We have thus far demonstrated the association of the distal socio-economic variables, ethnicity, and education and of three different proximate variables (place of delivery, antenatal care and distance to health facilities) to neonatal mortality.
In a first analysis of the proximate variables investigated, ANC attendance, delivery place, and distance to the closest health facility showed an association with neonatal mortality.
The explanatory variables included community level contextual variables, socioeconomic and proximate determinants, covering maternal, neonatal, pre-natal, delivery, and post-natal factors.
The explanatory variables included community level distal socioeconomic, the household and individual level socioeconomic determinants and proximate determinants, covering maternal, infant, pre-natal, delivery, and post-natal factors in line with conceptual framework of study.
Community factors (place of residence and ecological region), socio-demographic factors (wealth status, religion, education, maternal occupation) and proximate factors (the use of recommended ANC service, place of delivery, skilled attendance during delivery) were significantly associated with the utilisation of postnatal care.
On its request, the PGDPHM programme was evaluated to understand the programme structure and processes and delivery of programme contents and assess the proximate outcomes related to the work performance of the PGDPHM graduates.
The proximate determinants health care utilisation prior to and at delivery seems to be a plausible explanation for the discrepancy in survival between the majority and minority groups since ethnic minority mothers are more likely not to attend ANC and to deliver at home – which are well known and in the material presented here – as proven risk factors of neonatal death.
We have shown that the proximate cause of decreased fetal growth is not reduced oxygen availability, delivery, or consumption.
Specific aims were to analyse the rate and sources of information on neonatal mortality and to identify and assess socio-economic and proximate determinants of neonatal mortality including care-seeking patterns, place of delivery, and distance to health facilities.
If observation care is not associated with worse in-hospital or proximate outpatient outcomes, then it may advance the value of health care delivery.
In the final model, when the proximate variables were added to the significant variables of Model 2, place of delivery and antenatal care were significantly associated with postnatal care after controlling for community and sociodemographic factors.
