Impact of Place of Delivery on Neonatal Mortality in Rural Tanzania.
OBJECTIVE
Studies on factors affecting neonatal mortality have rarely considered the impact of place of delivery on neonatal mortality. This study provides epidemiological information regarding the impact of place of delivery on neonatal deaths.


METHODS
We analyzed data from the Rufiji Health and Demographic Surveillance System (RHDSS) in Tanzania. A total of 5,124 live births and 166 neonatal deaths were recorded from January 2005 to December 2006. The place of delivery was categorized as either in a health facility or outside, and the neonatal mortality rate (NMR) was calculated as the number of neonatal deaths per 1,000 live births. Univariate and multivariate logistic regression models were used to assess the association between neonatal mortality and place of delivery and other maternal risk factors while adjusting for potential confounders.


RESULTS
Approximately 67% (111) of neonatal deaths occurred during the first week of life. There were more neonatal deaths among deliveries outside health facilities (NMR = 43.4 per 1,000 live births) than among deliveries within health facilities (NMR = 27.0 per 1,000 live births). The overall NMR was 32.4 per 1,000 live births. Mothers who delivered outside a health facility experienced 1.85 times higher odds of experiencing neonatal deaths (adjusted odds ratio = 1.85; 95% confidence interval = 1.33-2.58) than those who delivered in a health facility.
Place of delivery is a significant predictor of neonatal mortality. Pregnant women need to be encouraged to deliver at health facilities and this should be done by intensifying education on where to deliver. Infrastructure, such as emergency transport, to facilitate health facility deliveries also requires urgent attention.
Kintampo Health Research Centre, Kintampo, Ghana; Ifakara Health Research and Development Centre, Ifakara, Tanzania; University of Witwatersrand, Johannesburg, South Africa.
Justice
J
Ajaari
Ifakara Health Research and Development Centre, Ifakara, Tanzania.
Honorati
H
Masanja
University of Witwatersrand, Johannesburg, South Africa; Soul City, Johannesburg, South Africa.
Renay
R
Weiner
John Snow Research and Training Institute, Accra, Ghana.
Shalom Akonvi
SA
Abokyi
Kintampo Health Research Centre, Kintampo, Ghana.
Seth
S
Owusu-Agyei
Maternal age; Neonatal mortality; Place of delivery; Socioeconomic status; Tanzania