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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

Article scientifique 2022 Anglais

Résumé

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.

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Noble, C., Mooney, C., Makasi, R., Ntozini, R., Majo, F., Church, J., Tavengwa, N., Prendergast, A., Humphrey, J., Jones, A., Manges, A., Mangwadu, G., Maluccio, J., Mbuya, M., Moulton, L., Stoltzfus, R., Tielsch, J., Smith, L., Chasokela, C., Chigumira, A., Heylar, W., Hwena, P., Kembo, G., Mutasa, B., Mutasa, K., Rambanepasi, P., Sauramba, V., Keilen, F., Zambezi, C., Chidhanguro, D., Chigodora, D., Chipanga, J., Gerema, G., Magara, T., Mandava, M., Mavhudzi, T., Mazhanga, C., Muzaradope, G., Mwapaura, M., Phiri, S., Tengende, A., Banda, C., Chasekwa, B., Chidamba, L., Chidawanyika, T., Chikwindi, E., Chingaona, L., Chiorera, C., Dandadzi, A., Govha, M., Gumbo, H., Gwanzura, K., Kasaru, S., Matsika, A., Maunze, D., Mazarura, E., Mpofu, E., Mushonga, J., Mushore, T., Muzira, T., Nkiwane, S., Nyamwino, P., Rukobo, S., Runodamoto, T., Seremwe, S., Simango, P., Tome, J., Tsenesa, B., Amadu, U., Bangira, B., Chiveza, D., Hove, P., Jombe, H., Kujenga, D., Madhuyu, L., Mandina-Makoni, P., Maramba, N., Maregere, B., Marumani, E., Masakadze, E., Mazula, P., Munyanyi, C., Musanhu, G., Mushanawani, R., Mutsando, S., Nazare, F., Nyarambi, M., Nzuda, W., Sigauke, T., Solomon, M., Tavengwa, T., Biri, F., Chafanza, M., Chaitezvi, C., Chauke, T., Chidzomba, C., Dadirai, T., Fundira, C. (2022). 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. https://doi.org/10.1186/s12884-022-05282-x

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Auteur(s)

C Noble Ciaran Mooney Rachel Makasi Robert Ntozini Florence D. Majo James A. Church Naume V. Tavengwa Andrew J. Prendergast Jean H. Humphrey Andrew D. Jones Amee R. Manges Goldberg Mangwadu John A. Maluccio Mduduzi N. N. Mbuya Lawrence H. Moulton Rebecca J. Stoltzfus James M. Tielsch Laura E. Smith Cynthia Chasokela Ancikaria Chigumira William Heylar Preston Hwena George Kembo Batsirai Mutasa Kuda Mutasa Philippa Rambanepasi Virginia Sauramba Franne Van Der Keilen Chipo Zambezi Dzivaidzo Chidhanguro Dorcas Chigodora Joseph Chipanga Grace Gerema Tawanda Magara Mandava Mandava Tafadzwa Mavhudzi Clever Mazhanga Grace Muzaradope Marian Mwapaura Simon Phiri Alice Tengende Cynthia Banda Bernard Chasekwa Leah Chidamba Theodore Chidawanyika Elisha Chikwindi Lovemore K. Chingaona Courage K. Chiorera Adlight Dandadzi Margaret Govha Hlanai Gumbo Karen T. Gwanzura Sarudzai Kasaru Alois M. Matsika Diana Maunze Exevia Mazarura Eddington Mpofu Johnson Mushonga Tafadzwa E. Mushore Tracey Muzira Sibongile Nkiwane Penias Nyamwino Sandra Rukobo Thompson Runodamoto Shepherd Seremwe Pururudzai Simango Joice Tome Blessing Tsenesa Umali Amadu Beauty Bangira Daniel Chiveza Priscilla Hove Horaiti A. Jombe Didymus Kujenga Lenin Madhuyu Prince Mandina-Makoni Naume Maramba Betty Maregere Ellen Marumani Elisha Masakadze Phathisiwe Mazula Caroline Munyanyi Grace Musanhu Raymond C. Mushanawani Sibongile Mutsando Felicia Nazare Moses Nyarambi Wellington Nzuda Trylife Sigauke Monica Solomon Tendai Tavengwa Farisai Biri Misheck Chafanza Cloud Chaitezvi Tsundukani Chauke Collen Chidzomba Tawanda Dadirai Clemence Fundira

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