Neonatal care practices in sub-Saharan Africa: a systematic review of quantitative and qualitative data

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.

Hypothermia amongst neonatal admissions in Kenya: a retrospective cohort study assessing prevalence, trends, associated factors, and its relationship with all-cause neonatal mortality

Background

Reports on hypothermia from high-burden countries like Kenya amongst sick newborns often include few centers or relatively small sample sizes.

Objectives

This study endeavored to describe: (i) the burden of hypothermia on admission across 21 newborn units in Kenya, (ii) any trend in prevalence of hypothermia over time, (iii) factors associated with hypothermia at admission, and (iv) hypothermia's association with inpatient neonatal mortality.

Methods

A retrospective cohort study was conducted from January 2020 to March 2023, focusing on small and sick newborns admitted in 21 NBUs. The primary and secondary outcome measures were the prevalence of hypothermia at admission and mortality during the index admission, respectively. An ordinal logistic regression model was used to estimate the relationship between selected factors and the outcomes cold stress (36.0°C-36.4°C) and hypothermia (<36.0°C). Factors associated with neonatal mortality, including hypothermia defined as body temperature below 36.0°C, were also explored using logistic regression.

Results

A total of 58,804 newborns from newborn units in 21 study hospitals were included in the analysis. Out of these, 47,999 (82%) had their admission temperature recorded and 8,391 (17.5%) had hypothermia. Hypothermia prevalence decreased over the study period while admission temperature documentation increased. Significant associations were found between low birthweight and very low (0-3) APGAR scores with hypothermia at admission. Odds of hypothermia reduced as ambient temperature and month of participation in the Clinical Information Network (a collaborative learning health platform for healthcare improvement) increased. Hypothermia at admission was associated with 35% (OR 1.35, 95% CI 1.22, 1.50) increase in odds of neonatal inpatient death.

Conclusions

A substantial proportion of newborns are admitted with hypothermia, indicating a breakdown in warm chain protocols after birth and intra-hospital transport that increases odds of mortality. Urgent implementation of rigorous warm chain protocols, particularly for low-birth-weight babies, is crucial to protect these vulnerable newborns from the detrimental effects of hypothermia.

Postnatal care and acceptability of emollient therapy in very low birthweight infants in Harare, Zimbabwe: a qualitative analysis

BACKGROUND

Preterm birth (birth before 37 completed weeks of pregnancy) is the leading cause of neonatal and child under-five mortality globally, both of which are highest regionally in sub-Saharan Africa. The skin barrier plays a critical role in neonatal health and increasing evidence supports the use of topical emollient therapy to promote postnatal growth and reduce hospital-acquired infections in preterm infants. The World Health Organization (WHO) currently recommends emollient therapy in preterm or low birthweight infants globally but calls for further research on impacts of emollient use, especially in Africa. Little is known about postnatal skincare practices and the tradition of oil massage across sub-Saharan Africa. Further documentation is necessary to understand the context for future emollient intervention trials.

METHODS

61 semi-structured interviews with mothers who just delivered preterm or term infants and 4 focus group discussions (32 participants) with physician and nurse providers of newborn care were conducted at Sally Mugabe Central Hospital (SMCH), in Harare, Zimbabwe. SMCH is the principal public-sector tertiary care hospital for newborn infants in the northern part of the country. Mothers and healthcare professionals were questioned about newborn care at the hospital, current neonatal skincare and bathing practices, and the community's receptivity to a future emollient therapy clinical trial.

RESULTS

Postnatal skincare is centrally important to Zimbabwean communities and petroleum jelly application is nearly universal. The use of cooking oil and other natural oils on infants is also part of traditional customs. The primary needs and desires of mothers who have just given birth to preterm infants are having greater agency in their children's care and financial support in purchasing prescribed medications while at the hospital. Community receptivity to emollient therapy as a cost-effective treatment is high, particularly if mothers are trained to assist with the intervention.

CONCLUSION

Emollient therapy will likely be well-received by communities in and around Harare because of its accordance with current skincare practices and perceptions; however, cultural norms and the experiences of new mothers who have given birth at a facility highlight challenges and considerations for future clinical trial execution.

TRIAL REGISTRATION

Clinicaltrials.gov NCT05461404.

Early newborn bathing practice and its determinants among postpartum women in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Early baby bathing has a major negative impact on the newborn's health. Even though early newborn bathing has numerous detrimental effects on neonatal health, evidence has provided little attention on the current level of practice. Furthermore, there is a dearth of data regarding the overall effects of early newborn bathing in Ethiopia, which would be helpful to program and policy designers. This meta-analysis aimed to ascertain the level of early bathing practice and its determinants among postpartum women in Ethiopia.

METHODS

All articles were searched from the Web of Sciences, CINAHL (EBOSCO), Science Direct, MEDLINE, PubMed, Google Scholar, and Google websites from inception to October 10, 2023. The meta-analysis was performed using Stata version 18. The summary estimates with 95% CI were estimated using the random effect model with the Der Simonian Liard method. Heterogeneity was explored using Galbraith plot, Cochrane Q statistics, I2 statistics, and test of theta. To deal with the observed heterogeneity, subgroup analysis, sensitivity analysis, and meta-regression were done.

RESULTS

This meta-analysis included a total of 2787 postpartum women. The pooled level of early newborn bathing practice among postpartum women in Ethiopia was 55% [95% CI: 38-71]. Based on subgroup analysis by region, the highest level of early newborn bathing practice was among studies conducted in the Afar region which was 73% (95% CI: 69-77). There is a significant association between maternal level of education and early newborn bathing practice among postpartum women in Ethiopia (AOR = 0.51, 95% CI: 0.24, 0.78).

CONCLUSIONS

In this meta-analysis, the overall estimate illustrates that more than half of postpartum women practice early newborn bathing in Ethiopia. Maternal level of education was significantly associated with early newborn bathing practice. Thus, both the government and all the concerned stakeholders should take coordinated action to boost information dissemination and awareness creation among postpartum women thereby reducing the practice of early newborn bathing and alleviating consequences of early newborn bathing.

A global survey on national standard care for newborn bathing

AIM

To describe national standard care for newborn bathing and its influential factors.

METHODS

A global survey was conducted using a web-based questionnaire. The targeted countries were 166 member countries of either the International Confederation of Midwives (ICM) or the International Council of Nurses (ICN). An eligible person included someone well informed of midwifery education/training or neonatal care, including newborn bathing, in their country. To examine the factors associated with the standard care for newborn bathing, information on mean annual temperature, precipitation, gross domestic product per capita, and basic water coverage was collected as external factors. Student's t tests and Chi-square tests were used for analysis.

RESULTS

Care standards were identified in 46 countries: seven from Africa, eight from the Americas, 15 from Asia, 14 from Europe, and two from Oceania. In most countries, newborns were bathed with warm water in a tub within 10 min. Bathing frequency, moisturization, and use of soap or cleanser varied by country. There were significant associations between bathing frequency and temperature and between moisturization and precipitation.

CONCLUSION

The national standard care for newborn bathing in each country was unique. Standard bathing care was associated with the climate. More consideration should be given to the differences in standard care for newborn bathing between countries when interpreting existing studies and conducting future studies on neonatal skin care.

Concept analysis: Community-based postnatal care

BACKGROUND

 Community-based postnatal care is a valuable resource in the provision of maternal and neonatal care, specifically outside the hospital environment. However, its application in maternal and neonatal care is not clearly documented in relation to the rendering of services by primary caregivers.

OBJECTIVES

 This study clarifies the concept of 'community-based postnatal care' by using the concept analysis method.

METHOD

 To analyse the concept, relevant literatures were reviewed and analysed using the Walker and Avant method, namely, selecting a concept, determining the purpose of analysis, identifying all uses of the concept, defining attributes, identifying a model case, identifying borderline, related and contrary cases, identifying antecedents and consequences and identifying the empirical referents. Characteristics that repeatedly appeared throughout the literature were noted and categorised.

RESULTS

 It was established from the concept analysis that 'community-based postnatal care' was complex and experienced ethnically. The analysis included that primary caregiver participation was based on home-levelled-skilled care, community participation and mobilisation, linkages of health services and community stakeholders. The attributes were influenced by antecedents and consequences.

CONCLUSION

 The empirical referents of community based can be integrated within the midwifery guidelines to measure the concept. When concepts are understood, self-care on early detection, early management and referral during early postnatal care will be enhanced.Contribution: The results of this study will foster independence, confidence and a respectful relationship between primary caregivers and the health care facility staff. The results are expected to guide future research and enhance community-based postnatal care in midwifery practice.

Perceptions, beliefs, and current practices regarding neonatal skin care and emollient use in eastern Uganda: a qualitative study

BACKGROUND

The skin is a major route of infection in the neonatal period, especially in low birthweight (LBW) infants. Appropriate and safe neonatal skin care practices are required to reduce this risk. The perceptions and beliefs of mothers and other caregivers towards various neonatal skin care practices in our setting have been documented. Data from Asia suggests that the application of emollient to the skin of LBW infants can promote growth, reduce serious neonatal infections, and potentially reduce mortality. This is the first study to explore the acceptability of emollients and massage as part of neonatal skin care in a low-resource setting in sub-Saharan Africa (SSA) that is representative of the majority of government health facilities in Uganda and many in SSA.

OBJECTIVE

To explore perceptions, beliefs, and current practices regarding neonatal skin care and emollient use in eastern Uganda.

METHODS

We conducted a qualitative study consisting of three focus group discussions (30 participants), eight in-depth interviews with mothers/caregivers of preterm and term neonates and 12 key informant interviews with midwives, doctors and community health workers involved in neonatal care, to explore the perceptions and practices surrounding neonatal skin care and emollient use. Data collected were transcribed and analyzed using thematic content analysis.

RESULTS

Mothers perceived that skin care began in utero. Skincare practices depended on the place of delivery; for deliveries in a health facility the skincare practices were mainly based on the health worker's advice. Vernix caseosa was often washed off due to its perceived undesirability and was attributed to sexual intercourse in the last trimester. Despite their deleterious attributes found in previous studies, petrolatum-based oils, petrolatum-based jellies and talcum baby powders were the most commonly reported items used in neonatal skin care. In our population, there was high acceptability of emollient therapy use; however, neonatal massage was treated with scepticism as mothers feared damaging the vulnerable neonate. Mothers suggested massage and emollient application be undertaken by health workers, if it becomes an intervention.

CONCLUSIONS

In eastern Uganda, the perceptions and beliefs of mothers/caregivers toward neonatal skincare influenced their practices of which some could potentially be beneficial, and others harmful. Emollient use would be easily accepted if adequate sensitisation is conducted and using the gatekeepers such as health workers.

Prevalence of essential newborn care in home and facility births in the Peruvian Amazon: analysis of census data from programme evaluation in three remote districts of the Loreto region

Background

Essential newborn care (ENC) covers optimal breastfeeding, thermal care, and hygienic cord care. These practices are fundamental to save newborn lives. Despite neonatal mortality remaining high in some parts of Peru, no comprehensive data on ENC is available. We sought to estimate the prevalence of ENC and assess differences between facility and home births in the remote Peruvian Amazon.

Methods

We used baseline data from a household census of rural communities of three districts in Loreto region, collected as part of the evaluation of a maternal-neonatal health (MNH) programme. Women between 15 and 49 years with a live birth in the last 12 months were invited to complete a questionnaire about MNH-related care and ENC. Prevalence of ENC was calculated for all births and disaggregated by place of birth. Adjusted prevalence differences (PD) were post-estimated from logistic regression models on the effect of place of birth on ENC.

Findings

All 79 rural communities with a population of 14,474 were censused. Among 324 (>99%) women interviewed, 70% gave birth at home, most (93%) without skilled birth assistance. Among all births, prevalence was lowest for immediate skin-to-skin contact (24%), colostrum feeding (47%), and early breastfeeding (64%). ENC was consistently lower in home compared to facility births. After adjusting for confounders, largest PD were found for immediate skin-to-skin contact (50% [95% CI: 38-62]), colostrum feeding (26% [16-36]), and clean cord care (23% [14-32]). ENC prevalence in facilities ranged between 58 and 93%; delayed bathing was lower compared to home births (-19% [-31 to -7]).

Interpretation

Low prevalence of ENC practices among home births in a setting with high neonatal mortality and difficult access to quality care in facilities suggests potential for a community-based intervention to promote ENC practices at home, along with promotion of healthcare seeking and simultaneous strengthening of routine facility care.

Funding

Grand Challenges Canada and Peruvian National Council of Science, Technology, and Technology Innovation.

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.

Experience of care of hospitalized newborns and young children and their parents: A scoping review

INTRODUCTION

Several global initiatives put parent involvement at the forefront of enabling children's well-being and development and to promote quality of care for newborns and hospitalized young children aged 0-24 months. Scanty evidence on mistreatment such as delays or neglect and poor pain management among newborns exists, with even less exploring the experience of their parents and their hospitalized young children. To address this gap, authors reviewed research on experience of care for hospitalized young children and their parents, and potential interventions that may promote positive experience of care.

METHODS

A scoping review of English language articles, guidelines, and reports that addressed the experiences of care for newborns and sick young children 0-24 months in health facilities was conducted. Multiple databases: PubMed, PROSPERO, COCHRANE Library and Google Scholar were included and yielded 7,784 articles. Documents published between 2009 and November 2020, in English and with evidence on interventions that addressed family involvement and partnership in care for their sick children were included.

RESULTS

The scoping review includes 68 documents across 31 countries after exclusion. Mistreatment of newborns comprises physical abuse, verbal abuse, stigma and discrimination, failure to meet professional standards, poor rapport between providers and patients, poor legal accountability, and poor bereavement and posthumous care. No literature was identified describing mistreatment of hospitalized children aged 60 days- 24 months. Key drivers of mistreatment include under-resourced health systems and poor provider attitudes. Positive experience of care was reported in contexts of good parent-provider communication. Three possible interventions on positive experience of care for hospitalized young children (0-24 months) emerged: 1) nurturing care; 2) family centered care and 3) provider and parental engagement. Communication and counseling, effective provider-parental engagement, and supportive work environments were associated with reduced anxiety and stress for parents and hospitalized young children. Few interventions focused on addressing providers' underlying attitudes and biases that influence provider behaviors, and how they affect engaging with parents.

CONCLUSION

Limited evidence on manifestations of mistreatment, lack of respectful care, drivers of poor experience and interventions that may mitigate poor experience of care for hospitalized young children 0-24 months especially in low resource settings exists. Design and testing appropriate models that enhance socio-behavioral dimensions of care experience and promote provider-family engagement in hospitals are required.

A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes

Preterm births (PTB) are the leading cause of neonatal deaths, the majority of which occur in low- and middle-income countries, particularly those in Sub-Saharan Africa (SSA). Understanding the epidemiology of prematurity is an essential step towards tackling the challenge of PTB in the sub-continent. We performed a scoping review of the burden, predictors and outcomes of PTB in SSA. We searched PubMed, Embase, and three other databases for articles published from the database inception to 10 July 2021. Studies reporting the prevalence of PTB, the associated risk factors, and/or its outcomes were eligible for inclusion in this review. Our literature search identified 4441 publications, but only 181 met the inclusion criteria. Last menstrual period (LMP) was the most commonly used method of estimating gestational age. The prevalence of PTB in SSA ranged from 3.4% to 49.4%. Several risk factors of PTB were identified in this review. The most frequently reported risk factors (i.e., reported in ≥10 studies) were previous history of PTB, underutilization of antenatal care (<4 visits), premature rupture of membrane, maternal age (≤20 or ≥35 years), inter-pregnancy interval, malaria, HIV and hypertension in pregnancy. Premature babies had high rates of hospital admissions, were at risk of poor growth and development, and were also at a high risk of morbidity and mortality. There is a high burden of PTB in SSA. The true burden of PTB is underestimated due to the widespread use of LMP, an unreliable and often inaccurate method for estimating gestational age. The associated risk factors for PTB are mostly modifiable and require an all-inclusive intervention to reduce the burden and improve outcomes in SSA.

A systematic review of newborn health interventions in humanitarian settings

BACKGROUND

Almost half of the under-5 deaths occur in the neonatal period and most can be prevented with quality newborn care. The already vulnerable state of newborns is exacerbated in humanitarian settings. This review aims to assess the current evidence of the interventions being provided in these contexts, identify strategies that increase their utilisation and their effects on health outcomes in order to inform involved actors in the field and to guide future research.

METHODS

Searched for peer-reviewed and grey literature in four databases and in relevant websites, for published studies between 1990 and 15 November 2021. Search terms were related to newborns, humanitarian settings, low-income and middle-income countries and newborn health interventions. Quality assessment using critical appraisal tools appropriate to the study design was conducted. Data were extracted and analysed using a narrative synthesis approach.

RESULTS

A total of 35 articles were included in this review, 33 peer-reviewed and 2 grey literature publications. The essential newborn care (ENC) interventions reported varied across the studies and only three used the Newborn Health in Humanitarian Settings: Field Guide as a guideline document. The ENC interventions most commonly reported were thermal care and feeding support whereas delaying of cord clamping and administration of vitamin K were the least. Training of healthcare workers was the most frequent strategy reported to increase utilisation. Community interventions, financial incentives and the provision of supplies and equipment were also reported.

CONCLUSION

There is insufficient evidence documenting the reality of newborn care in humanitarian settings in low-income and middle-income countries. There is a need to improve the reporting of these interventions, including when there are gaps in service provision. More evidence is needed on the strategies used to increase their utilisation and the effect on health outcomes.

PROSPERO REGISTRATION NUMBER

CRD42020199639.

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.

Health facility readiness to care for high risk newborn babies for early childhood development in eastern Uganda

Background

The neonatal mortality rate in Uganda has barely changed over the past decades, estimated at 28/1000 and 27/1000 live births in 2006 and 2016 respectively. The survivors have a higher risk of developing neurodevelopmental disabilities (NDD) due to brain insults from perinatal complications related to poor quality of health services during pregnancy, around the time of birth, and during the postnatal period. This study aimed to assess health facility readiness to care for high risk newborn babies in order to inform programming that fosters early childhood development in eastern Uganda.

Methods

A cross sectional study of 6 hospitals and 10 higher level health centers that offer comprehensive maternal and newborn care was carried out in February 2020 in eastern Uganda. A World Health Organization Service Availability and Readiness Assessment tool (SARA) was adapted and used to assess the health facility readiness to manage maternal and neonatal conditions that are related to NDD. In addition, 201 mothers of high risk newborn babies were interviewed on their satisfaction with health services received. Readiness scores were derived from percentage average facilities with available infrastructure and essential medical commodities to manage neonatal complications. Descriptive statistics were computed for client satisfaction with service provision, and p values used to compare private not for profit to public health facilities.

Results

There was limited availability in numbers and skilled human resource especially the neonatal nurses. Hospitals and health centers scored least in preterm and hypothermia care, with averages of 38% and 18% respectively. The highest scores were in essential newborn care, with readiness of 78% and 85% for hospitals and health centers, followed by resuscitation at 78% and 77%, respectively. There were no guidelines on positive interaction with newborn babies to foster neurodevelopment. The main cause of admission to neonatal care units was birth asphyxia followed by prematurity, indicative of intrapartum care challenges. The overall client satisfaction with health services was higher in private not for profit facilities at 91% compared to public hospitals at 73%, p = 0.017.

Conclusion

Health facility readiness was inadequate in management of preterm complications. Efforts should, therefore, be geared to improving availability of inputs and quality of emergency obstetric and newborn care in order to manage high risk newborns and reduce the burden of NDD in this setting.

Assessment of neonatal thermal cares: Practices and beliefs among rural women in West Guji Zone, South Ethiopia: A cross-sectional study

A newborn has a limited capacity to maintain temperature when exposed to cold environment. Neonatal hypothermia, a common neonatal problem, carries high case fatality rate particularly if concurrently occurs with other neonatal problems. This study assessed neonatal thermal care practices and beliefs among rural women in west Guji Zone, south Ethiopia. A community based cross sectional quantitative study combined with qualitative study was undertaken in rural areas of west Guji Zone, Ethiopia. Randomly selected 388 rural mothers of infants less than 6 months old were participated in the quantitative study. Three focus group discussions were conducted among mothers of infants less than 6 months old. Quantitative data were collected by using structured and pretested Afaan Oromo version questionnaire adapted from relevant literatures. Qualitative data were collected by focus group discussion guide. The quantitative data were cleaned, coded and analyzed by SPSS version 20. Qualitative data were transcribed, translated, coded, and analyzed by thematic analysis approach. In general rural women believe that thermal protection of newborn is important. The findings show that approximately 75% and 85% of newborns were dried and wrapped respectively after delivery. However drying and wrapping of newborn are usually done after the first newborn's bath. Just over 84% of newborns were bathed within the first 6 hours of delivery and majority of them were bathed with warm water. About 69.1% and 57.7% of women put head cover to their newborns immediately after birth, and initiated breast feeding within one hour of delivery respectively. Skin to skin care of newborn is non-existent in the study area and perceived as an odd, frightening and potentially dangerous practice. Studied women practice some of the recommended neonatal thermal cares and believe in their importance in keeping newborn warm. However, practice and beliefs about delayed first bath is against standard recommendation, whereas skin to skin care is non-existent and perceived as an odd practice. Interventions to familiarize skin to skin care and reduce misconceptions surrounding it should be introduced into the study area to improve thermal cares of high risk newborns.

"You can't even ask a question about your child": Examining experiences of parents or caregivers during hospitalization of their sick young children in Kenya: A qualitative study

Background

Globally, about 5.2 million children under the age of five died in 2019, and more than half of those deaths occurred in Sub-Saharan Africa. In almost every death of a sick child, there is a parent/caregiver seeking health services for their child. This study sought to understand the experiences of care for parents/caregivers (caregivers) as they navigate the hospital system with the aim of identifying opportunities to improve service delivery and child health outcomes.

Methods

Qualitative data were collected from five hospitals in Kenya: three in Nairobi County and two in Bungoma County. Twenty-five in-depth interviews with caregivers (couples and single women) of young children 0-24 months old, 17 focus group discussions with women and men, and 64 institutional ethnographic observations were completed. Data were analyzed by initial annotation of transcripts and field materials, followed by open coding and thematic analysis using Nvivo 12 software. Summary themes were used to compare experiences between female and male caregivers, their child's age group, and study sites.

Results

Caregivers faced complex processes of care while seeking health services for their sick young children. Three overarching themes emerged with some variability across female and male caregiver perspectives: (1) Navigating structural issues: long wait times, confusing payment mechanisms, overcrowding, unhygienic conditions, and strict visitation policies; (2) Interactions with providers: positive experiences, including providers showing empathy and concern, and negative experiences of harsh language, neglect, lack of privacy, discounting caregiver perspectives, and not involving men; Limited communication between caregivers and providers on child's diagnosis, treatment, and progress and lack of communication specifically between male caregivers and providers; and (3) Limited emotional support for both caregivers during difficult diagnosis or bereavement.

Conclusions

To improve experiences, interventions, programs, and policies need to focus on good provider-caregiver partnerships; enhancing opportunities for male engagement, such as supportive visiting hours; effective communication between caregivers and providers; access to adequate emotional support; and an enabling hospital environment.

Evaluation of a two-way SMS messaging strategy to reduce neonatal mortality: rationale, design and methods of the Mobile WACh NEO randomised controlled trial in Kenya

INTRODUCTION

Globally, approximately half of the estimated 6.3 million under-5 deaths occur in the neonatal period (within the first 28 days of life). Kenya ranks among countries with the highest number of neonatal deaths, at 20 per 1000 live births. Improved identification and management of neonates with potentially life-threatening illness is critical to meet the WHO's target of ≤12 neonatal deaths per 1000 live births by 2035. We developed an interactive (two-way) short messaging service (SMS) communication intervention, Mobile Solutions for Neonatal Health (Mobile women's and children's health (WACh) NEO), focused on the perinatal period. Mobile WACh NEO sends automated tailored SMS messages to mothers during pregnancy and up to 6 weeks post partum. Messages employ the Information-Motivation-Behaviour Skills framework to promote (1) maternal implementation of essential newborn care (ENC, including early, exclusive breast feeding, cord care and thermal care), (2) maternal identification of neonatal danger signs and care-seeking, and (3) maternal social support and self-efficacy. Participants can also send SMS to the study nurse, enabling on-demand remote support.

METHODS AND ANALYSIS

We describe a two-arm unblinded randomised controlled trial of the Mobile WACh NEO intervention. We will enrol 5000 pregnant women in the third trimester of pregnancy at 4 facilities in Kenya and randomise them 1:1 to receive interactive SMS or no SMS (control), and conduct follow-up visits at 2 and 6 weeks post partum. Neonatal mortality will be compared between arms as the primary outcome. Secondary outcomes include care-seeking, practice of ENC and psychosocial health. Exploratory analysis will investigate associations between maternal mental health, practice of ENC, care-seeking and SMS engagement.

ETHICS AND DISSEMINATION

This study received ethical approval from the University of Washington (STUDY00006395), Women and Infants Hospital (1755292-1) and Kenyatta National Hospital/University of Nairobi (P310/04/2019). All participants will provide written informed consent. Findings will be published in peer-reviewed journals and international conferences.

TRIAL REGISTRATION NUMBER

NCT04598165.

Indigenous neonatal feeding and bathing practices of caregivers in Vhembe District, Limpopo province

Bac kground

Caregivers are offered health information on neonatal care before they are discharged from the healthcare facilities after giving birth. However, they continue to feed and bath neonates in ways that are informed by indigenous traditions. Notably, these ways include the provision of supplementary feeds before 6 months and bathing the neonate as early as possible, which are practices that contradict the World Health Organization (WHO) recommendations of neonatal care.

Objectives

This study aimed to explore and describe the indigenous neonatal feeding and bathing practices of caregivers in Vhembe District, Limpopo province.

Setting

This study was conducted in Limpopo province at Vhembe District, Makhado Municipality.

Methodology

A qualitative, explorative and descriptive enquiry was used to conduct 18 semi-structured individual interviews to explore and describe their indigenous neonatal feeding and bathing practices. Purposive and snowball sampling methods were used to select participants. Creswell’s method of data analysis was used to analyse data. Ethical principles were maintained.

Results

Two themes with sub-themes resulted from data analysis presenting indigenous neonatal feeding practices and indigenous neonatal bathing practices.

Conclusion

This study revealed that caregivers use indigenous neonatal feeding and bathing practices across age groups and social standing. Younger mothers receive guidance from older women in their families or community. Midwives should know the indigenous neonatal feeding and bathing practices of the communities they serve to offer relevant culture-sensitive health education.

Contributions

This study contributes to the creation of knowledge about indigenous neonatal care practices amongst mothers and caregivers.

Essential newborn care practices in Benin: Are there differences by birth location?

BACKGROUND

Annually, about 60 infant deaths occur per 1000 live births in Benin; nearly one-half of these deaths occur during the neonatal period. Home- and health facility-based newborn care practices are essential for reducing neonatal death. The aim of this study was to explore relationships between location of childbirth and essential newborn care practices in the Republic of Benin, West Africa.

METHODS

We used cross-sectional data from the 2017 Benin Demographic and Health Survey. The study included 6831 women who had a recent live birth. We used multivariable logistic regression to examine associations between location of birth and early initiation of breastfeeding, breastfeeding support, and cord examination while adjusting for potential confounding factors.

RESULTS

There was no significant difference in early initiation of breastfeeding by birth location. Compared to women with home births, those who gave birth in public hospitals, public health centers/clinics, and private health facilities had significantly higher odds of receiving breastfeeding support (public hospitals: OR: 1.71, 95% CI: 1.23-2.59; public health centers/clinics: OR: 2.06, 95% CI: 1.46-2.91; private clinics: OR: 1.97, 95% CI: 1.35-2.88). Compared with women who gave birth at home, those who gave birth in public health centers/clinics and private health facilities were twice as likely to report newborn cord examination (OR: 1.99, 95% CI: 1.41-2.79; OR: 1.97, 95% CI: 1.36-2.83, respectively).

DISCUSSION

Despite the high prevalence of health facility births in Benin, the coverage of early newborn care is suboptimal, especially in public hospitals. Policies and public health interventions will be required, more so in public hospitals, to ensure that all mothers and newborns receive these potentially life-saving services.

Maternal and child factors associated with early initiation of breastfeeding in Chad: evidence from nationally representative cross-sectional data

Background

Early initiation of breastfeeding (EIB) is an inexpensive practice but has a substantial potential to reduce neonatal morbidity. Therefore, this study investigated the maternal and child-related factors associated with EIB and makes recommendations that could help improve the practice in Chad.

Methods

We used data from the children's recode file of the 2014–2015 Chad Demographic and Health Survey. A total of 3991 women ages 15–49 y who had last-born children in the 2 y preceding the survey were included in our study. The outcome variable for the study was EIB. Both descriptive (frequencies and percentages) and inferential (binary logistic regression) analyses were carried out. All results of the binary logistic analyses are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results

We found the prevalence of EIB in Chad to be 23.8%. In terms of maternal factors, the likelihood of EIB was high among non-working women (aOR 1.37 [95% CI 1.18 to 1.59]), the richest wealth quintile women (aOR 1.37 [95% CI 1.04 to 1.79]) and non-media-exposed women (aOR 1.58 [95% CI 1.24 to 2.02]) compared with working women, the poorest wealth quintile women and media-exposed women, respectively. EIB was lower among children whose mothers had one to three antenatal care visits (ANC; aOR 0.73 [95% CI 0.61 to 0.87]) and four or more ANC visits (aOR 0.80 [95% CI 0.66 to 0.97]) compared with those who had no ANC visits. With the child factors, EIB was higher among mothers of children who were smaller than average size at birth compared with those of larger than average birth size (aOR 1.47 [95% CI 1.24 to 1.74]). Mothers of children of fifth-order or more births compared with those of first-order births (aOR 1.51 [95% CI 1.07 to 2.12]) and those who were delivered through vaginal birth compared with those delivered through caesarean section (aOR 4.71 [95% CI 1.36 to 16.24]) were more likely to practice EIB.

Conclusions

Maternal and child-related factors play roles in EIB in Chad. Hence, it is important to consider these factors in maternal and neonatal health interventions. Such initiatives, including training of outreach health workers, health education, counselling sessions and awareness-raising activities on breastfeeding geared towards EIB should be undertaken. These should take into consideration the employment status, wealth quintile, exposure to mass media, size of the baby at birth, ANC visits, parity and delivery method.

Prevalence of Eight or More Antenatal Care Contacts: Findings From Multi-Country Nationally Representative Data

Optimal antenatal care is an important service required by women and babies. To promote healthy motherhood and for positive pregnancy outcomes, World Health Organization recently recommended a minimum of 8 ANC contacts. We aim to explore the prevalence of 8 or more ANC contacts using multi-country data. Urban dwellers, mothers with secondary or higher education, women from high household wealth, early birth order, and older mothers at childbirth had higher prevalence of 8 or more ANC contacts respectively. The pooled prevalence of 8 or more ANC contacts was 13.0%. Jordan had the leading prevalence of 8 or more ANC contacts (74.0%), followed by Ghana (43.0%) and Albania (30.0%). On the other hand, Senegal, Uganda, and Zambia had very low prevalence of 8 or more ANC contacts. There was heterogeneity in the prevalence of 8 or more ANC contacts across countries. There was low prevalence of 8 or more ANC contacts.

Critical Interpretive Synthesis of Qualitative Data on the Health Care Ecosystem for Vulnerable Newborns in Low- to Middle-Income Countries

OBJECTIVE

To critically assess and synthesize qualitative findings regarding the health care ecosystem for vulnerable (low-birth-weight or sick) neonates in low- to middle-income countries (LMICs).

DATA SOURCES

Between May 4 and June 2, 2020, we searched four databases (Medline [PubMed], SCOPUS, PsycINFO, and Web of Science) for articles published from 2010 to 2020. Inclusion criteria were peer-reviewed reports of original studies focused on the health care ecosystem for vulnerable neonates in LMICs. We also searched the websites of several international development agencies and included findings from primary data collected between May and July 2019 at a tertiary hospital in Kenya. We excluded studies and reports if the focus was on healthy neonates or high-income countries and if they contained only quantitative data, were written in a language other than English, or were published before 2010.

STUDY SELECTION

One of the primary authors conducted an initial review of titles and abstracts (n = 102) and excluded studies that were not consistent with the purpose of the review (n = 60). The two primary authors used a qualitative appraisal checklist to assess the validity of the remaining studies (n = 42) and reached agreement on the final 13 articles.

DATA EXTRACTION

The two primary authors independently conducted open and axial coding of the data. We incorporated data from studies with different units of analysis, types of methodology, research topics, participant types, and analytical frameworks in an emergent conceptual development process according to the critical interpretive synthesis methodology.

DATA SYNTHESIS

We synthesized our findings into one overarching theme, Pervasive Turbulence Is a Defining Characteristic of the Health Care Ecosystem in LMICs, and two subthemes: Pervasive Turbulence May Cause Tension Between the Setting and the Caregiver and Pervasive Turbulence May Result in a Loss of Synergy in the Caregiver-Parent Relationship.

CONCLUSION

Because pervasive turbulence characterizes the health care ecosystems in LMICs, interventions are needed to support the caregiver-parent interaction to mitigate the effects of tension in the setting.

Impact of 1% chlorhexidine gluconate bathing and emollient application on bacterial pathogen colonization dynamics in hospitalized preterm neonates - A pilot clinical trial

BACKGROUND

Chlorhexidine gluconate (CHG) body washes and emollient application may modulate bacterial pathogen colonization and prevent neonatal hospital-acquired infections.

METHODS

This pilot, non-randomized, open-label trial, enrolled preterm neonates (1000-1500g; day 1-3 of life) at a tertiary hospital in Cape Town, South Africa. Participants were sequentially allocated to 4 trial arms (n=20 each): 1% aqueous CHG (CHG), 1% CHG plus emollient (CHG+EM), emollient only (EM) and standard of care (SOC: no antiseptic/emollient). Trial treatment/s were applied daily for 10 days (d) post-enrolment, documenting neonatal skin condition score. Anterior nose, neck, umbilical and perianal swabs for bacterial culture were collected at d1, d3, d10 and d16 post-enrolment, (±1 day), reporting pathogen acquisition rates and semi-quantitative bacterial colony counts. (ClinicalTrials.gov identifier: NCT03896893; trial status: closed).

FINDINGS

Eighty preterm neonates (mean gestational age 30 weeks [SD 2]) were enrolled between 4 March and 26 August 2019. The bacterial pathogen acquisition rate (comparing d1 and d16 swabs) varied from 33·9% [95%CI 22·9-47·0] at the umbilicus, 39·3% [95%CI 27·6-52·4] at the neck, to 71·4% [95%CI 58·5-81·7] at both the nose and perianal region. At d10, CHG babies had reduced bacterial density detected from neck, umbilicus, and perianal swabs compared to other groups (see Table 3). Following intervention cessation, colonization density was similar across all trial arms, but S. aureus colonization was more prevalent among EM and CHG+EM babies. Neonatal skin condition score improved in babies receiving emollient application (EM: -0·87 [95%CI 0·69-1·06] and CHG+EM: -0·73 [0·45-0·99]), compared to the SOC and CHG arms (Table 2); no CHG-related skin reactions occurred.

INTERPRETATION

Bacterial colonization density was significantly reduced in babies receiving 1% CHG washes but colonization levels rebounded rapidly post-intervention. Emollient application improved skin condition but was associated with higher rates of S. aureus colonization.

FUNDING

South African Medical Research Council; National Institutes of Health (TW010682).

Initiation of Breast Milk Expression and Associated Factors Among Mothers of Preterm and Low Birth Weight Neonates Admitted to Neonatal Intensive Care Units of Government Hospitals in Addis Ababa, Ethiopia,2020

BACKGROUND

In early preterm and very low birth weight, breast milk expression is an optimal solution to continue with breastfeeding. This study aimed to assess the initiation of breast milk expression and associated factors among preterm and low birth weight mothers in the neonatal intensive care units of public hospitals in Addis Ababa.

METHODS

Institution-based cross-sectional study was performed in selected public hospitals, Addis Ababa, among 124 breast feeding mothers chosen from different public health facilities of Addis Ababa; from April 5 to May 15, 2020. Information was collected using questionnaires administered by the interviewer, double data entry was performed using Epi Info version 4.6.02 software, cleaned finally exported to SPSS statistics version 26 for analysis. To predict the association of research variables, logistic regression models were used and adjusted for potential confounders.

RESULTS

All respondents were started milk expression after six hours following delivery. Getting instruction on the method of their choice (AOR=0.55; CI=0.31 to 0.96) and gestational age ≤32 weeks (AOR=2.39; CI=1.34 to 4.24) were factors significantly associated with initiation of milk expression.

CONCLUSION

The study indicated breast milk expression was poor. Inter-departmental collaboration is required in order to promote good practice of breast milk expression among mothers of neonates with preterm and low birth weight.

Timely initiation of breastfeeding and associated factors among mothers having children less than two years of age in sub-Saharan Africa: A multilevel analysis using recent Demographic and Health Surveys data

BACKGROUND

Despite the significant advantages of timely initiation of breastfeeding (TIBF), many countries particularly low- and middle-income countries have failed to initiate breastfeeding on time for their newborns. Optimal breastfeeding is one of the key components of the SDG that may help to achieve reduction of under-five mortality to 25 deaths per 1000 live births.

OBJECTIVE

To assess the pooled prevalence and associated factors of timely initiation of breastfeeding among mothers having children less than two years of age in sub-Saharan Africa.

METHODS

We used pooled data from the 35 sub-Saharan Africa (SSA) Demographic and Health Surveys (DHS). We used a total weighted sample of 101,815 women who ever breastfeed and who had living children under 2 years of age. We conducted the multilevel logistic regression and variables with p<0.05, in the multivariable analysis, were declared significantly associated with TIBF.

RESULTS

The pooled prevalence of TIBF in SSA was 58.3% [95%CI; 58.0-58.6%] with huge variation between countries, ranging from 24% in Chad to 86% in Burundi. Both individual and community level variables were associated with TIBF. Among individual-level factors; being older-aged mothers, having primary education, being from wealthier households, exposure to mass media, being multiparous, intended pregnancy, delivery at a health facility, vaginal delivery, single birth, and average size of the child at birth were associated with higher odds of TIBF. Of community-level factors, rural place of residence, higher community level of ANC utilization, and health facility delivery were associated with higher odds of TIBF.

CONCLUSION

In this study, the prevalence of TIBF in SSA was low. Both individual and community-level factors were associated with TIBF. The authors recommend interventions at both individual and community levels to increase ANC utilization as well as health facility delivery that are crucial for advertising optimal breastfeeding practices such as TIBF.

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.

A review of ethnomedicinal uses of shea butter for dermatoses in Sub-Saharan Africa

Indigenous therapies, or traditional medicines (TMs), constitute a highly accessible and continuously growing health system in many parts of the world, including Sub-Saharan Africa (SSA). Shea butter, a fat produced from the kernels of the shea tree, has historically been used as an indigenous therapy for dermatologic ailments in SSA. Characterizing traditional therapeutic applications for shea butter is important to inform the continued development of TM in SSA. We conducted a literature review aimed at identifying all available publications on the use of shea butter to treat dermatoses within SSA and evaluating patterns of use. We found 24 dermatologic uses across 30 references. The most common study design was descriptive cross-sectional analysis (46.7%), often relying on the use of in-depth interviews, focus groups, and surveys. Eight SSA countries were represented and there were disparities in availability of information across SSA with the eastern and southern regions less likely to be represented. The most frequently investigated conditions were scabies, wound healing, and umbilical cord care. Shea butter was most commonly used in combination with other ingredients to produce a medical treatment with the most frequent adjuvant being Elaeis guineensis, African oil palm. Broad use of TM to treat varied skin diseases throughout SSA warrants increased investigations into this field in order to further develop the capacity of TM as a source of healthcare.

The first 2 h after birth: prevalence and factors associated with neonatal care practices from a multicountry, facility-based, observational study

BACKGROUND

Amid efforts to improve the quality of care for women and neonates during childbirth, there is growing interest in the experience of care, including respectful care practices. However, there is little research on the prevalence of practices that might constitute mistreatment of neonates. This study aims to describe the care received by neonates up to 2 h after birth in a sample of three countries in west Africa.

METHODS

Data from this multicountry, facility-based, observational study were collected on 15 neonatal care practices across nine facilities in Ghana, Guinea, and Nigeria, as part of WHO's wider multicountry study on how women are treated during childbirth. Women were eligible if they were admitted to the participating health facilities for childbirth, in early established labour or active labour, aged 15 years or older, and provided written informed consent on behalf of themselves and their neonate. All labour observations were continuous, one-to-one observations of women and neonates by independent data collectors. Descriptive statistics and multivariate logistic regressions were used to examine associations between these neonatal care practices, maternal and neonate characteristics, and maternal mistreatment. Early neonate deaths, stillbirths, and higher order multiple births were excluded from analysis.

FINDINGS

Data collection took place from Sept 19, 2016, to Feb 26, 2017, in Nigeria; from Aug 1, 2017, to Jan 18, 2018, in Ghana; and from July 1 to Oct 30, 2017, in Guinea. We included data for 362 women-neonate dyads (356 [98%] with available data for neonatal care practices) in Nigeria, 760 (749 [99%]) in Ghana, and 558 (522 [94%]) in Guinea. Delayed cord clamping was done for most neonates (1493 [91·8%] of 1627); other practices, such as skin-to-skin contact, were less commonly done (1048 [64·4%]). During the first 2 h after birth, separation of the mother and neonate occurred in 844 (51·9%) of 1627 cases; and was more common for mothers who were single (adjusted odds ratio [AOR; adjusting for country, maternal age, education, marital status, neonate weight at birth, and neonate sex] 1·8, 95% CI 1·3-2·6) than those who were married or cohabiting. Lack of maternal education was associated with increased likelihood of neonates not receiving recommended breastfeeding practices. Neonates with a low birthweight (<2·5 kg) were more likely (1·7, 1·1-2·8) to not begin breastfeeding on demand than full weight neonates. When women experienced physical abuse from providers within 1 h before childbirth, their neonates were more likely to be slapped (AOR 1·9, 1·1-3·9).

INTERPRETATION

A high proportion of neonates did not receive recommended care practices, and some received practices that might constitute mistreatment. Further research is needed on understanding and measuring mistreatment to improve care, including respectful care, for mothers and neonates.

FUNDING

US Agency for International Development, and the UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO.

Are We Using the Right Approach to Change Newborn Care Practices in the Community? Qualitative Evidence From Ethiopia and Northern Nigeria

In Ethiopia, high community-level exposure to consistent messages and the perceptions of community health workers and relationships with them drove newborn care behavior change. In Nigeria, exposure to messages was limited, community health workers were less trusted, and behavior change was reported less frequently.

Changing behaviors is usually a core component of the role of community health workers (CHWs), but little is known about the mechanisms through which they change behavior. We collected qualitative data from 8 sites in Ethiopia and northern Nigeria where CHWs were active to understand how they change newborn care behaviors. In each country, we conducted 12 narrative interviews and 12–13 in-depth interviews with recent mothers and 4 focus group discussions each with mothers, fathers, grandmothers, and CHWs. We identified 2 key mechanisms of behavior change. The first was linked to the frequency and consistency of hearing messages that led to a perception that change had occurred in community-wide behaviors, collective beliefs, and social expectations. The second was linked to trust in the CHW, obligation, and hierarchy. We found little evidence that constructs that often inform the design of counseling approaches, such as knowledge of causality and perceived risks and benefits, were mechanisms of change.

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.

Association between birth attendant and early newborn care in Senegal

OBJECTIVE

To examine the association between type of birth attendant and early newborn care in Senegal.

DESIGN

This was a secondary analysis of cross-sectional data from the 2017 Continuous Demographic and Health Survey.

PARTICIPANTS

The study included data on 6328 women with live births in the three years preceding the survey.

MEASUREMENTS

The main exposure was the type of birth attendant (doctor, nurse/midwife, auxiliary midwife/matrone, traditional birth attendant, or "others (friend, relative, or no one)). We assessed three outcomes: 1) early initiation of breastfeeding, 2) breastfeeding support, and 3) cord examination. We used multivariable logistic regression to estimate the odds ratios and 95% confidence intervals of early newborn care after adjusting for potential confounders.

FINDINGS

The coverage of all three newborn care indicators of interest was low. In the adjusted regression models, women whose births were assisted by a nurse/midwife were nearly twice as likely to initiate breastfeeding early compared to those assisted by doctors (odds ratio: 1.87, 95% confidence interval: 1.00-3.45). Women assisted at birth by doctors were significantly more likely to report breastfeeding support and newborn cord examination than those assisted by other types of birth attendants.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Although most recent births were facility-based and assisted by skilled birth attendants, the prevalence of early newborn care was suboptimal. This presents a missed opportunity to improve neonatal outcomes. Training and supporting skilled birth attendants may bridge the gap between opportunity and practice, and lead to improved coverage and quality of newborn care in Senegal.

Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India

BACKGROUND

Despite progress toward meeting the Sustainable Development Goals, a large burden of maternal and neonatal mortality persists for the most vulnerable people in rural areas. We assessed coverage, coverage change and inequity for 8 maternal and newborn health care indicators in parts of rural Nigeria, Ethiopia and India.

METHODS

We examined coverage changes and inequity in 2012 and 2015 in 3 high-burden populations where multiple actors were attempting to improve outcomes. We conducted cluster-based household surveys using a structured questionnaire to collect 8 priority indicators, disaggregated by relative household socioeconomic status. Where there was evidence of a change in coverage between 2012 and 2015, we used binomial regression models to assess whether the change reduced inequity.

RESULTS

In 2015, we interviewed women with a birth in the previous 12 months in Gombe, Nigeria (n = 1100 women), Ethiopia (n = 404) and Uttar Pradesh, India (n = 584). Among the 8 indicators, 2 positive coverage changes were observed in each of Gombe and Uttar Pradesh, and 5 in Ethiopia. Coverage improvements occurred equally for all socioeconomic groups, with little improvement in inequity. For example, in Ethiopia, coverage of facility delivery almost tripled, increasing from 15% (95% confidence interval [CI] 9%-25%) to 43% (95% CI 33%-54%). This change was similar across socioeconomic groups (p = 0.2). By 2015, the poorest women had about the same facility delivery coverage as the least poor women had had in 2012 (32% and 36%, respectively), but coverage for the least poor had increased to 60%.

INTERPRETATION

Although coverage increased equitably because of various community-based interventions, underlying inequities persisted. Action is needed to address the needs of the most vulnerable women, particularly those living in the most rural areas.

Skin-to-skin contact at birth for vaginally delivered neonates in a tertiary care hospital: A cross-sectional study

Background

Neonates undergoing skin-to-skin contact (SSC) have shown to have better cardiovascular stability, improved duration of breastfeeding, temperature maintenance and bonding. The primary objective was to estimate the existing prevalence of SSC among mother-infant dyads in the first hour after vaginal delivery, and the secondary objective was to ascertain the factors affecting adherence of SSC after vaginal delivery.

Methods

This cross-sectional study was carried out in a tertiary care teaching hospital between September 2017 and December 2017. All mother-newborn dyads in the labour room were eligible for the study. Mothers with their newborns, who gave multiple births, or with major congenital malformations or those requiring any form of resuscitation or having respiratory distress or requiring observation in neonatal intensive care unit (NICU) were excluded. All included mother-newborn dyads, after exclusion, were observed for SSC, and the duration in each dyad was recorded. All enrolled mothers, the attending doctors and nurses were asked questions based on a prevalidated questionnaire for the possible barriers of implementation.

Results

Of a total of 164 mother-infant dyads studied, only 34 (20.7%) carried out SSC for more than 30 min. Sixty-two (37.8%) mother-infant dyads did not participate in any SSC. The commonest reason for non-adherence to SSC was unawareness about the practice in 82.25%, followed by pain and exhaustion after the labour process in 8%.

Conclusion

The rate of SSC at birth is suboptimal, and the commonest reason is lack of awareness about this important step of essential newborn care.

Factors influencing the early initiation of breast feeding in public primary healthcare facilities in Northeast Nigeria: a mixed-method study

INTRODUCTION

The early initiation of breast feeding is a high-impact intervention that gives newborns a better chance of survival. We assess the barriers and facilitators influencing the practice of early breast feeding of newborns in public primary healthcare facilities (PHCs) in Northeast Nigeria, to influence the planning of programmes targeted at improving newborn care in the region.

METHOD

We used an explanatory mixed-method approach. We conducted case observation of childbirths and newborn care for the quantitative arm, and interviewed mothers and birth attendants 1 hour after childbirth for the qualitative arm. The analysis for the quantitative arm was done with SPSS V.23. For the qualitative arm, we transcribed the audio files, coded the texts and categorised them using thematic analysis.

RESULT

We observed 393 and 27 mothers for the quantitative and qualitative arms of the study, respectively. The quantitative arm shows that 39% of mothers did not breastfeed their newborns within 1 hour of birth. The qualitative arm shows that 37% of mothers did not breastfeed within 1 hour of birth. Themes that describe the barriers to early breast feeding in public PHCs are: birth attendants' unwillingness or inability to accommodate mothers' safe traditional practices, ineffective rooming-in practices, staff shortages, lack of privacy in the lying-in ward and poor implementation of visiting-hour policy in public PHCs. The pregnant women denied safe traditional birth practices like chanting, praying or reading religious books during delivery are five times more likely not to breastfeed newborns within the first hour of birth (relative risk=4.5, 95% CI 1.2-17.1) compared with pregnant women allowed these practices.

CONCLUSION

Stakeholders must increase their focus on improving breastfeeding practices in public PHCs. Instituting policies that protect mothers' privacy and finding innovative ways to accommodate and promote safe traditional practices in the intrapartum and postpartum period in PHCs will improve the early breast feeding of newborns in these PHCs.

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.

Integrated review of healthcare provider postnatal newborn care recommendations in Sub-Saharan Africa

AIMS

To (1) identify formal and informal healthcare provider knowledge and counselling on newborn care recommendations; (2) identify care guidelines used; and (3) determine healthcare provider training regarding recommendations.

BACKGROUND

In sub-Saharan Africa, many newborn deaths occur in the community between days two to 42 of life.

INTRODUCTION

Formal and informal healthcare providers, including nurses and community health workers, counsel newborn caregivers but little is known about their recommendations.

METHODS

Integrative review of studies conducted 2000-2018 after search of PubMed, CINAHL, Embase, and African healthcare journals. Study quality was assessed and findings synthesized.

FINDINGS

Twelve qualitative, quantitative, or mixed-methods studies (quality good to poor) from seven countries were included. Eleven reported on one to three recommendations; one study reported on eight recommendations. Knowledge or counselling on feeding, cord care, recognizing illness, referrals, informal treatment, home visits, immunizations, follow-up examinations, thermal care, low birthweight, and bed net usage were reported. Formal healthcare providers gave recommendations in only two studies. Four studies documented use of guidelines. Six studies reported on training.

DISCUSSION

Studies were primarily descriptive, limiting quality. Feeding and cord care recommendations were prioritized. Care guidelines were underutilized. Additional training on recommendations is needed. These findings regarding healthcare providers align with other regions with high neonatal mortality.

CONCLUSION

Research is needed to improve and sustain knowledge, counselling, and guideline usage among providers to address neonatal mortality.

IMPLICATIONS FOR NURSING

The unique role of nurses to promote newborn health appears under-researched. Nurse professionalization and specialization may contribute to sustained knowledge of and counselling on newborn recommendations.

IMPLICATIONS FOR HEALTH POLICY

As countries adopt universal health care, policies that enable formal providers to encourage maternal-newborn engagement in newborn health promotion before transition to the community are needed. Collaboration between formal and informal providers may improve dissemination of recommendations and contribute to gains in newborn health.

Parent and family perspectives on home-based newborn care practices in lower-income countries: a systematic review of qualitative studies

OBJECTIVES

To understand family and parent perspectives on newborn care provided at home to infants in the first 28 days of life, in order to inform behavioural interventions for improving care in low-income countries, where the majority of newborn deaths occur.

DESIGN

A comprehensive, qualitative systematic review was conducted. MEDLINE/PubMed, Embase and Cumulative Index of Nursing and Allied Health databases were systematically searched for studies examining the views of parents and family members on newborn care at home. The search period included all studies published from 2006 to 2017. Studies using qualitative approaches or mixed-methods studies with substantial use of qualitative techniques in both the methods and analysis sections were included. Studies meeting the inclusion criteria were extracted and evaluated using Critical Appraisal Skills Programme guidelines. Following the initial selection and appraisal, barriers and facilitators to recommended care practices across several domains were synthesised.

RESULTS

Of 411 results retrieved, 37 met both inclusion and quality appraisal criteria for methodology and reporting. Geographical representation largely reflected that of newborn health outcomes globally, with the majority of studies conducted in the region of Sub-Saharan Africa and South Asia. Specific barriers and facilitators were identified among a range of domains including: cord care, drying and wrapping, thermal control, skin to skin contact, hygiene, breast feeding, care-seeking for illness, and low birthweight recognition. Cross cutting facilitators, common to all domains were evident and includeddelivery at a health facility, inclusion of female relatives in care counselling, lower healthcare costs, and exposure to newborn care behaviour change messaging in the community.

CONCLUSIONS

When designing behavioural interventions to address newborn mortality at scale, policy-makers and practitioners must include barriers and facilitators important to families in low-income settings.

PROSPERO REGISTRATION NUMBER

CRD42016035674.

Breastfeeding in low-resource settings: Not a "small matter"

Despite its clear biological benefits, many infants globally do not receive exclusive breastfeeding. In a Guest Editorial, Lars Åke Persson discusses what is needed to make breastfeeding the social norm.