Association between Antenatal Care (ANC), Breastfeeding, and Neonatal Mortality in Cameroon Open Access

Simoben, Jamie (Spring 2023)

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Background: As of 2020, Cameroon has a neonatal mortality rate (NMR) of 28 per 1,000 live births. This study sought to determine if Antenatal Care (ANC) and initiating breastfeeding within an hour from birth (early initiation of breastfeeding, EIBF) influences the likelihood of neonatal mortality (NNM) in Cameroon.


Subjects and Method: This was a cross-sectional study using the 2018 Cameroon Demographic and Health Survey (DHS). Women aged 15-49 (n=13,527) provided information on all children they had given birth to (n=34,990), living or dead. Bivariate analysis, chi-square, and multivariate logistic regression models were used for analysis. Adjusted models analyzed three primary relationships: (1) ANC on NNM, (2) EIBF on NNM, and (3) ANC on EIBF.


Results: Adequate ANC coverage (aOR 1.16 (95%CI 0.64-2.10), p=0.195) and EIBF (aOR 0.55 (0.29-1.05), p=0.070) were not significantly associated with NNM, nor was adequate ANC coverage significantly associated with EIBF (aOR 1.05 (95%CI 0.89-1.25), p=0.543). Significant risk factors of NNM were adolescent mothers (OR 1.60 (95%CI 1.34-1.92), p=0.023), mothers with no education (OR 1.39(95%CI 1.05-1.85), p=0.014), poorer households (OR 1.26 (95%CI 0.96-1.66), p=0.027), being male(OR 1.23 (95%CI 1.08-1.41), p=0.002), and low birthweight (LBW) (OR 5.11 (95%CI 3.20-8.16), p<0.001). Factors that decreased the odds of EIBF were adolescent mothers (OR 0.87 (95%CI 0.73-1.03), p=0.020), mothers with no education (OR 0.81 (95%CI 0.64-1.002), p=0.002), a Muslim household (OR 0.74 (95%CI 0.50-1.09), p=0.006), being born at home (OR 0.75 (95%CI 0.61-0.91), p=0.005), born through Cesarean section(OR 0.36 (95%CI 0.25-0.49), p<0.001), or being male (OR 0.88 (95% CI0.78-1.00), p=0.041). Houses of the richest quintile(OR 1.65 (95%CI 1.31-2.07), p<0.001) or mothers with a higher education(OR 1.49 (95%CI 1.09-2.04), p=0.002) made children significantly more likely to experience EIBF.


Conclusion: Receiving adequate ANC and EIBF was not significantly associated with NNM. Receiving adequate ANC was not associated with EIBF. Maternal age, maternal education, household wealth index, sex of the child, and birthweight were significant risk factors of NNM. Maternal age, maternal education, household wealth index, religion, mode of delivery, and sex of the child were significant predictors of EIBF.

Table of Contents

Table of Contents

Chapter 1: Background Literature Review 1

I. Child Mortality and the Global Burden of Disease 1

a. Global Trends in Child Mortality 1

b. Global Efforts to Reduce Child Mortality (MDG/SDG) 1

c. Disparity in Child Mortality in LMIC 2

d. Child Mortality in Cameroon 3

II. Neonatal Mortality in Cameroon 4

a. Clinical Causes of Neonatal Mortality 4

b. Risk Factors Associated with Neonatal Mortality 8

III. Antenatal Care (ANC) 13

a. WHO Recommendations on ANC 13

b. Benefits of ANC 15

c. ANC and Neonatal Mortality 19

d. ANC in Cameroon 20

e. Patterns of ANC usage in Cameroon 21

f. Attitudes Towards ANC in Cameroon 23

g. Adoption of Revised 2016 WHO Guidelines for ANC 25

IV. Breastfeeding 26

a. WHO Recommendations on Breastfeeding 26

b. Breastfeeding and Neonatal Mortality 27

c. Barriers to Breastfeeding in Cameroon 28

V. Research Gap 33

VI. Significance 34

Chapter 2: Journal Article 35

Student Contribution 35

I. Abstract 36

II. Background 38

III. Subjects and Methods 40

1. Study Design, Population, and Sample 40

2. Study Instruments 40

3. Study Variables 41

4. Data analysis 41

IV. Results 42

1. Sample Characteristics 42

2. Bivariate Analysis 44

3. Multivariate Analysis 44

V. Discussions 45

VI. Tables and Figures 52

Chapter 3: Future Directions/Public Health Implications 57

Future Directions 57

Public Health Implications 58

Appendix 59

Supplemental Data Tables 59

References 65

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