"Why not bathe the baby today?": A qualitative study of thermal care beliefs and practices in four African sites

Level of skin-to-skin care practices among postnatal mothers in Ethiopia. A systematic review and meta-analysis

Introduction

Even though skin-to-skin contact offers several advantages for the survival of the newborn, it is not often practiced in Ethiopia. For instance, hypothermia which increases the risk of neonatal mortality by five times is prevented by this practice. Despite this, there are inconsistent findings that can affect policymaking. Consequently, this metanalysis aimed to produce trustworthy national data regarding skin-to-skin care practice and its determinants among postpartum mothers in Ethiopia.

Methods

A search of the publications was conducted using MEDLINE, PubMed, Embase, Scopus, Web of Sciences, and Google Scholar. The program used for cleaning and analysis was STATA version 18.2. The random-effects model was utilized to estimate the pooled prevalence, which was then presented using a forest plot with a 95 % confidence interval. We evaluated heterogeneity using I2 and Cochrane Q statistics. Moreover, a visual examination of a funnel plot and Egger's regression test were used to evaluate publication bias.

Results

This study included eight studies with a total of 10410 postpartum mothers. The overall level of skin-to-skin care practices was 48 % (95%CI: 31, 65. I2=99.38 %, P = 0.001). Based on subgroup analysis by year of publication, studies published between 2017 and 2019 years showed that the level of skin-to-skin care practice among postnatal mothers was 52 % (95 % CI: 14-89, I2 = 99.19). The knowledge of mothers about skin-to-skin care was significantly associated with practicing a level of skin-to-skin care.

Conclusions

The findings showed that in Ethiopia, comparatively less than half of the newborns received skin-to-skin care. Moreover, there was a substantial correlation between the mother's knowledge and practice of skin-to-skin care. Therefore, both the government and all stakeholders should take coordinated action to improve and expand skin-to-skin care practices through health education, so that all postnatal mothers can practice this vital newborn care.

Neonatal emollient therapy and massage practices in Africa: a scoping review

There have been few reports from Africa on the use and health effects of emollient therapy for newborn infants. We aimed to describe neonatal skin care practices in Africa, and to illuminate opportunities to introduce evidence-based interventions to improve these practices. We conducted a scoping review of the quantitative and qualitative published peer-reviewed and grey literature in English on emollient use in Africa. Outcomes of interest included neonatal skin care practices, with a focus on the application of oils and other products to infant skin, including in association with bathing and massage. We screened 5257 articles and summarised findings from 23 studies-13 qualitative, nine quantitative and one mixed methods-that met our study criteria. Seven studies reported the use of emollients for perceived benefits, including thermal care, treatment for illness, promotion of growth and development, infection reduction, skin condition improvement, spirituality and lubrication to aid massage. Four studies reported the quantitative health impact of skin care product applications, including improvements in skin condition, neurodevelopment and bone growth, as well as a reduction in nosocomial infections. This review highlights opportunities for skin care intervention and future research on neonatal skin care practices in Africa.

Maternal and child factors associated with late neonatal bathing practices in Nigeria: evidence from a national survey

BACKGROUND

Twohundred and seventy out of every thousand live births died in Nigeria in 2019. These deaths were attributable to infections, complications of preterm birth, and intrapartum-related conditions. The World Health Organization recommends withholding bathing of neonates until 24 h after birth or until their vital signs become stable to prevent hypothermia. Despite the link between neonatal bathing and thermal control, the subject is understudied in Nigeria. This study aimed at investigating the factors associated with late neonatal bathing practices in Nigeria.

METHODS

The study adopted a cross-sectional design and extracted data from the women's file of the 2018 Nigerian Demographic and Health Survey. The unit of analysis was limited to 12,972 women who had complete data for the study. We applied chi-square test of independence to ascertain the association between the outcome variable and explanatory variables. At 95% confidence interval, two logistic regression models were built with Model I consisting of only maternal factors whilst Model II contained both maternal and child factors, and results were presented in adjusted odds ratio.

RESULTS

Descriptively, 12% (CI = 0.122-0.134) of the women bathed their neonates after 24 h of delivery. Inferentially, women with secondary/higher education [AOR = 1.30, CI = 1.05-1.61], the rich [AOR = 1.24, CI = 1.03-1.50], those with access to mass media [AOR = 131, CI = 1.15-1.50], women that professed other religions [AOR = 9.28, CI = 4.24-17.56], those who delivered in a health facility [AOR = 1.93, CI = 1.66-2.25], whose child was small in size at birth [AOR = 1.46, CI = 1.21-1.77] and delivered by caesarean section [AOR = 2.50, CI = 1.97-3.18] had higher odds of bathing their neonates 24 h after birth.

CONCLUSIONS

The proportion of women who practised late neonatal bathing was generally low. To improve the practice of late neonatal bathing, much-concerted effort should be directed to women's education and approaches to increasing receptivity of late neonatal bathing among pregnant women through the media. The Nigerian Ministry of Health should incorporate routine counselling on the risks of bathing newborns prematurely into antenatal and postnatal care services.

Evidence-Based Consensus Recommendations for Skin Care in Healthy, Full-Term Neonates in India

Purpose

Neonatal skin care practices guided by personal experience and preferences might be substantially different across different hospital settings. The aim of this consensus recommendation is to provide clinical practice guidance to healthcare practitioners on evidence-based neonatal skin care practices from delivery-to-discharge, in hospital settings.

Patients and Methods

A Scientific Advisory Board meeting on "Evidence-based Neonatal Skin Care Practices and Protocols" was held in December 2020 with an expert panel comprising neonatologists, pediatricians, obstetricians and gynecologists and pediatric dermatologist. Comprehensive literature search was performed up to 23 March 2021 using PubMed and Google Scholar to retrieve relevant evidence.

Results

Recommendations were developed on critical aspects of skin care in healthy full-term neonates including cleansing at birth, skin-to-skin care, cord care, diaper area care, initial and routine bathing, cleansers and emollients use, and criteria to choose appropriate skin care products. Recommendations include inclusion of skin assessment in routine neonatal care, first bath timing after cardio-respiratory and thermal stabilization, 6-24 hours after birth; bathing with water alone or adding a mild liquid cleanser could be considered appropriate as it does not impact the developing skin barrier; use of emollients is recommended for neonates with higher risk of development of eczema to maintain and enhance skin barrier function and integrity; and inclusion of skin care advice in neonatal discharge checklist. Importance of rigorous quality control, high-quality clinical trials for assessment of baby products, usage of products that are formulated appropriately for newborns, and full label transparency for baby products were highlighted. The panel identified gaps in literature and discussed the scope for future research.

Conclusion

These recommendations may help to standardize evidence-based skin care for healthy full-term neonates in Indian hospital settings to improve the quality of care that neonates receive in hospital and facilitate improvement in overall neonatal health outcomes.

Early Baby Bathing Practice and its Associated Factors Among Mothers who Give Birth in the Past One Month in Gurage Zone, Ethiopia, 2022

Background

Ethiopia has still suffered the highest burden of neonatal morbidity and mortality. The World Health Organization's practical guide for the thermal protection of newborns recommends delaying the bathing of newborns for at least 24 h following delivery, as it is crucial to prevent neonatal mortality and morbidity and to achieve 2030 sustainable development goals. However, little is known about delayed newborn bathing practices in Ethiopia. Therefore, the purpose of this study was to assess early baby bathing practices and associated factors among postpartum women.

Methods

A mixed community-based cross-sectional study was conducted among a total of 582 postnatal mothers. A multistage sampling technique was used to select study participants. A pre-tested and structured questionnaire was used to collect data. The data was entered into Epi-Data version 4.2.0 and exported into SPSS version 23 for analysis. Three focus group discussions with postnatal mothers were used for qualitative data. A purposive sampling method was used. Thematic analysis was used for qualitative data. Bivariate and multivariate logistic regression analyses were used in the analysis. To declare statistically significant, p-values of .05 were used.

Result

This study revealed that 250 (43%) mothers were practicing early newborn bathing. Early baby bathing was associated with antenatal care (ANC) follow-up (AOR  =  5.1  =  .95% CI  =  (2.6-9.9)), having no recent complications during birth (AOR  =  1.9  =  95% CI  =  (1.02-3.6), having information about the time of baby bathing (AOR  =  6.02, 95% CI  =  (3.9, 9.3)), knowledge of hypothermia (AOR  =  3.3  =  95.6% CI (1.9-5.8), and poor knowledge about neonatal danger signs.

Conclusion and Recommendation

ANC follow-up, recent complications during birth, having information, knowledge about hypothermia, and neonatal danger signs were significantly associated with early baby bathing. Continuous health education on the appropriate time of baby bathing and neonatal danger signs and enhanced ANC service utilization are recommended.

Mother and newborn skin-to-skin contact and timely initiation of breastfeeding in sub-Saharan Africa

BACKGROUND

Mother and newborn skin-to-skin contact (SSC) plays a key role in breastfeeding practices of mothers. In this study, we examined the association between mother and newborn SSC and timely initiation of breastfeeding in sub-Saharan Africa (SSA).

METHODS

This cross-sectional study utilized nationally representative data from the Demographic and Health Surveys of 17 countries in SSA from 2015 to 2020. Multilevel binary logistic regression analysis was performed to examine the association between mother and newborn SSC and timely initiation of breastfeeding. The results are presented using adjusted odds ratios (aOR), with 95% confidence interval (CI).

RESULTS

The pooled prevalences of mother and newborn SSC and timely initiation of breastfeeding were 45.68% (95% CI = 34.12-57.23) and 62.89% (95% CI = 55.67-70.11), respectively. Mothers who practiced newborn SSC were more likely to practice timely initiation of breastfeeding compared to those who did not practice SSC [aOR = 1.68, 95% CI = 1.58, 1.78] and this persisted after controlling for all the covariates [aOR = 1.38, 95% CI = 1.29, 1.47]. At the country level, mother and newborn SSC increased the odds of timely initiation of breastfeeding in Angola [aOR = 1.99, 95% CI = 1.44, 2.76], Cameroon [aOR = 1.43, 95% CI = 1.02, 1.99], Ethiopia [aOR = 1.62, 95% CI = 1.16, 2.28], Guinea [aOR = 1.69, 95% CI = 1.10, 2.60], Liberia [aOR = 2.03, 95% CI = 1.33, 3.12], Malawi [aOR = 1.47, 95% CI = 1.02, 2.12], Mali [aOR = 1.42, 95% CI = 1.10, 1.84], Sierra Leone [aOR = 1.87, 95% CI = 1.23, 2.83], South Africa [aOR = 2.59, 95% CI = 1.41, 4.76], Tanzania [aOR = 1.60, 95% CI = 1.27, 2.01], Uganda [aOR = 1.43, 95% CI = 1.02, 1.99], Zambia [aOR = 1.86, 95% CI = 1.50, 2.30], and Zimbabwe [aOR = 1.65, 95% CI = 1.24, 2.21].

CONCLUSION

The prevalence of SCC was relatively low but timely initiation of breastfeeding was high. Mother and newborn SSC is a strong predictor of timely initiation of breastfeeding in SSA. To enhance timely initiation of breastfeeding after birth, this study recommends that more child and maternal healthcare interventions focused on improving mother and newborn SSC should be implemented.

Knowledge, Practice, and Associated Factors of Essential Newborn Care among Sudanese Women in Eastern Sudan

(1) Background: There is a high neonatal mortality rate in countries with low resources, especially sub-Saharan countries. There is no published data in Sudan on mothers’ knowledge and practice of essential newborn care. This study aimed to assess the maternal knowledge and practice of essential newborn care in Gadarif city, eastern Sudan. (2) Methods: A cross-sectional study was conducted in Gadarif city, eastern Sudan. Postnatal mothers (384) were recruited from postnatal and vaccination clinics. A structured questionnaire was used to collect the data. Mothers who responded to essential newborn care knowledge and practice items at a rate equal to 75% or above were classified as having good knowledge and practice. Logistic regression analysis was performed to identify the factors associated with essential newborn care knowledge and practice. (3) Results: In this study, 268 (66.4%) and 245 (63.8%) of the 384 participants had good knowledge and practice of essential newborn care, respectively. None of the investigated factors (age, residence, education, occupation, parity, antenatal care, and mode of delivery) was associated with knowledge and practice of essential newborn care with sociodemographic and obstetric factors. Mothers with poor knowledge were less likely to have good practices (adjusted odds ratios = 0.41; 95% CI (0.26–0.64)). The reported malpractices were giving dietary supplements to the babies (48.2%), mainly water (40.0%) and cow’s milk (43.2%), and putting substances on the umbilical cord (62.8%), with butter (92.1%) accounting for the majority. (4) Conclusion: In the present study, around two-thirds of the participants had good essential newborn care knowledge and practice. Poor knowledge was less likely to be associated with good newborn care practices. More research is needed to build baseline data for neonatal mortality reduction plans.

Self-care interventions for sexual and reproductive health in humanitarian and fragile settings: a scoping review

BACKGROUND

Self-care is the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and manage illness and disability with or without a health care provider. In resource-constrained settings with disrupted sexual and reproductive health (SRH) service coverage and access, SRH self-care could play a critical role. Despite SRH conditions being among the leading causes of mortality and morbidity among women of reproductive age in humanitarian and fragile settings, there are currently no reviews of self-care interventions in these contexts to guide policy and practice.

METHODS

We undertook a scoping review to identify the design, implementation, and outcomes of self-care interventions for SRH in humanitarian and fragile settings. We defined settings of interest as locations with appeals for international humanitarian assistance or identified as fragile and conflict-affected situations by the World Bank. SRH self-care interventions were described according to those aligned with the Minimum Initial Services Package for Reproductive Health in Crises. We searched six databases for records using keywords guided by the PRISMA statement. The findings of each included paper were analysed using an a priori framework to identify information concerning effectiveness, acceptability and feasibility of the self-care intervention, places where self-care interventions were accessed and factors relating to the environment that enabled the delivery and uptake of the interventions.

RESULTS

We identified 25 publications on SRH self-care implemented in humanitarian and fragile settings including ten publications on maternal and newborn health, nine on HIV/STI interventions, two on contraception, two on safe abortion care, one on gender-based violence, and one on health service provider perspectives on multiple interventions. Overall, the findings show that well-supported self-care interventions have the potential to increase access to quality SRH for crisis-affected communities. However, descriptions of interventions, study settings, and factors impacting implementation offer limited insight into how practical considerations for SRH self-care interventions differ in stable, fragile, and crisis-affected settings.

CONCLUSION

It is time to invest in self-care implementation research in humanitarian settings to inform policies and practices that are adapted to the needs of crisis-affected communities and tailored to the specific health system challenges encountered in such contexts.

Early Newborn Bath Practice and Its Associated Factors in Jimma, South West Ethiopia, 2021

Aims

The timing of the first bath is an important variable in newborn care despite variations from setting to setting. Early first bath can affect the newborn’s temperature, blood sugar levels, bonding with his/her mother, comfort, and security. Thus, timing affects several aspects of newborn care and is still a major concern. However, in Ethiopia, there is insufficient evidence regarding newborn bath timing. Therefore, this study aimed to assess early newborn bath practice and its associated factors in Jimma, Southwest Ethiopia, 2021.

Materials and Methods

An institutional-based cross-sectional study was conducted from July to August 2021 on 388 postpartum women who came for newborn immunization. Data were collected through face-to-face interviews using a structured questionnaire. Data were entered into Epi-data 4.4.2.1 and exported to Stata version 14 for cleaning and analysis. Logistic regression was used to determine the association between explanatory and response variables. The level of significance was declared at a p-value of less than 0.05 in multivariable logistic regression.

Results

This study revealed 126 (32.5%) of mothers were practicing early newborn bathing. Vaginal mode of delivery (AOR: 3.84 (95% CI: 1.96–7.52)), poor knowledge about danger signs (AOR: 6.78 (95% CI: 3.77–12.19), poor knowledge about hypothermia (AOR: 0.35 (95% CI: 0.20–0.58) and educational level of women (AOR: 0.33 (95% CI: 0.15–0.73) were variables significantly associated with early newborn bathing practice.

Conclusion

Early neonatal bathing practice in this study is high and needs priority as it results in neonatal hypothermia and its complications. Therefore, Education for women and their families on delayed bathing of their newborns could begin in antenatal care visit, on admission into the labor and delivery unit and again on the postpartum unit.

Skin-to-skin contact and breastfeeding practices in Nigeria: a study of socioeconomic inequalities

BACKGROUND

The effects of breastfeeding practices on children's health are undoubtedly of great interest. However, inequalities in breastfeeding practices and mother and newborn skin-to-skin contact (SSC) exist in many resource-constrained settings. This study examined the regional prevalence and socioeconomic inequalities in exclusive breastfeeding (EBF), early initiation of breastfeeding and SSC in Nigeria.

METHODS

Data on 2936 infants under six months were extracted from the 2018 Nigeria Demographic and Health Survey (NDHS) to determine EBF. In addition, data on 21,569 children were analysed for early initiation of breastfeeding and SSC. Concentration index and curves were used to measure socioeconomic inequalities in EBF, early initiation of breastfeeding and SSC.

RESULTS

The prevalence of EBF, early initiation of breastfeeding and SSC were 31.8, 44.2 and 12.1% respectively. Furthermore, Ogun state had the highest prevalence of EBF (71.4%); while Bayelsa state had the highest prevalence of SSC (67.8%) and early initiation of breastfeeding (96.2%) respectively. Urban dwellers had higher prevalence of EBF, SSC and early initiation of breastfeeding across household wealth quintile and by levels of mothers' education in contrast to their rural counterparts. We quantified inequalities in early initiation of breastfeeding, EBF, and SSC according to household wealth and maternal education. The study outcomes had greater coverage in higher household wealth, in contrast to the lower household wealth groups; early initiation of breastfeeding (concentration index = 0.103; p = 0.002), EBF (concentration index = 0.118; p < 0.001), and SSC (concentration index = 0.152; p < 0.001) respectively. Furthermore, early initiation of breastfeeding (concentration index = 0.091; p < 0.001), EBF (concentration index = 0.157; p < 0.001) and SSC (concentration index = 0.156; p < 0.001) had greater coverage among mothers with higher educational attainment.

CONCLUSION

Low prevalence and socioeconomic inequalities in early initiation of breastfeeding, EBF and SSC were identified. We recommend that health promotion programs targeted and co-designed with disadvantaged mothers are critical to meet global breastfeeding targets. Also, future researchers should conduct further studies especially clinical control trials and qualitative studies to unravel the possible reasons for differences in the indicators.

Coverage and factors associated with mother and newborn skin-to-skin contact in Nigeria: a multilevel analysis

BACKGROUND

Mother and newborn skin-to-skin contact (SSC) is an immediate postpartum intervention known to improve the health of newborn and mothers alike. Albeit, there is paucity of data that explored the coverage or factors associated with SSC in Nigeria. Therefore, we aimed to explore the coverage and hierarchical nature of the factors associated with SSC among women of reproductive age in Nigeria.

METHODS

The 2018 Nigeria Demographic and Health Survey (NDHS) data was used for this study. Data on 29,992 women who had ever given birth were extracted for analysis. SSC was the outcome variable as determined by women's report. A multivariable multilevel logistic regression model was used to estimate the fixed and random effects of the factors associated with SSC. Statistical significance was determined at p< 0.05.

RESULTS

The coverage of SSC was approximately 12.0%. Educated women had higher odds of SSC, when compared with women with no formal education. Those who delivered through caesarean section (CS) had 88% reduction in SSC, when compared with women who had vaginal delivery (OR= 0.12; 95%CI: 0.07, 0.22). Women who delivered at health facility were 15.58 times as likely to practice SSC, when compared with those who delivered at home (OR= 15.58; 95%CI: 10.64, 22.82). Adequate ANC visits and low birth weight significantly increased the odds of SSC. Women from richest household were 1.70 times as likely to practice SSC, when compared with women from poorest household (OR= 1.70; 95%CI: 1.04, 2.79). There was 65% reduction in SSC among women with high rate of community non-use of media, when compared with women from low rate of community non-use of media (OR= 0.35; 95%CI: 0.20, 0.61).

CONCLUSION

SSC coverage was low in Nigeria. Moreover, individual, household and community level factors were associated with SSC. More enlightenment should be created among women to bring to limelight the importance of SSC specifically to newborn's health.

Neonatal hypothermia in Northern Uganda: a community-based cross-sectional study

OBJECTIVE

To determine the prevalence, predictors and case fatality risk of hypothermia among neonates in Lira district, Northern Uganda.

SETTING

Three subcounties of Lira district in Northern Uganda.

DESIGN

This was a community-based cross-sectional study nested in a cluster randomised controlled trial.

PARTICIPANTS

Mother-baby pairs enrolled in a cluster randomised controlled trial. An axillary temperature was taken during a home visit using a lithium battery-operated digital thermometer.

PRIMARY AND SECONDARY OUTCOMES

The primary outcome measure was the prevalence of hypothermia. Hypothermia was defined as mild if the axillary temperature was 36.0°C to <36.5°C, moderate if the temperature was 32.0°C to <36.0°C and severe hypothermia if the temperature was <32.0°C. The secondary outcome measure was the case fatality risk of neonatal hypothermia. Predictors of moderate to severe hypothermia were determined using a generalised estimating equation model for the Poisson family.

RESULTS

We recruited 1330 neonates. The prevalence of hypothermia (<36.5°C) was 678/1330 (51.0%, 95% CI 46.9 to 55.1). Overall, 32% (429/1330), 95% CI 29.5 to 35.2 had mild hypothermia, whereas 18.7% (249/1330), 95% CI 15.8 to 22.0 had moderate hypothermia. None had severe hypothermia. At multivariable analysis, predictors of neonatal hypothermia included: home birth (adjusted prevalence ratio, aPR, 1.9, 95% CI 1.4 to 2.6); low birth weight (aPR 1.7, 95% CI 1.3 to 2.3) and delayed breastfeeding initiation (aPR 1.2, 95% CI 1.0 to 1.5). The case fatality risk ratio of hypothermic compared with normothermic neonates was 2.0 (95% CI 0.60 to 6.9).

CONCLUSION

The prevalence of neonatal hypothermia was very high, demonstrating that communities in tropical climates should not ignore neonatal hypothermia. Interventions designed to address neonatal hypothermia should consider ways of reaching neonates born at home and those with low birth weight. The promotion of early breastfeeding initiation and skin-to-skin care could reduce the risk of neonatal hypothermia.

TRIAL REGISTRATION NUMBER

ClinicalTrial.gov as NCT02605369.

Prevalence and determinants of mother and newborn skin-to-skin contact in The Gambia: a secondary data analysis

BACKGROUND

Skin-to-skin contact (SSC) between mother and the newborn brings many benefits including its potential to promote the survival of the newborn. Nevertheless, it is a practice that is underutilized in many resource-constrained settings including The Gambia where a high rate of maternal and child mortality has been reported. In this study, we examined the prevalence and determinants of mother and newborn SSC in The Gambia.

METHODS

We used secondary data from The Gambia Multiple Indicator Cluster Survey (MICS)-2018. Data from 9205 women between 15-49 years who gave birth within 5 years of the survey was extracted for the analysis. Percentages and chi-square test were used for analyses. The significant variables from chi-square test were included in the multivariable binary logistic regression model to calculate the adjusted odds ratios (with corresponding 95% CI) of the factors associated with mother and newborn SSC.

RESULTS

The results of this study showed that the national prevalence of mother and newborn SSC was 35.7%. Across local government areas; Mansakonko (47.8%) and Kerewan (44.2%) had the highest prevalence, while Basse (28.5%) and Brikama (26.5%) had the least prevalence of mother and newborn SSC in The Gambia. Based on results from the logit model, normal weight (at least 2.5 kg) children were 1.37 times as likely to have mother and newborn SSC, compared with the low birthweight (< 2.5 kg) children (OR = 1.37; 95% CI: 1.05, 1.78). In addition, there was 38% increase in the odds of rural women who reported mother and newborn SSC, compared with urban women (OR = 1.38; 95% CI: 1.06, 1.79). Women who delivered at health facility were 3.35 times as likely to have mother and newborn SSC, compared with women who delivered at home (OR = 3.35; 95% CI: 2.37, 4.75). Furthermore, women who initiated antenatal care (ANC) after the first trimester had 21% reduction in the odds of mother and newborn SSC, compared with women who initiated ANC within the first trimester (OR = 0.79; 95% CI: 0.68, 0.93).

CONCLUSION

The prevalence of mother and newborn SSC was low. In addition, geographical residence, birth weight, urban-rural residential status, place of delivery, and timing to ANC initiation were associated with mother and newborn SSC. There is a need to promote institutional based delivery using skilled birth attendance, promote early ANC initiation and healthy fetal growth.

Characteristics of Early Newborn Care: A Descriptive Analysis of Recent Births in Nigeria

BACKGROUND OR OBJECTIVES

The neonatal period, the first 28 days of life, is the most critical period for child survival. In 2017, 214,000 children in Nigeria died during the neonatal period. Newborn care practices play a key role in preventing these deaths. The aim of this study was to examine the association between delivery location and early newborn care in Nigeria.

METHODS

Data from the 2013 Nigeria Demographic and Health Survey were analyzed. The main exposure variable was delivery location (home, public hospital, public health center/clinic and private hospital/clinic). The outcomes were early initiation of breastfeeding, breastfeeding support, and cord examination. We used multivariate logistic regression to estimate the odds of newborn care.

RESULTS

We observed that the prevalence of all three outcome indicators was low. After adjusting for confounders, birth in public health facilities, compared to home birth, was associated with early initiation of breastfeeding (public hospitals: OR 1.62, 95% CI: 1.29-2.03; public health centers/clinics OR: 1.28, 95% CI: 1.02-1.61). Breastfeeding support and cord examination were each associated with birth in public hospitals only compared to home birth (OR 1.41, 95% CI: 1.09-1.81 and OR 1.41, 95% CI: 1.11-1.79, respectively).

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Early newborn care in Nigeria was suboptimal and the quality of this care varied across delivery locations and birth attendants. Public hospitals had the most favorable newborn care outcomes. Policies and programs to enhance the quality of facility-based early newborn care and promote community-based newborn care could improve neonatal outcomes and reduce overall child mortality in resource-challenged settings.

Monitoring childbirth care in primary health facilities: a validity study in Gombe State, northeastern Nigeria

BACKGROUND

Improving the quality of facility-based births is a critical strategy for reducing the high burden of maternal and neonatal mortality and morbidity across all settings. Accurate data on childbirth care is essential for monitoring progress. In northeastern Nigeria, we assessed the validity of childbirth care indicators in a rural primary health care context, as documented by health workers and reported by women at different recall periods.

METHODS

We compared birth observations (gold standard) to: (i) facility exit interviews with observed women; (ii) household follow-up interviews 9-22 months after childbirth; and (iii) health worker documentation in the maternity register. We calculated sensitivity, specificity, and area under the receiver operating curve (AUC) to determine individual-level reporting accuracy. We calculated the inflation factor (IF) to determine population-level validity.

RESULTS

Twenty-five childbirth care indicators were assessed to validate health worker documentation and women's self-reports. During exit interviews, women's recall had high validity (AUC≥0.70 and 0.75

CONCLUSIONS

In addition to standard household surveys, monitoring of facility-based childbirth care should consider drawing from and linking multiple data sources, including routine health facility data and exit interviews with recently delivered women.

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MESH Headings

• Adolescent
• Adult
• Delivery, Obstetric/standards
• Documentation/methods
• Female
• Humans
• Infant, Newborn
• Medical Records
• Middle Aged
• Nigeria
• Pregnancy
• Primary Health Care
• Reproducibility of Results
• Rural Health Services
• Self Report
• Young Adult

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Affiliation(s)

Antoinette Alas Bhattacharya Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
Elizabeth Allen Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
Nasir Umar Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
Adamu Umar Usman Data Research and Mapping Consult, Abuja, Nigeria
Habila Felix State Primary Health Care Development Agency, Gombe, Nigeria
Ahmed Audu State Primary Health Care Development Agency, Gombe, Nigeria
Joanna Rm Schellenberg Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
Tanya Marchant Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK

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Mothers' Experiences with Neonatal Care for Low Birth Weight Infants at Home; A Qualitative Study in the Hohoe Municipality, Ghana

PURPOSE

To explore knowledge and beliefs of mothers on low birth weight (LBW), examine care provision at home and societal perceptions of LBW infants.

DESIGN AND METHODS

This qualitative study was conducted using hermeneutic phenomenological approach. Data of mothers who delivered LBW infants within 2 years preceding the study were purposively extracted from the medical records of the Hohoe Municipality Hospital in Ghana. Twenty semi-structured interviews and three focus group discussions were conducted. A thematic analysis approach was performed using Atlas.ti.

RESULTS

Mothers identified and described LBW babies based on frailty, size and activity levels. LBW recognition was easier for multiparous mothers by comparing with previous deliveries. LBW was linked to poor maternal diet, diseases during pregnancy and heavy workload. Although most mothers perceived their LBW babies as healthy irrespective of the size a few home-care practises differed. Smaller LBW infants were less likely to be socially accepted. In the first few weeks after birth the care of LBW infants is the core responsibility of grandmothers. Primiparous mothers and those whose infants were smaller (<2 kg) quested for more information and support on LBW newborn care at home.

CONCLUSION

There is a need to increase knowledge on risk factors and tackle lapses in the recognition and care of LBW infants. Counselling on recommended neonatal care should begin during antenatal care and reiterated during postnatal care.

PRACTICAL IMPLICATION

Tailored in-depth and culturally-adapted counselling, discharge instructions and home-based postnatal visits targeted at LBW infants and their primary caregivers could improve care.

Effect of Timing of the First Bath on a Healthy Newborn's Temperature

OBJECTIVE

To determine if a healthy newborn's age in hours (3, 6, or 9 hours after birth) affects thermoregulatory status after the first bath as indicated by axillary and skin temperatures.

DESIGN

Quasi-experimental, mixed-model (between subjects and within subjects) design with hours of age as the nonrepeated variable and prebath and postbath temperatures as the repeated variables.

SETTING

Family-centered care unit at an urban hospital in the southwestern United States.

PARTICIPANTS

Healthy newborns (N = 75) 37 weeks or more completed gestation.

METHODS

Mothers chose time of first bath based on available time slots (n = 25 newborns in each age group). Research nurses sponge bathed the newborns in the mothers' rooms. Axillary temperature, an index of core temperature, was measured with a digital thermometer, and skin temperature, an index of body surface temperature, was measured with a thermography camera. Temperatures were taken before the bath; immediately after the bath; and 5, 30, 60, and 120 minutes after the bath. Immediately after the bath, newborns were placed in skin-to-skin care (SSC) for 60 or more minutes.

RESULTS

We found a difference (p = .0372) in axillary temperatures between the 3- and 9-hour age groups, although this difference was not clinically significant (0.18 °F [0.10 °C]). We found no statistically significant differences in skin temperatures among the three age groups. Regardless of age group, axillary and skin temperatures initially decreased and then recovered after the bath.

CONCLUSION

For up to 2 hours postbath, axillary and skin temperatures were not different between healthy newborns bathed at 3, 6, or 9 hours of age. Thermography holds promise for learning about thermoregulation, bathing, and SSC.

Thermal care of newborns: drying and bathing practices in Malawi and Bangladesh

Background

Thermal care of newborns is one of the recommended strategies to reduce hypothermia, which contributes to neonatal morbidity and mortality. However, data on these two topics have not been collected at the national level in many surveys. In this study, we examine two elements of thermal care: drying and delayed bathing of newborns after birth with the objectives of examining how two countries collected such data and then looking at various associations of these outcomes with key characteristics. Further, we examine the data for potential data quality issues as this is one of the first times that such data are available at the national level.

Methods

We use data from two nationally-representative household surveys: the Malawi Multiple Indicator Cluster Survey 2014 and the Bangladesh Demographic and Health Survey 2014. We conduct descriptive analysis of the prevalence of these two newborn practices by various socio-demographic, economic and health indicators.

Results

Our results indicate high levels of immediate drying/drying within 1 hour in Malawi (87%). In Bangladesh, 84% were dried within the first 10 minutes of birth. Bathing practices varied in the two settings; in Malawi, only 26% were bathed after 24 hours but in Bangladesh, 87% were bathed after the same period. While in Bangladesh there were few newborns who were never bathed (less than 5%), in Malawi, over 10% were never bathed. Newborns delivered by a skilled provider tended to have better thermal care than those delivered by unskilled providers.

Conclusion

These findings reveal gaps in coverage of thermal care and indicate the need to further develop the role of unskilled providers who can give unspecialized care as a means to improve thermal care for newborns. Further work to harmonize data collection methods on these topics is needed to ensure comparable data across countries.

Skin care for healthy babies at term: A systematic review of the evidence

OBJECTIVES

to identify what skin practices are important for the protection of baby skin in healthy term babies (0-6 months) and generate evidence-based conclusions to inform health professionals and parents.

DESIGN

eleven databases were searched for all empirical quantitative and qualitative research published between 2000-2015 which explored baby skin care for bathing and cleansing, nappy care, hair and scalp care, management of dry skin or baby massage, for healthy term babies up to 6 months old. Papers not published in English were excluded. A total of 3062 papers were identified. Pairs of reviewers assessed all citations and extracted data independently. There were 26 included papers: 16 RCTs, 3 non-randomised experimental studies, 1 mixed-methods study and 6 qualitative studies. Primary and secondary outcome measures were analysed using meta-analysis or narrative descriptive statistics. Synthesis of qualitative data was not possible due to disparity of the evidence.

FINDINGS

from the small numbers of studies with comparable data, there was no evidence of any significant differences between tested wash products and water or tested baby wipes and water. There was some evidence to suggest that daily use of full-body emollient therapy may help to reduce the risk of atopic eczema in high risk babies with a genetic predisposition to eczema; however, the use of olive oil or sunflower oil for baby dry skin may adversely affect skin barrier function. There was no evidence about hair/scalp care or baby massage. Qualitative research indicates that parents and health professionals believe that water alone is best.

KEY CONCLUSIONS

meta-analysis was restricted due to the lack of consistency of study outcome measures. Although there is considerable RCT evidence comparing the use of specific products against water alone, or another product, for bathing, cleansing and nappy care, the power of this evidence is reduced due to inconsistency of outcome measures in terms of outcome, treatment site or time-point. The development of a core outcome measure set is advocated for trials assessing skin care practices.

IMPLICATIONS FOR PRACTICE

this review offers health professionals best evidence available on which to base their advice. Of those studies with comparative outcomes, the evidence indicates no difference between the specific products tested and water alone; offering parents a choice in their baby skin care regimen. Protocol available: http://www.crd.york.ac.uk/PROSPEROFILES/28054_PROTOCOL_20151009.pdf.

Sociocultural factors affecting uptake of home-based neonatal thermal care practices in Africa: A qualitative review

Neonatal hypothermia is a major contributor to neonatal mortality in sub-Saharan Africa, often as a comorbidity of severe infections, preterm births or asphyxia. Simple, cost-effective thermal care practices (TCPs) immediately at birth and in the post-natal period are recommended in the World Health Organization 'warm chain'. Current practices are suboptimal in the home in low-resource settings, where approximately half of neonatal deaths occur. Several databases (PubMed, OVID SP, Web of Science, The Cochrane Library and Google Scholar) were searched for original research on home-based TCPs. Seventeen articles were identified, and the results were analysed using a 'thermal care behavioural model'. This review of the qualitative literature on home-based practices across Africa illuminates the sociocultural factors affecting the uptake of recommended practices and strategies for behaviour change. Findings from the review confirm that potentially harmful cultural norms and traditions influence the sequence of TCPs in different contexts across Africa. Furthermore, caregiver factors and contextual barriers or facilitating factors to TCPs and behaviour change exist. Hypothermia and home-based TCPs are areas for further research. Thermal care behaviour change interventions tailored to the sociocultural context are necessary to improve neonatal outcomes in Africa.