Abstract:
Background: Though promising progress has been made towards achieving the Millennium Development Goal
four through substantial 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 review was conducted with the aim of determining
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 done 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 for 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 2,216 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.
Conclusion: Health facility delivery is found to reduce the risk of neonatal mortality by 29% in low and middle
income countries. Expansion of health facilities, fulfilling the enabling environments and promoting their utilization
during childbirth are essential in areas where home delivery is a common practice.
