No difference in perinatal mortality between home and facility delivery in rural Tanzania: a prospective community-based study
Notice bibliographique
Résumé
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.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».