On the association between skilled attendance at birth and newborn survival in sub-Saharan Africa

Agbessi Amouzou, United Nations Children's Fund (UNICEF)
Ziqi Meng, United Nations Children's Fund (UNICEF)
Liliana Carvajal-Velez, United Nations Children's Fund (UNICEF)

Background: Recent studies have shown that newborns delivered with skilled attendance at birth (SAB) have higher neonatal mortality than those without in sub-Saharan Africa. Uncertainties in measurement of SAB, selection bias and poor quality of care were suggested as explanations. We reassessed the relationship by distinguishing the first day of life versus days 2-27. Method: We analyzed DHS data from 20 countries in sub-Saharan Africa with available data on 2010-2014. We fitted a generalized linear mixed model on mortality outcome defined in three categories: died on day 1, day 2-17 and survived days 2-27. Analysis were adjusted for socio-demographic variables. Results: newborn delivered with SAB have similar first day mortality risk as those without SAB. However, past the first day, there is higher survival chances associated with SAB. Conclusion: Focus on improving quality of skilled delivery care is urgent to accelerate decline in neonatal mortality in sub-Saharan Africa.