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
Randomized Controlled Trial
. 2022 Dec 30;22(1):981.
doi: 10.1186/s12884-022-05282-x.

Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial

Christie Noble #  1 , Ciaran Mooney #  2 , Rachel Makasi  3 , Robert Ntozini  3 , Florence D Majo  3 , James A Church  1   3 , Naume V Tavengwa  3 , Andrew J Prendergast  1   3   4 , Jean H Humphrey  3   4 ; Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team
Collaborators, Affiliations
Randomized Controlled Trial

Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial

Christie Noble et al. BMC Pregnancy Childbirth. .

Abstract

Background: Despite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions.

Methods: This study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes.

Results: Among 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference.

Conclusions: Preterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe.

Trial registration: The trial is registered with ClinicalTrials.gov, number NCT01824940.

Keywords: Birth outcomes; Global health; Home delivery; Institutional delivery; Maternal health; Neonatal health; Neonatal mortality.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Hug L, Alexander M, You D, Alkema L. For child UI-aG: national, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health. 2019;7(6):e710–e720. doi: 10.1016/S2214-109X(19)30163-9. - DOI - PMC - PubMed
    1. Ronsmans C, Graham WJ. Group LMSSs: maternal mortality: who, when, where, and why. Lancet. 2006;368(9542):1189–1200. doi: 10.1016/S0140-6736(06)69380-X. - DOI - PubMed
    1. Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, Flenady V, Frøen JF, Qureshi ZU, Calderwood C, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387(10018):587–603. doi: 10.1016/S0140-6736(15)00837-5. - DOI - PubMed
    1. Filippi V, Ronsmans C, Campbell OM, Graham WJ, Mills A, Borghi J, Koblinsky M, Osrin D. Maternal health in poor countries: the broader context and a call for action. Lancet. 2006;368(9546):1535–1541. doi: 10.1016/S0140-6736(06)69384-7. - DOI - PubMed
    1. Kinney MV, Kerber KJ, Black RE, Cohen B, Nkrumah F, Coovadia H, Nampala PM, Lawn JE. On behalf of the science in action: saving the lives of Africa's mothers n, children working g: sub-Saharan Africa's mothers, newborns, and children: where and why do they die? PLoS Med. 2010;7(6):e1000294. doi: 10.1371/journal.pmed.1000294. - DOI - PMC - PubMed

Publication types

Associated data