Comparison of neonates born outside and inside hospitals in a children emergency unit, southwest of Nigeria.

Objective: To describe the effects of out-of-hospital birth on early neonatal morbidity and outcome among referred newborns.

Methods: Using a structured case record form, we prospectively collected data on place of birth, morbidity, and outcome of all neonates admitted to the Emergency Ward, University College Hospital, Ibadan, in the first week of life.

Results: Of the 541 admitted in the early neonatal period, 61.8% and 38.2% were delivered outside and inside the hospital setting, respectively. Babies were delivered at religious or "mission" house (46.7%), house of residence (38.0%), traditional birth attendants' homes (8.4%), and on the way to the hospital (6.9%). Births outside the hospital significantly increased as the birth order increased (chi = 34.04; P = 0.000). Over half of the out-of-hospital deliveries took place under personnel whose primary responsibilities did not include labor care. Women who had less than secondary level of education and those from the lower social class were more likely to deliver outside the hospital (P < 0.05). Out-of-hospital births were significantly associated with many complications, namely, hypothermia (53.6%), perinatal asphyxia (48.5%), hemorrhage (26.5%), cephalhematoma (12.9%), prematurity (9.9%), and neonatal tetanus (4.2%). Neonatal mortality rate of 12.6% in the out-of-hospital group was significantly higher than 6.3% obtained in the hospital birth group (P = 0.019).

Conclusions: Out-of-hospital births had greater risk of morbidity than hospital births. There is need to retrain and monitor the activities of birth attendants and midwives involved in births outside the hospitals closer than it is presently done.