No difference in perinatal mortality between home and facility delivery in rural Tanzania: a prospective community-based study

Abstract

Background Facility-based delivery with skilled birth attendants in an enabling environment is recommended for life-saving and for improving maternal and newborn health outcomes. Inconsistent results exist regarding the protective effects of facility delivery on maternal and perinatal mortality in developing countries. The primary objective of this study was to investigate the association between place of delivery and maternal and perinatal mortality. A secondary objective was to examine the association between place of delivery and maternal complications during pregnancy, labor and delivery, and 48 hours postpartum. Methods This community-based prospective study recruited a cohort of 1719 women in their third trimester of pregnancy through a door-to-door survey in randomly selected wards in rural Geita Northwest Tanzania between September 2016 and December 2017. A total of 1385 eligible mother-infant pairs were followed to seven days post-delivery. Results Half of the women delivered at a health facility (52.23%). A limited number of maternal deaths (n=7) were observed; 3 of these occurred at health facilities. No association was found between place of delivery and perinatal mortality (adjusted odds ratio, aOR=1.60, 95% confidence interval, CI=0.65-3.80). The prevalence of maternal complications during pregnancy, labor and delivery, and 48 hours postpartum were 6.14%, 8.74%, and 12.56%, respectively. A higher proportion of women who delivered at health facilities reported complications during labor and delivery (13.26% vs 3.78%) and 48 hours postnatally (14.78% vs 10.14%) than women who delivered at home. Conclusions Health facility delivery was not associated with reduced perinatal mortality. A higher proportion of women who delivered at health facilities reported complications during labour and delivery. Controlling for maternal complications attenuated the association between place of delivery and perinatal mortality. Many health facilities in rural Geita Tanzania remain ill-equipped to deal with unpredictable complications during childbirth. Improving staff training, access to essential drugs and equipment, and quality care could reduce perinatal mortality.