The Effect of Health Facility Delivery on Neonatal Mortality in Developing countries: Systematic Review and Meta-Analysis

Debelew, Gurmesa

INTRODUCTION: Though substantial progress has been made towards achieving the millennium development goal four through remarkable reduction in under-five mortality, the decline in neonatal mortality remains stagnant, mainly in the middle and low-income countries. As an option, health facility delivery is assumed to reduce this problem significantly. However, the existing evidences show contradicting conclusions about this fact, particularly in areas where enabling environments are constraint. Thus, this study aimed to determine the pooled effect of health facility delivery on neonatal mortality.

METHODS: The reviewed studies were accessed through electronic web based search strategy from PUBMED, Cochrane Library and Advanced Google Scholar by using combination key terms. The analysis was made by using STATA-11. I² test statistic was used to assess heterogeneity. Funnel plot, Begg’s test and Egger’s test were used to check publication bias. Pooled effect size was determined in the form of relative risk in the random-effects model using DerSimonian and Laird's estimator.

RESULTS: A total of 2216 studies conducted on the review topic were identified. During screening, 37 studies found to be relevant for data abstraction. From these, only 19 studies fulfilled the preset criteria and included in the analysis. In 10 of the 19 studies included in the analysis, facility delivery had significant association with neonatal mortality; while in 9 studies the association was not significant. Based on the random effects model, the final pooled effect size in the form of relative risk was 0.71 (95%CI: 0.54, 0.87) for health facility delivery as compared to home delivery.

CONCLUSIONS: Health facility delivery is found to reduce the risk of neonatal mortality by 29%. Expansion of health facilities, fulfilling the enabling environment and promoting its utilization during child birth is essential in areas where home delivery is a common practice.