghana; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007630:Kenya; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008880:Midwifery; D011247:Pregnancy; D012424:Rural Population; D012807:Sierra Leone; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: birth attendant; infant mortality; sub-Saharan Africa