This study was done in Ifakara Health and Demographic Surveillance Site located in Southern Tanzania, Morogoro region. The HDSS site was started by conducting baseline census between September and December 1996. Since then every household in the surveillance area has been visited by a trained interviewer every 4 months to record pregnancies, pregnancy outcomes, deaths and migrations that have happened since the previous visit. Date of birth of each individual is included in the household registers and each event is recorded along with specific date it happened. Place of delivery and place of death are recorded as health facility, home or elsewhere. Educational levels of each individual and household assets are recorded annually. Currently (2011), the site includes over 100,000 people living in 25 villages in parts of two districts, Kilombero and Ulanga in Southern Tanzania. The population is predominantly rural and ethnically heterogeneous. Majority of the households earn their living from subsistence farming, few are engaged in fishing and small-scale trading. Detailed description of the study area is presented elsewhere .
The population of the study districts is served by a network of health facilities, at the time of the study there were two hospitals, four health centres and twenty one dispensaries in Kilombero district; two hospitals, three health centres and twenty dispensaries in Ulanga district. In 2008, comprehensive EMOC was available in two hospitals in each district. Health facilities with staff available for 24 hours, 7 days per week to perform normal delivery were only 59% and 72% in Kilombero and Ulanga districts, respectively. Within the study population, about 60% of all deliveries occur in health facilities mainly in dispensaries. Use of antenatal services by women in the study area is over 95% (at least one visit to ANC clinic). At the time of study, continuum of care was not fully introduced in the study area.
This paper reports analysis of observational data collected in the Ifakara Health and Demographic Surveillance Site (IHDSS) for children born between 2005 and 2007. Three birth cohorts of singleton neonates were extracted from the database including their survival status within the first 28 days of life. Variables of interest included date of birth, date of death, birth order, sex, maternal age at birth, maternal education, household economic status, place of delivery and place of death.
Data credibility was ensured at all stages of collection and processing. Up to 5% of randomly selected households were visited by field supervisors for repeated interviews. Other strategies included accompanied interviews as well as surprise field visits by field managers. Data was keyed in computers using a household registration system (HRS), software for relational database with inbuilt consistency and range checks. Captured inconsistencies were referred back to the field.
Neonatal death is defined as termination of life of a live-born child within 28 days of life. Place of delivery is classified as "in the health facility" or "in the community". Health facility includes dispensaries, health centres and hospitals. Delivery at home, TBAs homes or anywhere else besides health facilities are classified here as "in the community". We included in this paper only singleton live births that occurred between year 2005 and 2007.
Neonatal mortality was calculated as the number of neonatal deaths divided by number of live births in a given year and expressed per 1000 live births. Mortality on the same day of life was calculated as the number of neonates that had date of birth same as date of death divided by number of live births in a given year and expressed per 1000 live births.
We calculated means and percentages of the background characteristics and performed t tests for means and χ2 tests for proportions to asses differences in the maternal and child background characteristics between the two defined places of delivery (health facility, community).
For each year of study, Poisson regression models were fitted to estimate crude relative risks of neonatal death by place of delivery. Adjusted ratios were derived by controlling for maternal age, birth order, maternal schooling, sex of the child and wealth status of the maternal household.
Daily survival functions of the neonates born in health facilities and those born in the community were estimated and compared using log rank tests.
Ifakara Health and Demographic Surveillance System was established with an initial aim of evaluating the effect of a large-scale social marketing of insecticide-treated nets on child survival in rural Tanzania. The study was approved by local and national ethical committees.