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Assessing Antenatal Care and Newborn Survival in Sub-Saharan Africa within the Context of Renewed Commitments to Save Newborn Lives

机译：在重新承诺挽救新生儿生命的背景下评估撒哈拉以南非洲的产前保健和新生儿生存

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Antenatal care (ANC) is one of the key interventions of the Every Newborn action plan to improve newborn health and prevent stillbirths by 2035. However, little is known about its relationship with neonatal mortality in sub-Saharan Africa since the 1990s. We use data from 54 Demographic and Health Survey (DHS) from 27 countries to make comparisons of neonatal mortality by ANC attendance. Each country had two surveys that were categorized as ‘earliest surveys’ (i.e. conducted since 1990 but before 2010) and ‘latest surveys’ (from 2010 to 2014). Multi-level logistic regression model and meta-analysis were applied on 1.1 million births that occurred among women in the 5 years preceding the surveys. Overall neonatal mortality rate (NMR) was 37.7 (95% CI, 37.4–38.1) deaths per 1000 live births; NMR in the earliest surveys were 46.0 (95% CI, 45.4–46.7) and 33.4 (95% CI, 33.0–33.8) deaths per 1000 live births in the latest surveys. The overall NMR was also 10% higher than expected NMR (37.7 vs 34.3 deaths per 1000 live births). NMR was 2.2 times higher among births of women with no ANC compared to those who had at least one ANC visit (42.5 vs 19.6 per 1000 live births). After adjusting for place of delivery, maternal age at birth, relative household wealth, residence, mother's education, marital status, birth order, sex of child, and period of survey, the overall odds ratio (OR) demonstrated that women with at least one ANC visit were 48% less likely to report neonatal deaths (OR: 0.52; 95% CI: 0.47–0.57) than women who did not receive ANC. NMR was 27% less likely to occur during the latest surveys than during the earliest surveys (OR: 0.73; 95% CI: 0.71–0.75). We discuss these results within the context of calls for continued efforts to deploy interventions aimed at improving the quality of maternal and newborn care.
机译：产前保健（ANC）是“每个新生儿”行动计划的主要干预措施之一，该计划旨在改善新生儿健康并在2035年之前预防死产。但是，自1990年代以来，对它与撒哈拉以南非洲新生儿死亡率的关系知之甚少。我们使用来自27个国家/地区的54个人口与健康调查（DHS）的数据，按ANC出席率对新生儿死亡率进行比较。每个国家都有两项调查，分别分为“最早调查”（即1990年以来至2010年之前进行的调查）和“最新调查”（2010年至2014年）。多级逻辑回归模型和荟萃分析适用于调查前5年内110万例妇女的出生。每1000例活产婴儿的总新生儿死亡率（NMR）为37.7例死亡（95％CI，37.4–38.1）。在最新调查中，最早的调查显示，每1000例活产中的NMR死亡数为46.0（95％CI，45.4-46.7）和33.4（95％CI，33.0-33.8）。总体NMR也比预期的NMR高出10％（每千名活产儿死亡37.7 vs 34.3）。没有ANC的妇女的出生核磁共振比至少有一次ANC的妇女的核磁共振高2.2倍（每1000活产42.5比19.6）。在对分娩地点，出生时的产妇年龄，相对家庭财富，住所，母亲的教育程度，婚姻状况，出生顺序，孩子的性别以及调查时间进行调整之后，总体比值比（OR）表明，至少有一个女性与未接受ANC的女性相比，ANC访视报告新生儿死亡的可能性降低了48％（OR：0.52； 95％CI：0.47-0.57）。在最新的调查中，NMR发生的可能性比最早的调查低27％（OR：0.73; 95％CI：0.71-0.75）。我们在呼吁继续努力部署旨在提高孕产妇和新生儿护理质量的干预措施的背景下讨论这些结果。

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