Examining the influence of antenatal care and skilled attendence of neonatal deaths in Zambia: A multilevel analysis

Abstract

Neonatal mortality is a global challenge; identification of individual and community determinants associated with it, are important for targeted interventions. Although many studies have emphasized the importance of accessible maternal healthcare as a means of reducing maternal and child mortality, very few of these studies have explored the influence of antenatal care visits and skilled attendance on neonatal deaths. The main objective is to examine the influence of antenatal care visits and skilled attendance on neonatal deaths in Zambia using a multi-level analysis. The study uses data of women in their reproductive years from the 2013/2014 Zambia Demographic and Health Survey data. The aim was to identify individual (age, maternal education, paternal education, skilled attendance, antenatal care visits, delivery and other postnatal services) and community determinants associated with neonatal deaths. We further used IV estimation strategy to deal with the potential endogeneity of the antenatal care visits. The results showed both individual and community characteristics to be associated with neonatal deaths. The study finds that adequate utilization of antenatal care services, skilled attendance during pregnancy or/and delivery reduced the likelihood of neonatal deaths. Neonates who were born to mothers who had less than three ANC visits [OR 1.36; 95% CI .95 - 1.96; P-value <0.1] had a higher likelihood of dying within the neonatal period. Infants that were born under caesarean section had 1.19 times higher chances of dying within one month after birth [OR 1.19; CI .58 - 2.45; P-Value< 0.1]. However, neonates who were born to mothers who were attended by skilled health personnel had less likelihood of having their neonates dying before reaching the age of one month. We also find that male infants were more likely to die than the female counterparts [OR 1.74; CI .51-2.06; P-value <0.1]. Some community level factors were shown to be associated with child survival within the first 28 days of life. Babies born to women who come from households with high poverty levels in the community were 1.47 times more likely to die within 28 days after birth [OR 1.47; CI .71 - 3.06, P-value<0.1]. Women who stay in the rural areas of Zambia have 1.23 times higher likelihood of having their neonates die compared to the urban counterparts [OR1.23; CI .49 - 2.10, P-value<0.5]. Both individual and community characteristics show a marked impact on neonatal survival. Implementation of community- based interventions addressing basic education, poverty alleviations in rural areas, ANC service provisions and skilled attendance and increased focus on the continuum of care approach in healthcare service will improve neonatal survival.