Prenatal care associated with reduction of neonatal mortality in Sub-Saharan Africa: evidence from Demographic and Health Surveys.

OBJECTIVE: To determine whether prenatal care by a skilled provider (physician, nurse or midwife) and specific prenatal interventions were associated with decreased neonatal mortality.
DESIGN: Mothers' reports in nationally representative surveys (conducted 2003-2009) about their most recent delivery were analyzed. Setting. Sub-Saharan Africa, 17 least developed countries (UN designation). POPULATION: 89 655 women aged 15-49 years with a singleton birth within 3 years prior to survey. Methods. Logistic regression models were used to measure the associations between having a skilled prenatal provider, as well as specific interventions, and neonatal mortality. MAIN OUTCOME MEASURES: Neonatal mortality, defined as a live birth ending in death at less than one month of age.
RESULTS: Overall, 70.7% of women saw a skilled prenatal provider during their previous pregnancy. Prenatal care from a skilled provider was associated with a decreased neonatal mortality risk compared with no provider [adjusted odds ratio (AOR) 0.70, 95% confidence interval (CI) 0.62-0.80] and compared with an unskilled provider (AOR 0.81, 95% CI 0.68-0.96). The most effective prenatal interventions were weight (AOR 0.71, 95% CI 0.64-0.80) and blood pressure measurements (AOR 0.77, 95% CI 0.69-0.86), and two or more tetanus immunizations (AOR 0.78, 95% CI 0.70-0.86). Four or more prenatal visits compared with none were associated with decreased neonatal mortality risk (AOR 0.68, 95% CI 0.59-0.79).
CONCLUSIONS: Prenatal care provided by skilled providers, at least four prenatal visits, weight and blood pressure assessment, and two or more tetanus immunizations were associated with decreased neonatal mortality in Sub-Saharan African countries.