title: Term infants born at home in Peru are less likely to be hospitalised in the neonatal period than those born in hospital.
abstract: BACKGROUND
  More than 50% of women worldwide give birth at home, but little is known about home birth and subsequent neonatal hospitalisation.
  
  
  OBJECTIVE
  The objective of the study was to investigate home birth and neonatal hospitalisation of term neonates in Peru.
  
  
  METHODS
  The relationship between birth setting [home - with or without skilled birth attendant (SBA), health centre, hospital] and neonatal hospitalisation (n = 1656) and incubator care (n = 1651) was investigated using data from the 2002 Young Lives Study. Infants were sampled from 20 sentinel sites across Peru. At each sentinel site 100 households with children aged 6-18 months were randomly sampled (therefore the sample only captured children surviving to 6 months of age). Multivariate regression modelling was used with models adjusted for a range of demographic and clinical factors.
  
  
  RESULTS
  After adjustment, the odds of hospitalisation were lower in neonates born at home (with SBA OR 0.20, 95% CI 0.0-0.8, p = 0.021; without SBA OR = 0.4, 95% CI 0.2-0.7, p = 0.002) than in those born in hospital. Socio-demographic factors such as ethnicity, rural living, education, socio-economic status and access to transport did not influence neonatal hospitalisation, time in hospital, incubator care or time under incubator care.
  
  
  CONCLUSIONS
  Neonates born at home were less likely to be hospitalised after birth owing to neonatal morbidity than neonates born in hospital. It is unclear whether this finding reflects poorer accessibility to hospital care for neonates born at home, or if neonates born at home required hospitalisation less frequently than neonates born in hospital owing to lower neonatal morbidity or other factors such as lower rates of medical intervention for home births. Further research is needed to explore the underlying mechanisms of these findings.
authors.affiliation: a Centre for Health Services Research, School of Population Health, The University of Western Australia , Perth , Australia.
authors.forename: Tina
authors.initials: T
authors.lastname: Lavin
authors.affiliation: a Centre for Health Services Research, School of Population Health, The University of Western Australia , Perth , Australia.
authors.forename: David B
authors.initials: DB
authors.lastname: Preen
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D008297:Male; D010568:Peru / Q000453:epidemiology; D011795:Surveys and Questionnaires; D047929:Term Birth
keywords: Home birth; Peru; Young Lives; inequity; neonatal hospitalisation; skilled birth attendants