Neonatal Mortality and Education Related Inequality in Cesarean Births in Sub-Saharan Africa: Multi-Country Propensity Score Matching and Meta-Analysis
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Data
2.2. Samples/Dataset
2.3. Variables
2.4. Covariates
2.5. Statistical Analysis
2.6. Individual Patient Data (IPD) Meta-Analysis
2.7. Propensity Score Matching Analysis
3. Results
3.1. Summary of Respondents’ Characteristics
3.2. Crude Differences in Neonatal Mortality Risk across All Countries between Uneducated Versus Educated Women
3.3. Propensity Score-Adjusted Uneducated–Educated Differences in Neonatal Mortality Risk Prevalence
4. Discussion
4.1. Education Related Inequality in Neonatal Mortality Risk Prevalence
4.2. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- World Health Organization. Newborns: Improving Survival and Well-Being. 2020. Available online: https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality (accessed on 5 March 2022).
- UNICEF. Data Warehouse—UNICEF DATA. 2022. Available online: https://data.unicef.org/resources/data_explorer/unicef_f/?ag=UNICEF&df=GLOBAL_DATAFLOW&ver=1.0&dq=WORLD.CME_TMM0+CME_PND..&startPeriod=2010&endPeriod=2020 (accessed on 16 June 2022).
- Mandal, S.; Chouhan, P. Maternal Education and Child Mortality Differentials: An Upshot From the National Family Health Survey 2015–2016, India. Omega 2021, 84, 348–359. [Google Scholar] [CrossRef] [PubMed]
- Oyekale, A.S.; Maselwa, T.C. Maternal Education, Fertility, and Child Survival in Comoros. Int. J. Environ. Res. Public Health 2018, 15, 2814. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gurung, G. Investing in mother’s education for better maternal and child health outcomes. Rural. Remote Health 2010, 10, 1352. [Google Scholar] [CrossRef]
- Vikram, K.; Vanneman, R. Maternal Education and the Multidimensionality of Child Health Outcomes in India. J. Biosoc. Sci. 2020, 52, 57. [Google Scholar] [CrossRef] [PubMed]
- Skoufias, E.; Vinha, K. Child stature, maternal education, and early childhood development in Nigeria. PLoS ONE 2021, 16, e0260937. [Google Scholar] [CrossRef] [PubMed]
- Akinyemi, J.O.; Bamgboye, E.A.; Ayeni, O. Trends in neonatal mortality in Nigeria and effects of bio-demographic and maternal characteristics. BMC Pediatry 2015, 15, 36. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mekonnen, Y.; Tensou, B.; Telake, D.S.; Degefie, T.; Bekele, A. Neonatal mortality in Ethiopia: Trends and determinants. BMC Public Health 2013, 13, 483. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ezeh, O.K.; Agho, K.E.; Dibley, M.J.; Hall, J.J.; Page, A.N. Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria: A pooled cross-sectional analysis. BMJ Open 2015, 5, e006779. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Rutstein, S.O.; Rojas, G. Guide to DHS Statistics: Demographic and Health Survey’s Methodology; United States Agency for International Development (USAID): Calverton, MD, USA, 2006. [Google Scholar]
- MEASURE DHS/ICF International. Demographic and Health Surveys Methodology: Standard Recode Manual for DHS 6; United States Agency for International Development (USAID): Calverton, MD, USA, 2013. [Google Scholar]
- DerSimonian, R.; Laird, N. Meta-analysis in clinical trials. Control. Clin. Trials 1986, 7, 177–188. [Google Scholar] [CrossRef]
- Cochran, W.G. The combination of estimates from different experiments. Biometrics 1954, 10, 101–129. [Google Scholar] [CrossRef]
- Higgins, J.P.T.; Thompson, S.G.; Deeks, J.J.; Altman, D.G. Measuring inconsistency in meta-analyses. BMJ 2003, 327, 557–560. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Higgins, J.P.T.; Thompson, S.G. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002, 21, 1539–1558. [Google Scholar] [CrossRef] [PubMed]
- World Health Organisation. COVID-19 and the Social Determinants of Health and Health Equity: Evidence Brief; WHO: Geneva, Switzerland, 2021. [Google Scholar]
- Fonseca, S.C.; Flores, P.V.G.; Camargo, K.R.; Pinheiro, R.S.; Coeli, C.M. Maternal education and age: Inequalities in neonatal death. Rev. Saude Publica 2017, 51, 94. [Google Scholar] [CrossRef] [PubMed]
- McKinnon, B.; Harper, S.; Kaufman, J.S.; Bergevin, Y. Socioeconomic inequality in neonatal mortality in countries of low and middle income: A multicountry analysis. Lancet Glob. Health 2014, 2, e165–e173. [Google Scholar] [CrossRef] [Green Version]
- Kiross, G.T.; Chojenta, C.; Barker, D.; Tiruye, T.Y.; Loxton, D. The effect of maternal education on infant mortality in Ethiopia: A systematic review and meta-analysis. PLoS ONE 2019, 14, e0220076. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ratnasiri, A.W.G.; Lakshminrusimha, S.; Dieckmann, R.A.; Lee, H.C.; Gould, J.B.; Parry, S.S.; Arief, V.N.; DeLacy, I.H.; DiLibero, R.J.; Basford, K.E. Maternal and infant predictors of infant mortality in California, 2007–2015. PLoS ONE 2020, 15, e0236877. [Google Scholar] [CrossRef] [PubMed]
- Arntzen, A.; Mortensen, L.; Schnor, O.; Cnattingius, S.; Gissler, M.; Andersen, A.M.N. Neonatal and postneonatal mortality by maternal education—A population-based study of trends in the Nordic countries, 1981–2000. Eur. J. Public Health 2008, 18, 245–251. [Google Scholar] [CrossRef] [PubMed]
- Mensch, B.S.; Chuang, E.K.; Melnikas, A.J.; Psaki, S.R. Evidence for causal links between education and maternal and child health: Systematic review. Trop. Med. Int. Health 2019, 24, 504. [Google Scholar] [CrossRef] [PubMed]
- Miller, S.; Abalos, E.; Chamillard, M.; Ciapponi, A.; Colaci, D.; Comandé, D.; Diaz, V.; Geller, S.; Hanson, C.; Langer, A.; et al. Beyond too little, too late and too much, too soon: A pathway towards evidence-based, respectful maternity care worldwide. Lancet 2016, 388, 2176–2192. [Google Scholar] [CrossRef]
- Bishop, D.; Dyer, R.A.; Maswime, S.; Rodseth, R.N.; van Dyk, D.; Kluyts, H.-L.; Tumukunde, J.T.; Madzimbamuto, F.D.; Elkhogia, A.M.; Ndonga, A.; et al. Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: A 7-day prospective observational cohort study. Lancet Glob. Health 2019, 7, e513–e522. [Google Scholar] [CrossRef] [Green Version]
Before Matching | After Matching | |||||||
---|---|---|---|---|---|---|---|---|
Uneducated | Educated | Uneducated | Educated | |||||
Variable | % | % | p-Value | % Bias | % | % | p-Value | % Bias |
Educational attainment | ||||||||
Urban | 37.9% | 56.8% | 37.9% | 39.2% | ||||
Rural | 62.1% | 43.2% | <0.001 | 38.6 | 62.1% | 60.8% | 0.397 | 2.6 |
Respondent’s current age (years) | ||||||||
15–24 | 20.1% | 27.7% | 20.1% | 21.0% | ||||
25–34 | 44.6% | 48.2% | <0.001 | −7.2 | 44.6% | 46.1% | 0.327 | −3 |
35–49 | 35.3% | 24.1% | <0.001 | 24.6 | 35.3% | 32.9% | 0.101 | 5.2 |
Wealth index combined | ||||||||
Poorest | 22.5% | 9.2% | 22.5% | 25.2% | ||||
Poorer | 19.1% | 12.5% | <0.001 | 18 | 19.1% | 17.1% | 0.088 | 5.5 |
Middle | 19.7% | 15.1% | <0.001 | 12.1 | 19.7% | 20.0% | 0.76 | −1 |
Richer | 21.6% | 22.1% | 0.649 | −1.1 | 21.6% | 20.9% | 0.576 | 1.7 |
Richest | 17.2% | 41.1% | <0.001 | −54.4 | 17.2% | 16.8% | 0.745 | 0.9 |
No. of ANC visits during pregnancy | ||||||||
None | 3.6% | 1.4% | 3.6% | 3.3% | ||||
1 to 4 | 59.9% | 47.1% | <0.001 | 25.9 | 59.9% | 60.4% | 0.708 | −1.1 |
5 or more | 36.5% | 51.5% | <0.001 | −30.5 | 36.5% | 36.3% | 0.874 | 0.5 |
Media Access | ||||||||
None | 35.1% | 14.7% | 35.1% | 36.6% | ||||
Access | 64.9% | 85.3% | <0.001 | −48.6 | 64.9% | 63.4% | 0.294 | 3.7 |
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Olukade, T.O.; Uthman, O.A. Neonatal Mortality and Education Related Inequality in Cesarean Births in Sub-Saharan Africa: Multi-Country Propensity Score Matching and Meta-Analysis. Children 2022, 9, 1260. https://doi.org/10.3390/children9081260
Olukade TO, Uthman OA. Neonatal Mortality and Education Related Inequality in Cesarean Births in Sub-Saharan Africa: Multi-Country Propensity Score Matching and Meta-Analysis. Children. 2022; 9(8):1260. https://doi.org/10.3390/children9081260
Chicago/Turabian StyleOlukade, Tawa O., and Olalekan A. Uthman. 2022. "Neonatal Mortality and Education Related Inequality in Cesarean Births in Sub-Saharan Africa: Multi-Country Propensity Score Matching and Meta-Analysis" Children 9, no. 8: 1260. https://doi.org/10.3390/children9081260