Facility-based delivery and maternal and early neonatal mortality in sub-Saharan Africa: A regional review of the literature

Cheryl A. Moyer, Phyllis Dako-Gyeke, Richard M. Adanu

Abstract

Regional variability in facility-based delivery (FBD) rates in sub-Saharan Africa (SSA) is not well understood, nor is the relationship between FBD and national maternal and early neonatal mortality rates. A systematic literature review identified studies documenting the factors associated with FBD, stratified by region. Rates of skilled birth attendance, facility delivery, maternal mortality, and early neonatal mortality were compared across nations and regions. 70 articles met inclusion criteria, reflecting wide variability in the number, type, and quality of studies by region. Within-country differences were most pronounced in nations where multiple studies were conducted. Correlation between FBD and maternal mortality rates throughout SSA was -0.69 (p=.008), and the correlation between facility delivery rates and early neonatal mortality rates was -0.41 (p=0.08). This study demonstrates the need to attend to regional differences both across and within SSA nations if facility delivery rates are to be improved to reduce maternal and early neonatal mortality. (Afr J Reprod Health 2013; 17[3]: 30-43)

 

Résumé

L’on comprend mal le taux de variabilité régionale dans l’accouchement dans des établissements de santé (AES) en Afrique subsaharienne (ASS), pas plus que la relation entre AES et les taux national  de mortalité maternelle et néonatale précoce. Une révision systématique de la documentation  a identifié les études qui documentent les facteurs associés à AES, stratifiées selon les régions. Les taux d'accouchement assurés par des accoucheuses  qualifiées, l’accouchement dans des établissements, la mortalité maternelle et la mortalité néonatale précoce ont été comparés auprès des  nations et des régions. 70 articles répondaient aux critères d'inclusion, ce qui reflète une grande variabilité dans le nombre, le type et la qualité des études selon les  régions. Les différences au sein des pays ont été plus remarquables dans les pays où de multiples études ont été menées. Les corrélations entre les taux de mortalité maternelle dans l'ensemble AES et SSA était  de -0.69 (p = .008), et la corrélation entre les taux d’accouchement dans des établissements et les taux de mortalité néonatale précoce était de -0.41 (p = 0,08). Cette étude démontre la nécessité de s’occuper des différences régionales à la fois à travers  et au sein des pays d'Afrique subsaharienne si les taux d’accouchement doivent être améliorés pour réduire la mortalité maternelle et néonatale précoce. (Afr J Reprod Health 2013; 17[3]: 30-43)

 

Keywords: Institutional delivery, skilled birth attendance, maternal mortality, neonatal mortality, developing countries

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