Traditional birth attendant-assisted versus unassisted births: a comparison of neonatal deaths in Nigeria, 2008-2018.

PURPOSE: to directly compare the risk of neonatal death between traditional birth attendant (TBA)-assisted and unassisted deliveries in Nigeria. METHODS: Using data on live births from the 2008, 2013, and 2018 Nigeria Demographic and Health Surveys, this cross-sectional study compared risk of neonatal death for TBA-assisted versus unassisted births. We used survey-featured logistic regression to estimate the odds of neonatal death. Survey year-stratified and propensity score-matched (PSM) estimates were obtained. Multivariate imputation by chained equation (MICE) for missing data was conducted. RESULTS: A total of 28, 922 births were included. Regression and PSM analysis of pooled data showed that unassisted births had lower odds of neonatal death compared to TBA-assisted births, (aOR 0.81, 95% CI: 0.65,1.00) and (aOR 0.80, 95% CI: 0.64,1.00), respectively. Regression analysis by survey year yielded non-significant higher odds of neonatal death for TBA-assisted births. Pooled estimates from MICE showed non-significant higher odds of death for TBA-assisted births. CONCLUSIONS: These findings indicate that birth care by TBAs do not necessarily lead to better neonatal survival. Jurisdictions seeking to allow continued operation of TBAs need to consider measures such as training, supervision, and regulation to ensure the safety of newborns.

Maternal Instruction About Jaundice and the Incidence of Acute Bilirubin Encephalopathy in Nigeria.

OBJECTIVE: To evaluate whether teaching mothers about neonatal jaundice will decrease the incidence of acute bilirubin encephalopathy among infants admitted for jaundice. STUDY DESIGN: This was a multicenter, before-after and cross-sectional study. Baseline incidences of encephalopathy were obtained at 4 collaborating medical centers between January 2014 and May 2015 (Phase 1). Structured jaundice instruction was then offered (May to November 2015; Phase 2) in antenatal clinics and postpartum. Descriptive statistics and logistic regression models compared 3 groups: 843 Phase 1 controls, 338 Phase 2 infants whose mothers received both antenatal and postnatal instruction (group A), and 215 Phase 2 infants whose mothers received no instruction (group B) either because the program was not offered to them or by choice. RESULTS: Acute bilirubin encephalopathy occurred in 147 of 843 (17%) Phase 1 and 85 of 659 (13%) Phase 2 admissions, which included 63 of 215 (29%) group B and 5 of 338 (1.5%) group A infants. OR for having acute bilirubin encephalopathy, comparing group A and group B infants adjusted for confounding risk factors, was 0.12 (95% CI 0.03-0.60). Delayed care-seeking (defined as an admission total bilirubin ≥18 mg/dL at age ≥48 hours) was the strongest single predictor of acute bilirubin encephalopathy (OR 11.4; 6.6-19.5). Instruction decreased delay from 49% to 17%. Other major risk factors were home births (OR 2.67; 1.69-4.22) and hemolytic disease (hematocrit ≤35% plus bilirubin ≥20 mg/dL) (OR 3.03; 1.77-5.18). The greater rate of acute bilirubin encephalopathy with home vs hospital birth disappeared if mothers received jaundice instruction. CONCLUSIONS: Providing information about jaundice to mothers was associated with a reduction in the incidence of bilirubin encephalopathy per hospital admission.