Postnatal care by provider type and neonatal death in sub-Saharan Africa: a multilevel analysis
Kavita Singh1, Paul Brodish, Erica Haney
1Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. kavita_singh@unc.edu.
Insights
Postnatal care (PNC) for newborns, even from unskilled providers, significantly reduces neonatal deaths in sub-Saharan Africa. Early PNC on day 1 or by day 7 offers crucial protection against infant mortality.
Area of Science:
- Public Health
- Neonatal Medicine
- Global Health
Background:
- Postnatal care (PNC) is promoted globally to reduce neonatal mortality.
- Few studies examine early PNC's impact on neonatal outcomes in sub-Saharan Africa.
- This study investigates PNC timing and provider type in relation to neonatal death.
Purpose of the Study:
- To assess the association between early postnatal care and neonatal mortality in sub-Saharan Africa.
- To compare the effectiveness of PNC provided by skilled versus unskilled birth attendants.
- To analyze the impact of PNC timing (day 1 vs. day 7) on neonatal death rates.
Main Methods:
- Pooled data from Demographic and Health Surveys in 10 African countries (2009 onwards).
- Multilevel logistic regression analysis to examine PNC associations with neonatal mortality.
- Controlled for socioeconomic, maternal, and infant factors like antenatal care and breastfeeding.
Main Results:
- Postnatal care, from both skilled and unskilled providers, is protective against neonatal death.
- Unskilled PNC on day 1 reduced mortality by 32% (OR: 0.68) during days 2-28.
- PNC by day 7, skilled or unskilled, significantly reduced neonatal death on days 2-7 and days 2-28.
Conclusions:
- Postnatal care is a vital strategy for reducing neonatal mortality.
- While skilled providers are preferred, unskilled providers offer a valuable intermediate approach.
- Expanding PNC access, regardless of provider type, can save newborn lives.
Background:
Globally postnatal care (PNC) of the newborn is being promoted as a strategy to reduce neonatal deaths, yet few studies have looked at associations between early PNC and neonatal outcomes in sub-Saharan Africa. In this study we look at the associations of PNC provided on day 1 and by day 7 of life by type of provider - skilled (doctor, midwife or nurse or unskilled (traditional birth attendant or community health worker) on neonatal death on days 2 to 7 and days 2 to 28.
Methods:
Data from 10 African countries with recent (from 2009 onwards) Demographic and Health Surveys are pooled and used in a multilevel logistic regression analysis to study associations between the PNC variables with the mortality outcomes after controlling for relevant socioeconomic and maternal factors (including antenatal care, skilled delivery, tetanus immunization and ever breastfed).
Results:
Findings indicate that PNC, whether provided by a skilled or unskilled provider, is protective against both neonatal death outcomes. Unskilled PNC on day 1 was associated with a 32% decrease in the probability of death (compared to no PNC on day 1) during days 2 to 28 after controlling for other factors (OR: 0.68; 95% CI: 0.48, 0.97). Both skilled and unskilled PNC by day 7 were associated with reduced neonatal death during days 2 to 7 (Skilled: OR: 0.40; 95% CI 0.18, 0.88; Unskilled: OR 0.34; 95% CI 0.23, 0.52) and days 2 to 28 (Skilled: OR: 0.51; 95% CI 0.35, 0.75; Unskilled: OR 0.34; 95% CI 0.30, 0.38). There were also significant associations between four or more antenatal care visits and ever breastfed with both outcomes.
Conclusion:
PNC is an important strategy to reduce neonatal death. While postnatal care by a skilled provider is a preferred strategy, PNC provided by unskilled providers can also serve as an intermediate implementation approach as countries strive to reach more newborns and save more lives.
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