Place of delivery and perinatal mortality in Kenya

Melissa Kunkel, Irene Marete, Erika R. Cheng, Sherri Bucher, Edward Liechty, Fabian Esamai, Janet L. Moore, Elizabeth McClure, Rachel C. Vreeman

Research output: Contribution to journalReview article

Abstract

Background: Increasing access to skilled birth attendants is a key goal in reducing perinatal mortality. In Kenya, where 40% of births occur at home, efforts toward this goal have focused on providing free maternity services in government facilities and discouraging home births. Purpose: To identify trends in facility deliveries and determine the association between delivery location and PM in Kenya. Methods: We utilized data on 36,375 deliveries from the Kenya site of the Global Network for Women's and Children's Health Research, which maintains a prospective, population-based observational study of pregnancy and neonatal outcomes. We identified temporal trends in facility utilization and perinatal mortality. We then assessed associations between delivery location and PM using generalized linear mixed equations. Results: The percentage of facility births increased from 38.4% in 2009 to 47.6% in 2013, with no change in perinatal mortality. Infants delivered in a facility had a higher risk of perinatal mortality than infants delivered at home (aOR = 1.41, p = 0.005). In stratified analyses, hospital deliveries had a higher adjusted odds of perinatal mortality than home and health center deliveries, with no difference between health center and home deliveries. Conclusion: The increase in facility deliveries between 2009 and 2013 was not associated with a decline in perinatal mortality. Infants born in facilities had a 41% greater risk of perinatal mortality than infants born at home. Further research is needed to assess possible explanations for this finding, including delays in referring and caring for complicated pregnancies, higher risk infants delivering at facilities, and poor quality of care in facilities.

Original languageEnglish (US)
JournalSeminars in Perinatology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Perinatal Mortality
Kenya
Parturition
High-Risk Pregnancy
Quality of Health Care
Health
Women's Health
Pregnancy Outcome
Research
Observational Studies
Population

Keywords

  • Africa
  • Delivery, obstetric
  • Developing countries
  • Health facilities
  • Home childbirth
  • Home delivery
  • Kenya
  • Maternal health services
  • Perinatal mortality

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Kunkel, M., Marete, I., Cheng, E. R., Bucher, S., Liechty, E., Esamai, F., ... Vreeman, R. C. (2019). Place of delivery and perinatal mortality in Kenya. Seminars in Perinatology. https://doi.org/10.1053/j.semperi.2019.03.014

Place of delivery and perinatal mortality in Kenya. / Kunkel, Melissa; Marete, Irene; Cheng, Erika R.; Bucher, Sherri; Liechty, Edward; Esamai, Fabian; Moore, Janet L.; McClure, Elizabeth; Vreeman, Rachel C.

In: Seminars in Perinatology, 01.01.2019.

Research output: Contribution to journalReview article

Kunkel, M, Marete, I, Cheng, ER, Bucher, S, Liechty, E, Esamai, F, Moore, JL, McClure, E & Vreeman, RC 2019, 'Place of delivery and perinatal mortality in Kenya', Seminars in Perinatology. https://doi.org/10.1053/j.semperi.2019.03.014
Kunkel, Melissa ; Marete, Irene ; Cheng, Erika R. ; Bucher, Sherri ; Liechty, Edward ; Esamai, Fabian ; Moore, Janet L. ; McClure, Elizabeth ; Vreeman, Rachel C. / Place of delivery and perinatal mortality in Kenya. In: Seminars in Perinatology. 2019.
@article{9104692daf0b408a8323bcf2a0c4fc00,
title = "Place of delivery and perinatal mortality in Kenya",
abstract = "Background: Increasing access to skilled birth attendants is a key goal in reducing perinatal mortality. In Kenya, where 40{\%} of births occur at home, efforts toward this goal have focused on providing free maternity services in government facilities and discouraging home births. Purpose: To identify trends in facility deliveries and determine the association between delivery location and PM in Kenya. Methods: We utilized data on 36,375 deliveries from the Kenya site of the Global Network for Women's and Children's Health Research, which maintains a prospective, population-based observational study of pregnancy and neonatal outcomes. We identified temporal trends in facility utilization and perinatal mortality. We then assessed associations between delivery location and PM using generalized linear mixed equations. Results: The percentage of facility births increased from 38.4{\%} in 2009 to 47.6{\%} in 2013, with no change in perinatal mortality. Infants delivered in a facility had a higher risk of perinatal mortality than infants delivered at home (aOR = 1.41, p = 0.005). In stratified analyses, hospital deliveries had a higher adjusted odds of perinatal mortality than home and health center deliveries, with no difference between health center and home deliveries. Conclusion: The increase in facility deliveries between 2009 and 2013 was not associated with a decline in perinatal mortality. Infants born in facilities had a 41{\%} greater risk of perinatal mortality than infants born at home. Further research is needed to assess possible explanations for this finding, including delays in referring and caring for complicated pregnancies, higher risk infants delivering at facilities, and poor quality of care in facilities.",
keywords = "Africa, Delivery, obstetric, Developing countries, Health facilities, Home childbirth, Home delivery, Kenya, Maternal health services, Perinatal mortality",
author = "Melissa Kunkel and Irene Marete and Cheng, {Erika R.} and Sherri Bucher and Edward Liechty and Fabian Esamai and Moore, {Janet L.} and Elizabeth McClure and Vreeman, {Rachel C.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1053/j.semperi.2019.03.014",
language = "English (US)",
journal = "Seminars in Perinatology",
issn = "0146-0005",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Place of delivery and perinatal mortality in Kenya

AU - Kunkel, Melissa

AU - Marete, Irene

AU - Cheng, Erika R.

AU - Bucher, Sherri

AU - Liechty, Edward

AU - Esamai, Fabian

AU - Moore, Janet L.

AU - McClure, Elizabeth

AU - Vreeman, Rachel C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Increasing access to skilled birth attendants is a key goal in reducing perinatal mortality. In Kenya, where 40% of births occur at home, efforts toward this goal have focused on providing free maternity services in government facilities and discouraging home births. Purpose: To identify trends in facility deliveries and determine the association between delivery location and PM in Kenya. Methods: We utilized data on 36,375 deliveries from the Kenya site of the Global Network for Women's and Children's Health Research, which maintains a prospective, population-based observational study of pregnancy and neonatal outcomes. We identified temporal trends in facility utilization and perinatal mortality. We then assessed associations between delivery location and PM using generalized linear mixed equations. Results: The percentage of facility births increased from 38.4% in 2009 to 47.6% in 2013, with no change in perinatal mortality. Infants delivered in a facility had a higher risk of perinatal mortality than infants delivered at home (aOR = 1.41, p = 0.005). In stratified analyses, hospital deliveries had a higher adjusted odds of perinatal mortality than home and health center deliveries, with no difference between health center and home deliveries. Conclusion: The increase in facility deliveries between 2009 and 2013 was not associated with a decline in perinatal mortality. Infants born in facilities had a 41% greater risk of perinatal mortality than infants born at home. Further research is needed to assess possible explanations for this finding, including delays in referring and caring for complicated pregnancies, higher risk infants delivering at facilities, and poor quality of care in facilities.

AB - Background: Increasing access to skilled birth attendants is a key goal in reducing perinatal mortality. In Kenya, where 40% of births occur at home, efforts toward this goal have focused on providing free maternity services in government facilities and discouraging home births. Purpose: To identify trends in facility deliveries and determine the association between delivery location and PM in Kenya. Methods: We utilized data on 36,375 deliveries from the Kenya site of the Global Network for Women's and Children's Health Research, which maintains a prospective, population-based observational study of pregnancy and neonatal outcomes. We identified temporal trends in facility utilization and perinatal mortality. We then assessed associations between delivery location and PM using generalized linear mixed equations. Results: The percentage of facility births increased from 38.4% in 2009 to 47.6% in 2013, with no change in perinatal mortality. Infants delivered in a facility had a higher risk of perinatal mortality than infants delivered at home (aOR = 1.41, p = 0.005). In stratified analyses, hospital deliveries had a higher adjusted odds of perinatal mortality than home and health center deliveries, with no difference between health center and home deliveries. Conclusion: The increase in facility deliveries between 2009 and 2013 was not associated with a decline in perinatal mortality. Infants born in facilities had a 41% greater risk of perinatal mortality than infants born at home. Further research is needed to assess possible explanations for this finding, including delays in referring and caring for complicated pregnancies, higher risk infants delivering at facilities, and poor quality of care in facilities.

KW - Africa

KW - Delivery, obstetric

KW - Developing countries

KW - Health facilities

KW - Home childbirth

KW - Home delivery

KW - Kenya

KW - Maternal health services

KW - Perinatal mortality

UR - http://www.scopus.com/inward/record.url?scp=85065784705&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065784705&partnerID=8YFLogxK

U2 - 10.1053/j.semperi.2019.03.014

DO - 10.1053/j.semperi.2019.03.014

M3 - Review article

C2 - 31104765

AN - SCOPUS:85065784705

JO - Seminars in Perinatology

JF - Seminars in Perinatology

SN - 0146-0005

ER -