Correlates of poor perinatal outcomes in non-hospital births in the context of weak health system: The nigerian experience

Abstract

Background: Nigeria's high perinatal mortality rate (PNMR) could be most effectively reduced by targeting factorsthat are associated with increased newborn deaths. Low access to skilled birth attendants (SBAs) and weak healthsystem are recognized factors associated with high PNMR but other socio-demographic and reproductive factorscould have significant influences as well. Identification of the major factors associated with high PNMR would berequired in designing interventions to improve perinatal outcomes.Methods: For this cross-sectional study, data from the Nigeria Demographic and Health Survey 2008 were used toestimate the PNMR of non-hospital births in identified socio-demographic and reproductive situations that areknown to influence PNMR. The estimated PNMR were compared using logistic regression analysis.Results: The PNMR was 36 per 1000 live births. North central region had the lowest PNMR while the south eastregion had the highest rate (odds ratio 1.59; 95% CI: 1.03, 2.45). Other correlates of high PNMR were belonging tothe poorest wealth quintile (odds ratio 1.87; 95% CI: 1.30, 2.70), maternal age group 15-19 years (odds ratio 1.59;95% CI: 1.05, 2.22), multiple birth (odds ratio 3.12; 95% CI: 2.11, 4.59), history of previous perinatal death (odds ratio3.31; 95% CI: 2.73, 4.02), birth interval shorter than 18 months (odds ratio 1.65; 95% CI: 1.26, 2.17) and having a smallbirth size (odds ratio 2.56; 95% CI 1.79, 3.69). Birth attendant, place of birth, parity, maternal education and rural/urban residence had no association with PNMR.Conclusions: Reproductive factors that require midwifery skills were found to contribute most to PNMR. Werecommend general strengthening of the health system, recruitment of SBAs and retraining of available birthattendants with emphasis on identification and referral of complicated cases. Family planning should be a coreMCH activity to address the issues of teenage pregnancy and short pregnancy intervals.