Caesarean delivery and neonatal mortality: Evidence from selected slums in and around Dhaka city, Bangladesh- A prospective cohort study

Background This study examined the survival of new-born up to neonatal period for those who delivered caesarean vs. vaginal using a prospective cohort. Methods A total of 6,989 births registered during 2016–2018 and were followed for neonatal survival from the selected slums of Dhaka (North & South) and Gazipur city corporations, where icddr,b maintained the Health and Demographic Surveillance System (HDSS) since 2015. Neonatal mortality was compared by maternal and new-born characteristics and mode of delivery using Z-ratios. Logistic regression model performed for neonatal mortality by mode of delivery controlling covariates and reported adjusted odd ratios with 95% confidence interval. Results Out of 6,989 births registered, 27.7% were caesarean and the rest were vaginal delivery; of these births, 265 neonatal deaths occurred during the follow-up. The neonatal mortality rate was 2.7 times (46 vs. 17 per 1,000 births) for vaginal than caesarean delivered. Until 3rd day of life, the risk of death was very high for both vaginal and caesarean delivered; however, on the 1st day of life, the risk of death was 3.8 times (24.8 vs. 6.3 per 1,000 births) for vaginal than caesarean delivered. In the regression analysis, the risk of neonatal mortality was higher for vaginal than caesarean delivered (aOR = 3.01; 95% CI: 1.80, 5.04), higher for adolescent than elderly adult mother (aOR = 1.64; 95% CI: 1.06, 2.55), lower for girl than boy (aOR = 0.75; 95% CI: 0.58, 0.96), lower for mother who had 5 or more years of schooling than those who had no schooling (aOR = 0.77; 95% CI: 0.57, 1.03), higher for multiple than singleton birth (aOR = 5.50; 95% CI: 2.78, 10.23), higher for very/moderate (aOR = 4.96; 95% CI: 2.56, 6.91), and late preterm birth (aOR = 1.86; 95% CI: 1.04, 2.06) than term birth. The causes of death differ for those vaginal and caesarean delivered. Conclusion Our study found that caesarean delivered babies had significantly lower neonatal mortality than vaginal delivered. This could be due to the differences in quality of care as caesarean delivery is performed by highly trained staff and the mother and newborn had to stay long time at the facility.