Sources for and quality of neonatal care in 45 low- and middle-income countries.

IntroductionSuboptimal maternal practices in home cord care, breastfeeding, and thermoregulation for newborns pose significant public health concerns, with far-reaching implications for neonatal health. Understanding the determinants influencing these maternal practices is crucial for developing effective interventions.AimThis study aimed to identify predictors of mothers' home cord care, breastfeeding, and thermoregulation practices for newborns in a southeastern state in Nigeria.MethodsA cross-sectional survey of 365 postpartum mothers randomly selected from sampled health facilities in Ihiala Local Government Area was done. Consenting mothers were followed up to their homes. A self-structured, validated, interviewer-administered questionnaire with a reliability score of 0.87 was used for data collection. Appropriate umbilical cord care, breastfeeding, and thermoregulation practices of mothers were evaluated by rating their responses: 1 for YES and 0 for NO. SPSS version 25 was used for data analysis. Data were summarized in tables and charts. Associations between variables were tested using multivariable logistic regression.ResultsThe majority (83.3%) of mothers practiced appropriate thermoregulation for their newborns, while only 23.8% and 41.3% practiced exclusive breastfeeding and proper cord care, respectively. The most common reasons given for the poor practice of essential newborn care (ENBC) were ignorance and the influence of family and friends. Predictors of good ENBC practices among the variables tested included place of delivery and educational status of mothers. Place of delivery significantly influenced umbilical cord care, with mothers who delivered in primary health centers showing the lowest odds of practicing proper cord care (AOR = 0.50; 95% CI: 0.28–0.89; p = 0.018). Similarly, educational status significantly influenced mothers' thermoregulation practices, with mothers who had only primary education exhibiting the least odd to practicing good thermoregulation (AOR = 0.30; 95% CI: 0.09–0.97; p = 0.044).ConclusionThe study noted sub-optimal ENBC among postnatal mothers specifically: umbilical cord care, practice of exclusive breastfeeding and skin-to-skin contact. The findings underscore the need for targeted, culturally sensitive interventions in Anambra State, Nigeria, particularly focusing on umbilical cord management and breastfeeding.

Background: A time-bound and chronologically ordered series of medical interventions that a baby receives at birth are referred to as the "essential newborn protocol." This period of immediate care is critical for the babies' subsequent well-being and adaptation. However, there are still reports of health workers lacking good knowledge and practice with newborn care, which was not investigated in our hospital. 
 Methods: A hospital-based cross-sectional study was conducted in TASH with 114 selected gynecology and obstetrics residents and midwives. Using the SPSS version 25 software package, continuous data were described using the mean and standard deviation, while categorical data were de-scribed using frequency and percentage. To identify factors related to knowledge and practice, multivariable binary logistic regression analyses were used. 
 Result: Eighty-eight residents and 26 midwives were included. Nearly a quarter (24.6%) of participants had good knowledge about essential newborn care. Regarding knowledge level by profession, 31.8% of the residents had good knowledge of essential newborn care, and all the midwives had poor knowledge. The odds of having good knowledge of ENC were 96.3% lower for first-year residents and 90.5% lower for second-year residents as compared to year four. Untrained participants had an 84 percent lower chance of having good knowledge of essential newborn care than trained participants. Regarding practice level by profession, more than two-thirds of 68 (77.3%) residents and 21 (80.8%) midwives had sufficient skill in essential newborn care. 
 Conclusion: A substantial number of healthcare providers lacked essential newborn care knowledge and practice. The availability of service or on-the-job training, as well as the year of residency, were factors influencing newborn care knowledge. In-service training, encouraging supervision, and provisions should be reinforced to improve newborn care activities.

Despite existing policies on training health professionnels in essential newborn care (ENC), neonatal mortality still remains high in Mali. Our work aimed to assess the level of knowledge of health staff about ENC. Material and methods: From March 20th to April 20th, 2016, we interviewed newborn care providers at the six reference health centers and the Gabriel Toure University Hospital Center in Bamako. Results: In total, we interviewed 407 newborn care providers with a sex ratio of 0.52. Interviewees had over five years work experience in 62.1%. They considered a low Apgar score as an indication for neonatal resuscitation in 89%, regardless of profile (p = 0.1583). They knew the good aspiration technique in 54%, with nurses and midwives more knowledgeable (p < 0.001) of the reference health centers (p = 0.0000). The interviewees knew the indication and rate of ventilation in 30.2% and 16.0%, respectively. About one third (34%) thought oxygen administration should be systematic during ventilation. The knowledge level on ventilation was the lowest in the group of general practitioners (p = 0.0063 for oxygen indication and p < 0.001 for the technique). Knowledge level for other ENC components (temperature maintenance, eyes care, breastfeeding) were higher. The knowledge of the delay of the breasting did not correlated with either the profile (p = 0.0857) or the place of practice. The knowledge of the first bath was dependent on both the professional profile (p = 0.0002) and the reference level (p = 0.0238). Conclusion: The level of knowledge of health professionnels on ENC should be improved. This will involve the integration of ENC in initial training curricula along with an appropriate continuing training policy thereafter.

Skilled birth attendance (SBA) and essential obstetric care (EOC) are key strategies for reducing maternal and newborn mortality and morbidity globally. Lack of adequately trained competent staff is a key barrier to achieving this. We assessed the effectiveness of a new package of ‘Life Saving Skills – Essential Obstetric and Newborn Care Training’ (LSS-EOC and NC) designed specifically around the UN signal functions in seven countries in sub-Saharan Africa. Among 600 healthcare providers (nurse-midwives, doctors, clinical officers and specialists), knowledge about the diagnosis and management of complications of pregnancy and childbirth as well as newborn care significantly increased (p < 0.001). There was measurable improvement in skills (p < 0.001), and participants expressed a high level of satisfaction with the training. The training package was found to meet the needs of healthcare providers, increased awareness of the need for evidence-based care and encouraged teamwork.

Maternal health services utilisation by Kenyan adolescent mothers: Analysis of the Demographic Health Survey 2014

ObjectiveTo present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers'...

ABSTRACTBackgroundCompletion of the newborn and infant healthcare practices across the continuum of care, including essential newborn care, exclusive breastfeeding from birth to 6 months of age and immunisation, remains low in Ethiopia. Therefore, this study aimed to determine the impact of maternal pregnancy intention on the newborn and infant continuum of care in Ethiopia.MethodsThe analysis used data from the Performance Monitoring for Action Ethiopia longitudinal survey. This nationally representative survey was conducted from 2019 to 2021. The impact of maternal pregnancy intention on the newborn and infant continuum of care was assessed using propensity score methods. Essential newborn and infant care practices were examined as outcome variables, with pregnancy intention as the exposure variable. Adjusting for potential covariates, the impact of exposure on outcomes was determined using a logistic regression model with an odds ratio at 95% CI based on the inverse probability of treatment weights.ResultsWomen with intended pregnancies had 28% higher odds of early initiation of breastfeeding (AOR = 1.28, 95% CI: 1.03–1.59) and 34% higher odds of exclusive breastfeeding from birth to 6 months of age (AOR = 1.34, 95% CI: 1.08–1.66) compared with women with unintended pregnancies. Similarly, the odds of full infant immunisation were 39% higher among women with intended pregnancies compared with women with unintended pregnancies (AOR = 1.39, 95% CI: 1.03–1.87). However, there was no statistically significant difference in the odds of essential newborn care practices between women with intended and unintended pregnancies (AOR = 0.83, 95% CI: 0.53–1.31).ConclusionPregnancy intention significantly impacts the newborn and infant healthcare practices across the continuum of care. Therefore, prioritising interventions for preventing unintended pregnancies by providing family planning services, early identification of women with unintended pregnancies and ensuring they receive appropriate healthcare services is essential.

Background; Essential newborn care is important for the proper development and healthy life of a baby. Although 70% of infant deaths occur during the first month of life, the policy-makers and health professionals in developing countries, until recently, gave little attention for the new born care. But, the principles of essential newborn care are simple, requiring no expensive high technology equipment.Objective: the main aim of this study was to assess level of community based essential new born care practices and associated factors among rural women who gave birth in the last 12 months preceding the survey in Awabel District, Amhara, Ethiopia.Method: A community-based cross-sectional study was conducted in September and October 20013. Data were collected from randomly selected 570 women by interview. The collected data were entered into computer using Epi-Data version3.1 and analyzed using SPSS version 16. Logestic regression was fitted to assess possible associations and the strength of association was measured using odds ratio with 95% CI.Results: the study revealed that the level of Essential New born Care practices was 23.1%. Educational status, (OR=7.02, 95%, CI=2.27,21.74), immediate PNC visit, (OR=3.22,95%CI = 1.18,9.48), advise about Essential New born Care practices during monthly pregnant mothers group meeting (OR=4.77,95%CI=1.11, 19.79) advise about birth preparedness during ANC visits (OR=9.05,95% CI =2.76,29.61) and presence of radio in the household (OR=7.91,95%CI=2.64,23.67) were found to have statistically significant association with essential new born care practices.Conclusion: The study identified low comprehensive practices of essential new born care in the study area. Community oriented promotion of essential new born care practices including women empowerment through education, promotion of suitable IEC materials and emphasizing and providing information and education to all pregnant women is recommended.

Background Rwanda's neonatal mortality rate is 20/1000 live births, and the country aims to meet the Sustainable Development Goal of 12 deaths per 1000 live births, or less, by 2030. Countries have decreased newborn deaths, infections, and intensive care unit admissions using the evidenced-based 'Essential Newborn Care' (ENC) guidelines established by the World Health Organization. Objective To assess postnatal mothers’ knowledge and practice of Essential Newborn Care in Kayonza District, Rwanda. Method A descriptive cross-sectional design was used to assess 192 postnatal mothers at the six-week vaccination services at two health facilities. Data collection using a valid questionnaire occurred from February 28 to March 2, 2019. Data analysis included descriptive and binary logistic regression. Results The majority (65.1%) had good ENC knowledge and practice, whereas a third (34.9%) had poor knowledge and practice. Significant gaps in ENC included timing of breastfeeding 33(17.2%), cord care 32(16.7%), and thermoregulation of small birth weight newborns 6(3.1%). Significant associations with ENC included maternal age (p=0.003), and ENC education postpartum (p=0.020). Conclusion The overall knowledge and practice of ENC are encouraging in this population, particularly with ENC education given postpartum, and older mothers. However, major gaps included evidenced-based cord care, thermoregulation, and breastfeeding, particularly among younger mothers. Rwanda J Med Health Sci 2020;3(2):139-151

IntroductionDespite encouraging reductions in global maternal mortality rates, Millennium Development Goal (MDG) 5 on reducing maternal mortality and achieving universal access to reproductive health remains the most off-track of all MDGs. Furthermore a preoccupation with aggregate coverage statistics masks extensive disparities in health improvements between societal groups. Recent national health indicators for Cambodia highlight impressive improvements, for example, in maternal, infant and child mortality, whilst substantial government commitments have been made since 2000 to address health inequities. It is therefore timely to explore the extent of equity in access to key reproductive and maternal health services in Cambodia and how this has changed over time.MethodsAnalysis was conducted on three rounds of Demographic and Health Survey data from 2000, 2005 and 2010. Outcome variables comprised utilisation of six reproductive and maternal health services – antenatal care, skilled birth attendance, facility-based delivery, postnatal care, met need for family planning and abortion by skilled provider. Four equity measures were calculated – equity gaps, equity ratios, concentration curves and concentration indices. Household assets were used to create the social-stratification variable, using principal components analysis.ResultsCoverage levels of all six services improved over the decade. Coverage improvements were greatest amongst wealthier quintiles of the population, although poorer quintiles also increased use of services. Critically, inequity in service use of all services dramatically reduced over time, except for postnatal care where inequity increased slightly. However, in 2010 inequity in service use remained favouring wealthier quintiles, greatest in use of skilled birth attendance and facility-based delivery, though the magnitude of inequity was substantially reduced compared to 2000. Met need for family planning was almost perfectly equitable in 2010.ConclusionsCambodia has made impressive improvements in overall coverage of reproductive and maternal health services over the last decade, and also in the distribution of their use across wealth quintiles. A range of pro-poor health financing and supply-side policies as well as non-health factors may have contributed to these achievements. Further research will explore specific schemes qualitatively and quantitatively to assess their impact on equity and service use.

Background: Essential newborn care (ENC) provides for an opportunity to assess the infant’s growth and development and counsel mothers regarding proper newborn care. Acquainting the caregivers with knowledge pertaining to dangers signs, hygienic practices, feeding, weaning, health and nutrition including growth and behaviour of children, might affect the rearing of their children. Therefore the present study aims to study the knowledge of caregivers in relation to newborn care.Methods: A descriptive cross sectional study was conducted among the caregivers attending the immunization clinic in a tertiary care centre (King George's Medical University) in Lucknow between January- March, 2016. A pretested and structured interview questionnaire was used to collect data and analysis was done using SPSS ver 16.0.Results: In Majority (75%) of the caregivers the knowledge regarding ENC was found to be average. Only 4% of the caregivers had good knowledge of ENC. Among the variables the association of knowledge of ENC and age of the caregiver&lt; 30 years, general caste, level of education of the caregiver of high School and above, middle socioeconomic status, female sex of the newborn, birth order of 2 or more, &gt;4 ANC visits and new born care not discussed in the VHND being conducted in the area were found to be statistically significantly.Conclusions: On the whole, the results of our study indicated that most of the caregivers were having unsatisfactory knowledge of child care practices. The present scenario can be improved through enhancing information education and counselling activities, training of health workers and mothers focusing on newborn health care practices.

This Horizons report from the Swaziland Ministry of Health and Social Welfare discusses findings from an intervention which aimed to reposition postnatal care within the context of a high HIV prevalence environment. The objectives were to determine if changes to the sexual and reproductive health guidelines on postnatal care would result in the timely and quality provision of key components of essential maternal and newborn care in the postnatal period, increase utilization of postnatal care services among all postpartum women, and improve the care and follow up of HIV-positive postpartum women and their infants. The study confirms that the introduction of an improved postnatal package with revised timing and content provides key components of maternal, newborn, and HIV care, and increases the utilization of services among postpartum women and their infants.

Objective: Pakistan ranks third in newborn mortality. The study aims to examine any socioeconomic disparities in 48-hour newborn care practices in Pakistan using 6 signal functions. Materials and Methods: Using R (version 4.3.1), a secondary analysis of 3936 mothers' Pakistan Demographic and Health Survey 2017-2018 data was performed. Newborn care practices in 48 hours of life were measured using 6 indicators: cord examination, temperature measurement, danger sign counseling, breastfeeding counseling, breastfeeding observation, and weight measurement. The outcome variable was defined as completing at least 2 signal functions. The frequencies of explanatory variables were estimated using descriptive analysis. Multivariate logistic regression was performed between independent variables and at least 2 signal functions. Results: Among mothers practicing the most newborn care, 71.8% were from urban areas, 81.9% were among the richest, 68.9% had institutional deliveries, 71.3% had 4 or more antenatal care (ANC) visits, 81.5% had cesarean sections (C-sections), and 68.1% were attended by skilled birth attendants. After adjusting for covariates, the likelihood of having at least 2 signal functions was 2.46 times greater for C-sections and 1.58 times greater for institutional deliveries, 2.41 times more probable for mothers with over 4 ANC visits, 1.75 times more likely for those with skilled birth attendants, and 1.64 times more common for the richest mothers. Conclusion: Wealth, C-sections, institutional births, skilled birth attendants, and frequent ANC visits were related to higher care levels, indicating the need for targeted measures in vulnerable populations.

Uganda's neonatal mortality rate was 20/1000 live births, and the country aims to meet the Sustainable Development Goal of 12 deaths per 1000 live births, or less, by 2030. Countries have decreased newborn deaths,infections, and intensive care unit admissions using the evidenced-based 'Essential Newborn Care' guidelines established by the World Health Organization. To assess the neonatal care practices among mothers attending a postnatal clinic at Mukono General Hospital. Mukono District. A descriptive cross-sectional design was used to assess 385 postnatal mothers at the six-week vaccination services at Mukono General Hospital. Data collection was done using a valid questionnaire. Data analysis included descriptive and binary logistic regression. The majority (65.1%) had good ENC knowledge and practice, whereas a third (34.9%) had poor knowledge and practice. Significant gaps in ENC included timing of breastfeeding 33(17.2%), cord care 32(16.7%), and thermoregulation of small birth weight newborns 6(3.1%). Significant associations with ENC included maternal age (p=0.003), and ENC education postpartum (p=0.020). The overall knowledge and practice of ENC are encouraging in this population, particularly with ENC education given postpartum, and older mothers. However, major gaps included evidencebased cord care, thermoregulation, and breastfeeding, particularly among younger mothers. Keywords: Neonatal mortality rate, Newborns deaths, Breastfeeding, Postnatal Mothers, ENC.

BackgroundImproving maternal health and achieving universal health coverage (UHC) are important expectations in the global Sustainable Development Goals (SDGs) agenda. While health insurance has been shown as effective in the utilisation of maternal healthcare, there is a paucity of literature on this relationship in sub-Saharan Africa (SSA). We examined the relationship between health insurance coverage and maternal healthcare utilisation using demographic and health survey data.MethodsThis was a cross-sectional study of 195 651 women aged 15–49 y from 28 countries in SSA. We adopted bivariable and multivariable analyses comprising χ2 test and multilevel binary logistic regression in analysing the data.ResultsThe prevalence of maternal healthcare utilisation was 58, 70.6 and 40.7% for antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC), respectively. The prevalence of health insurance coverage was 6.4%. Women covered by health insurance were more likely to utilise ANC (adjusted OR [aOR]=1.48, 95% CI 1.41 to 1.54), SBA (aOR=1.37, 95% CI 1.30 to 1.45) and PNC (aOR=1.42, 95% CI 1.37 to 1.48).ConclusionHealth insurance coverage was an important predictor of maternal healthcare utilisation in our study. To accelerate progress towards the achievement of SDG 3 targets related to the reduction of maternal mortality and achievement of UHC, countries should adopt interventions to increase maternal insurance coverage, which may lead to higher maternal healthcare access and utilisation during pregnancy.