SynthesisBMC public health2014
Maternal and perinatal mortality by place of delivery in sub-Saharan Africa: a meta-analysis of population-based cohort studies.
Synthesis in BMC public health, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02643953 (Increasing Women's Access to Skilled Pregnancy Care to Reduce Maternal and Perinatal Mortality in Nigeria), which is not on this map. Cited by 62 papers, 8 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Increasing Women's Access to Skilled Pregnancy Care to Reduce Maternal and Perinatal Mortality in Nigeria: A Randomized Control Trial
Who cites it
62 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Perinatal mortality in eastern Africa: A systematic review and meta-analysis.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Pooled it
- Prevalence of Women's Home Birth Preferences and Its Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis.BioMed research international · 2024Pooled it
- Perinatal mortality and its association with antenatal care visit, maternal tetanus toxoid immunization and partograph utilization in Ethiopia: a meta-analysis.Scientific reports · 2021Pooled it
- The effect of antenatal care on perinatal outcomes in Ethiopia: A systematic review and meta-analysis.PloS one · 2021Pooled it
- Interventions to reduce preterm birth and stillbirth, and improve outcomes for babies born preterm in low- and middle-income countries: A systematic review.Journal of global health · 2021Pooled it
- Perinatal Mortality in Sub-Saharan Africa: A Meta-Analysis of Demographic and Health Surveys.Annals of global health · 2019Pooled it
- The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis.PloS one · 2019Pooled it
- Perinatal Mortality in South Asia: Systematic Review of Observational Studies.International journal of environmental research and public health · 2018Pooled it
- Trial
- Where Women Give Birth Is Changing in Sub-Saharan Africa: Evidence From 30 Countries Using DHS Data.Journal of pregnancy · 2026Article
- The effects of government-led cash transfer programmes on behavioural and health determinants of mortality: a difference-in-differences study.Lancet (London, England) · 2025Article
- Social and health system factors associated with maternal mortality in Eastern and Western China: Population health estimates using provincial-level data.PLoS medicine · 2025Article
- Article
- Regional Disparities, Economic Development, and Neonatal Mortality and Hospital Delivery in China.JAMA network open · 2024Article
- Trend, and multivariate decomposition of perinatal mortality in Ethiopia using further analysis of EDHS 2005-2016.BMC pediatrics · 2024Article
- Spatial Access to Continuous Maternal and Perinatal Health Care Services in Low-Resource Settings: Cross-Sectional Study.JMIR public health and surveillance · 2024Article
- Predicting place of delivery choice among childbearing women in East Africa: a comparative analysis of advanced machine learning techniques.Frontiers in public health · 2024Article
- Do disempowered childbearing women give birth at home in Sierra Leone? A secondary analysis of the 2019 Sierra Leone demographic health survey.BMC pregnancy and childbirth · 2023Article
- Predicting facility-based delivery in Zanzibar: The vulnerability of machine learning algorithms to adversarial attacks.Heliyon · 2023Article
- Spatial distribution and associated factors of dropout from health facility delivery after antenatal booking in Ethiopia: a multi-level analysis.BMC women's health · 2023Article
2 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFacility-based delivery has gained traction as a key strategy for reducing maternal and perinatal mortality in developing countries. However, robust evidence of impact of place of delivery on maternal and perinatal mortality is lacking. We aimed to estimate the risk of maternal and perinatal mortality by place of delivery in sub-Saharan Africa.
methodsWe conducted a systematic review of population-based cohort studies reporting on risk of maternal or perinatal mortality at the individual level by place of delivery in sub-Saharan Africa. Newcastle-Ottawa Scale was used to assess study quality. Outcomes were summarized in pooled analyses using fixed and random effects models. We calculated attributable risk percentage reduction in mortality to estimate exposure effect. We report mortality ratios, crude odds ratios and associated 95% confidence intervals.
resultsWe found 9 population-based cohort studies: 6 reporting on perinatal and 3 on maternal mortality. The mean study quality score was 10 out of 15 points. Control for confounders varied between the studies. A total of 36,772 pregnancy episodes were included in the analyses. Overall, perinatal mortality is 21% higher for home compared to facility-based deliveries, but the difference is only significant when produced with a fixed effects model (OR 1.21, 95% CI: 1.02-1.46) and not when produced by a random effects model (OR 1.21, 95% CI: 0.79-1.84). Under best settings, up to 14 perinatal deaths might be averted per 1000 births if the women delivered at facilities instead of homes. We found significantly increased risk of maternal mortality for facility-based compared to home deliveries (OR 2.29, 95% CI: 1.58-3.31), precluding estimates of attributable risk fraction.
conclusionEvaluating the impact of facility-based delivery strategy on maternal and perinatal mortality using population-based studies is complicated by selection bias and poor control of confounders. Studies that pool data at an individual level may overcome some of these problems and provide better estimates of relative effectiveness of place of delivery in the region.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.