Terhi J. Lohela|Oona M. R. Campbell|Sabine Gabrysch
Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia
Heidelberg University|Jorvi Hospital|Helsinki University Hospital|London School of Hygiene & Tropical Medicine|Heidelberg University
globally approximately 3 million babies die annually within first month access adequate care birth needed reduce newborn well maternal deaths explore influence distance delivery care level care early neonatal mortality rural zambia malawi influence distance level care facility delivery influence facility delivery early neonatal mortalitynational health facility censuses used classify level obstetric care 1131 zambian 446 malawian delivery facilities straightline distances facilities calculated 3771 newborns 2007 zambia dhs 8842 newborns 2004 malawi dhs association distance care early neonatal mortality malawi 097 95ci 058160 zambia distance per 10 km associated lower mortality 055 95ci 035087 level care provided closest facility showed association early neonatal mortality either malawi 102 95ci 090116 zambia 102 95ci 082126 countries distance care strongly associated facility use delivery malawi 035 per 10km 95ci 026046 results adjusted available confounders early neonatal mortality differ frequency facility delivery communitywhile better geographic access higher level care associated frequent facility delivery association lower early neonatal mortality could due low quality care newborns health facilities differential underreporting early neonatal deaths dhs alternative explanation improved data sources needed monitor progress provision obstetric newborn care impact mortality