Altman Rebecca, Sidney Kristi, De Costa Ayesha, Vora Kranti, Salazar Mariano
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Department of Reproductive and Child Health, Indian Institute of Public Health, Gandhinagar, Ahmedabad, Gujarat, India.
Matern Child Health J. 2017 May;21(5):1065-1072. doi: 10.1007/s10995-016-2202-y.
Objectives In low-income settings, neonatal mortality rates (NMR) are higher among socioeconomically disadvantaged groups. Institutional deliveries have been shown to be protective against neonatal mortality. In Gujarat, India, the access of disadvantaged women to institutional deliveries has increased. However, the impact of increased institutional delivery on NMR has not been studied here. This paper examined if institutional childbirth is associated with lower NMR among disadvantaged women in Gujarat, India. Methods A community-based prospective cohort of pregnant women was followed in three districts in Gujarat, India (July 2013-November 2014). Two thousand nine hundred and nineteen live births to disadvantaged women (tribal or below poverty line) were included in the study. Data was analyzed using multivariable logistic regression. Results The overall NMR was 25 deaths per 1000 live births. Multivariable analysis showed that institutional childbirth was protective against neonatal mortality only among disadvantaged women with obstetric complications during delivery. Among mothers with obstetric complications during delivery, those who gave birth in a private or public facility had significantly lower odds of having a neonatal death than women delivering at home (AOR 0.07 95% CI 0.01-0.45 and AOR 0.03, 95% CI 0.00-0.33 respectively). Conclusions for Practice Our findings highlight the crucial role of institutional delivery to prevent neonatal deaths among those born to disadvantaged women with complications during delivery in this setting. Efforts to improve disadvantaged women's access to good quality obstetric care must continue in order to further reduce the NMR in Gujarat, India.
目标 在低收入环境中，社会经济弱势群体的新生儿死亡率（NMR）较高。已证明机构分娩对新生儿死亡具有保护作用。在印度古吉拉特邦，弱势妇女获得机构分娩的机会有所增加。然而，机构分娩增加对新生儿死亡率的影响在此尚未得到研究。本文研究了在印度古吉拉特邦，机构分娩是否与弱势妇女较低的新生儿死亡率相关。方法 在印度古吉拉特邦的三个地区对一个基于社区的孕妇前瞻性队列进行了跟踪研究（2013年7月 - 2014年11月）。该研究纳入了2919例弱势妇女（部落或贫困线以下）的活产儿。使用多变量逻辑回归分析数据。结果 总体新生儿死亡率为每1000例活产儿中有25例死亡。多变量分析表明，仅在分娩时有产科并发症的弱势妇女中，机构分娩对新生儿死亡具有保护作用。在分娩时有产科并发症的母亲中，在私立或公立机构分娩的母亲发生新生儿死亡的几率明显低于在家分娩的妇女（调整后比值比分别为0.07，95%置信区间为0.01 - 0.45和调整后比值比为0.03，95%置信区间为0.00 - 0.33）。实践结论 我们的研究结果突出了机构分娩在预防该环境中分娩时有并发症的弱势妇女所生婴儿的新生儿死亡方面的关键作用。为了进一步降低印度古吉拉特邦的新生儿死亡率，必须继续努力改善弱势妇女获得优质产科护理的机会。
