Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Jan 22:13:18.
doi: 10.1186/1471-2393-13-18.

The effect of health facility delivery on neonatal mortality: systematic review and meta-analysis

Gurmesa Tura  1 , Mesganaw Fantahun, Alemayehu Worku
Affiliations
Meta-Analysis

The effect of health facility delivery on neonatal mortality: systematic review and meta-analysis

Gurmesa Tura et al. BMC Pregnancy Childbirth. .

Abstract

Background: Though promising progress has been made towards achieving the Millennium Development Goal four through substantial reduction in under-five mortality, the decline in neonatal mortality remains stagnant, mainly in the middle and low-income countries. As an option, health facility delivery is assumed to reduce this problem significantly. However, the existing evidences show contradicting conclusions about this fact, particularly in areas where enabling environments are constraint. Thus, this review was conducted with the aim of determining the pooled effect of health facility delivery on neonatal mortality.

Methods: The reviewed studies were accessed through electronic web-based search strategy from PUBMED, Cochrane Library and Advanced Google Scholar by using combination key terms. The analysis was done by using STATA-11. I(2) test statistic was used to assess heterogeneity. Funnel plot, Begg's test and Egger's test were used to check for publication bias. Pooled effect size was determined in the form of relative risk in the random-effects model using DerSimonian and Laird's estimator.

Results: A total of 2,216 studies conducted on the review topic were identified. During screening, 37 studies found to be relevant for data abstraction. From these, only 19 studies fulfilled the preset criteria and included in the analysis. In 10 of the 19 studies included in the analysis, facility delivery had significant association with neonatal mortality; while in 9 studies the association was not significant. Based on the random effects model, the final pooled effect size in the form of relative risk was 0.71 (95% CI: 0.54, 0.87) for health facility delivery as compared to home delivery.

Conclusion: Health facility delivery is found to reduce the risk of neonatal mortality by 29% in low and middle income countries. Expansion of health facilities, fulfilling the enabling environments and promoting their utilization during childbirth are essential in areas where home delivery is a common practice.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart showing the procedure of selecting studies for the systematic review and meta-analysis, 1988-2012.
Figure 2
Figure 2
Forest Plot of 19 studies on the effect of health facility delivery on neonatal mortality, 1988-2012.
Figure 3
Figure 3
Filled funnel plot of the 19 studies included in the meta-analysis on the effect of health facility delivery on neonatal mortality, 1988-2012.
See this image and copyright information in PMC

References

    1. UNICEF, World Health Organization, The World Bank, The United Nations Population Division. Levels & Trends in Child Mortality: Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation (IGME) New York, USA: IGME; 2012.
    1. UNICEF, World Health Organization, The World Bank, The United Nations Population Division. Levels & Trends in Child Mortality: Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation (IGME) New York, USA: IGME; 2011.
    1. UNICEF. The State of the World’s Children: Maternal and Newborn Health. New York, USA: UNICEF; 2009.
    1. Lawn JE, Cousens S, Zupan J. Four million neonatal deaths: when? Where? Why? Lancet. 2005;365(9462):891–900. doi: 10.1016/S0140-6736(05)71048-5. - DOI - PubMed
    1. Haws RA, Thomas AL, Bhutta ZA, Darmstadt G. Impact of packaged interventions on neonatal health: a review of the evidence. Health Policy Plan. 2007;22:193–215. doi: 10.1093/heapol/czm009. - DOI - PubMed