scholarly journals What impact do essential newborn care practices have on neonatal mortality in low and lower-middle income countries? Evidence from Bangladesh

2015 ◽  
Vol 36 (3) ◽  
pp. 225-230 ◽  
Author(s):  
T Akter ◽  
A Dawson ◽  
D Sibbritt
Keyword(s):  
Neonatal Mortality ◽  
Newborn Care ◽  
Essential Newborn Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Practices

scholarly journals Evidence-based interventions to reduce mortality among preterm and low-birthweight neonates in low-income and middle-income countries: a systematic review and meta-analysis

2021 ◽  
Vol 6 (2) ◽  
pp. e003618
Author(s):  
Mirjam Y Kleinhout ◽  
Merel M Stevens ◽  
Kwabena Aqyapong Osman ◽  
Kwame Adu-Bonsaffoh ◽  
Floris Groenendaal ◽  
...  
Keyword(s):  
Low Income ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Neonatal Resuscitation ◽  
Newborn Care ◽  
Evidence Based ◽  
Antenatal Corticosteroids ◽  
Essential Newborn Care ◽  
Middle Income ◽  
Middle Income Countries

BackgroundPreterm birth is the leading cause of under-five-mortality worldwide, with the highest burden in low-income and middle-income countries (LMICs). The aim of this study was to synthesise evidence-based interventions for preterm and low birthweight (LBW) neonates in LMICs, their associated neonatal mortality rate (NMR), and barriers and facilitators to their implementation. This study updates all existing evidence on this topic and reviews evidence on interventions that have not been previously considered in current WHO recommendations.MethodsSix electronic databases were searched until 3 March 2020 for randomised controlled trials reporting NMR of preterm and/or LBW newborns following any intervention in LMICs. Risk ratios for mortality outcomes were pooled where appropriate using a random effects model (PROSPERO registration number: CRD42019139267).Results1236 studies were identified, of which 49 were narratively synthesised and 9 contributed to the meta-analysis. The studies included 39 interventions in 21 countries with 46 993 participants. High-quality evidence suggested significant reduction of NMR following antenatal corticosteroids (Pakistan risk ratio (RR) 0.89; 95% CI 0.80 to 0.99|Guatemala 0.74; 0.68 to 0.81), single cord (0.65; 0.50 to 0.86) and skin cleansing with chlorhexidine (0.72; 0.55 to 0.95), early BCG vaccine (0.64; 0.48 to 0.86; I2 0%), community kangaroo mother care (OR 0.73; 0.55 to 0.97; I2 0%) and home-based newborn care (preterm 0.25; 0.14 to 0.48|LBW 0.42; 0.27 to 0.65). No effects on perinatal (essential newborn care 1.02; 0.91 to 1.14|neonatal resuscitation 0.95; 0.84 to 1.07) or 7-day NMR (essential newborn care 1.03; 0.83 to 1.27|neonatal resuscitation 0.92; 0.77 to 1.09) were observed after training birth attendants.ConclusionThe findings of this study encourage the implementation of additional, evidence-based interventions in the current (WHO) guidelines and to be selective in usage of antenatal corticosteroids, to reduce mortality among preterm and LBW neonates in LMICs. Given the global commitment to end all preventable neonatal deaths by 2030, continuous evaluation and improvement of the current guidelines should be a priority on the agenda.

scholarly journals Assessing the changes in childbirth care practices and neonatal outcomes in Western China: pre-comparison and post-comparison study on early essential newborn care interventions

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041829
Author(s):  
Wen Qu ◽  
Qing Yue ◽  
Yan Wang ◽  
Jin Liuxing Yang ◽  
Xi Jin ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Neonatal Mortality ◽  
Breast Feeding ◽  
Newborn Care ◽  
Western China ◽  
Comparison Study ◽  
Essential Newborn Care ◽  
Breastfeeding Rate ◽  
Care Practices ◽  
Childbirth Care

ObjectiveTo explore the changes in childbirth care practices and health outcomes of newborns after the introduction of early essential newborn care (EENC).DesignA pre-comparison and post-comparison study.SettingThe study was conducted in December 2016 and December 2018 in 18 counties in four western provinces of China.Participants46 hospitals that provide delivery services participated in the study.InterventionsEENC practices were introduced and implemented in the 46 hospitals.Outcome measuresThe changes of hospital indicators such as incidence of birth asphyxia and neonatal mortality were compared in 2016 and 2018. EENC coverage indicators, such as skin-to-skin (STS) contact, and time of first breast feeding were also compared before and after the intervention via interview with 524 randomly selected postpartum mothers (320 in 2016 and 204 in 2018).Results54 335 newborns were delivered in the pre-EENC period (2016) and 58 057 delivered in the post-EENC period (2018). According to hospital records, the proportion of newborns receiving immediate STS contact increased from 32.6% to 51.2% (Risk Ratio (RR)=1.57,95% CI 1.55 to 1.59) and the percentage of newborns receiving prolonged STS contact for more than 90 min increased from 8.1% to 26.8% (RR=3.31, 95% CI 3.21 to 3.41). No statistically significant changes were found in neonatal mortality, although slight decreases in birth asphyxiate and neonatal intensive care unit admission rates were detected. Among the mothers interviewed, the proportion of newborns receiving immediate STS contact increased from 34.6% to 80.0% (RR=2.31, 95% CI 1.69 to 3.17). The exclusive breastfeeding rate increased from 43% to 73.4% (RR=1.71, 95% CI 1.43 to 2.04). The average length of the first breast feeding increased from 15.8 min to 17.1 min.ConclusionsThe introduction of EENC has yielded significant improvements in newborn care services at the pilot hospitals, including enhanced maternal and newborn care practices, improved STS contact quality and early breastfeeding performance. Further studies are needed to evaluate the long-term impact of EENC on newborn health outcomes.

scholarly journals Just-in-time postnatal education programees to improve newborn care practices: needs and opportunities in low-resource settings

2020 ◽  
Vol 5 (7) ◽  
pp. e002660
Author(s):  
Laura Subramanian ◽  
Seema Murthy ◽  
Prasad Bogam ◽  
Shirley D Yan ◽  
Megan Marx Delaney ◽  
...  
Keyword(s):  
Survey Data ◽  
Newborn Care ◽  
Just In Time ◽  
Evidence Based ◽  
Care Seeking ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Education Model ◽  
Care Practices

Worldwide, many newborns die in the first month of life, with most deaths happening in low/middle-income countries (LMICs). Families’ use of evidence-based newborn care practices in the home and timely care-seeking for illness can save newborn lives. Postnatal education is an important investment to improve families’ use of evidence-based newborn care practices, yet there are gaps in the literature on postnatal education programees that have been evaluated to date. Recent findings from a 13 000+ person survey in 3 states in India show opportunities for improvement in postnatal education for mothers and families and their use of newborn care practices in the home. Our survey data and the literature suggest the need to incorporate the following strategies into future postnatal education programming: implement structured predischarge education with postdischarge reinforcement, using a multipronged teaching approach to reach whole families with education on multiple newborn care practices. Researchers need to conduct robust evaluation on postnatal education models incorporating these programee elements in the LMIC context, as well as explore whether this type of education model can work for other health areas that are critical for families to survive and thrive.

scholarly journals Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii47-ii65
Author(s):  
Kimberly Peven ◽  
Debra Bick ◽  
Edward Purssell ◽  
Torill Alise Rotevatn ◽  
Jane Hyldgaard Nielsen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Implementation Research ◽  
Newborn Care ◽  
Implementation Strategies ◽  
Community Based ◽  
Essential Newborn Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Implementation Outcomes ◽  
Low Middle Income Countries

Abstract Neonatal mortality remains a significant health problem in low-income settings. Low-cost essential newborn care (ENC) interventions with proven efficacy and cost-effectiveness exist but have not reached high coverage (≥90%). Little is known about the strategies used to implement these interventions or how they relate to improved coverage. We conducted a systematic review of implementation strategies and implementation outcomes for ENC in low- and low middle-income countries capturing evidence from five medical and global health databases from 1990 to 2018. We included studies of implementation of delayed cord clamping, immediate drying, skin-to-skin contact (SSC) and/or early initiation of breastfeeding implemented in the first hour (facility-based studies) or the 1st day (community-based studies) of life. Implementation strategies and outcomes were categorized according to published frameworks: Expert Recommendations for Implementing Change and Outcomes for Implementation Research. The relationship between implementation strategies and outcomes was evaluated using standardized mean differences and correlation coefficients. Forty-three papers met inclusion criteria. Interventions included community-based care/health promotion and facility-based support and health care provider training. Included studies used 3–31 implementation strategies, though the consistency with which strategies were applied was variable. Conduct educational meetings was the most frequently used strategy. Included studies reported 1–4 implementation outcomes with coverage reported most frequently. Heterogeneity was high and no statistically significant association was found between the number of implementation strategies used and coverage of ENC. This review highlights several challenges in learning from implementation of ENC in low- and low middle-income countries, particularly poor description of interventions and implementation outcomes. We recommend use of UK Medical Research Council guidelines (2015) for process evaluations and checklists for reporting implementation studies. Improved reporting of implementation research in this setting is necessary to learn how to improve service delivery and outcomes and thereby reduce neonatal mortality.

scholarly journals Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Karen Zamboni ◽  
Samiksha Singh ◽  
Mukta Tyagi ◽  
Zelee Hill ◽  
Claudia Hanson ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Neonatal Mortality ◽  
Process Evaluation ◽  
Andhra Pradesh ◽  
Newborn Care ◽  
Mechanisms Of Change ◽  
Evidence Based ◽  
Programme Implementation ◽  
Quasi Experimental ◽  
Care Practices

Abstract Background Improving quality of care is a key priority to reduce neonatal mortality and stillbirths. The Safe Care, Saving Lives programme aimed to improve care in newborn care units and labour wards of 60 public and private hospitals in Telangana and Andhra Pradesh, India, using a collaborative quality improvement approach. Our external evaluation of this programme aimed to evaluate programme effects on implementation of maternal and newborn care practices, and impact on stillbirths, 7- and 28-day neonatal mortality rate in labour wards and neonatal care units. We also aimed to evaluate programme implementation and mechanisms of change. Methods We used a quasi-experimental plausibility design with a nested process evaluation. We evaluated effects on stillbirths, mortality and secondary outcomes relating to adherence to 20 evidence-based intrapartum and newborn care practices, comparing survey data from 29 hospitals receiving the intervention to 31 hospitals expected to receive the intervention later, using a difference-in-difference analysis. We analysed programme implementation data and conducted 42 semi-structured interviews in four case studies to describe implementation and address four theory-driven questions to explain the quantitative results. Results Only 7 of the 29 intervention hospitals were engaged in the intervention for its entire duration. There was no evidence of an effect of the intervention on stillbirths [DiD − 1.3 percentage points, 95% CI − 2.6–0.1], on neonatal mortality at age 7 days [DiD − 1.6, 95% CI − 9–6.2] or 28 days [DiD − 3.0, 95% CI − 12.9—6.9] or on adherence to target evidence-based intrapartum and newborn care practices. The process evaluation identified challenges in engaging leaders; challenges in developing capacity for quality improvement; and challenges in activating mechanisms of change at the unit level, rather than for a few individuals, and in sustaining these through the creation of new social norms. Conclusion Despite careful planning and substantial resources, the intervention was not feasible for implementation on a large scale. Greater focus is required on strategies to engage leadership. Quality improvement may need to be accompanied by clinical training. Further research is also needed on quality improvement using a health systems perspective.

scholarly journals Essential newborn care practices and associated factors among home delivered mothers in Damot pulasa Woreda, southern Ethiopia

2018 ◽  
Vol 15 (1) ◽  
Author(s):  
Tesfaye Yitna Chichiabellu ◽  
Baze Mekonnen ◽  
Feleke Hailemichael Astawesegn ◽  
Birhanu Wondimeneh Demissie ◽  
Antehun Alemayehu Anjulo
Keyword(s):  
Associated Factors ◽  
Newborn Care ◽  
Southern Ethiopia ◽  
Essential Newborn Care ◽  
Care Practices

scholarly journals Level of Knowledge and Associated Factors of Postnatal Mothers’ towards Essential Newborn Care Practices at Governmental Health Centers in Addis Ababa, Ethiopia

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Demis Berhan ◽  
Hanna Gulema
Keyword(s):  
Associated Factors ◽  
Maternal Education ◽  
Addis Ababa ◽  
Newborn Care ◽  
Health Centers ◽  
Essential Newborn Care ◽  
Poor Knowledge ◽  
Postnatal Mothers ◽  
Level Of Knowledge ◽  
Care Practices

Background. Globally 4 million newborns die every year before they reach the age of one month and approximately 3.4 million newborns die within the first week of life. Of these deaths, 66% occur during the 1st 24 hours. Late death, i.e., after 24 hours, still occurs 34% and may be prevented if mothers have knowledge about newborn care including dangers sign of newborn. Objective. The aim of the study was to assess level of knowledge and associated factors of postnatal mothers towards essential newborn care practices at governmental health centers in Addis Ababa. Methodology. Institutional-based cross-sectional study with internal comparison was conducted using multistage sampling method in AA health centers from December 5 to January 30, 2016. Result. A total of 512 mothers who came for postnatal visit were interviewed using structured pretest questionnaires. Knowledge was assessed using closed and open ended questions. Poor knowledge has strong association with women’s occupation (AOR = 2.10, 95% CI : (1.38,3.20)). Parity of the women was found as one of significant predictors for poor knowledge of essential newborn care. Women who were primiparas are 1.99 times more likely to have poor knowledge of ENC compared to women who were multiparas AOR = 1.99,95% CI: (1.25,3.20). The other significant predictors for poor knowledge of ENC were ANC visit. Women who had less than four antenatal visits were 0.63 times less likely to have poor knowledge than those who visit four times and above. AOR = 0.63, 95% CI:( 0.40,0.99). Conclusion. Maternal education programs should be given emphasis for the components of ENC for mothers’ knowledge gaps. Special emphasis needs to be placed when educating vulnerable groups including those who failed to fully attend antenatal clinic visits.

scholarly journals Newborn Care Practices by the Mother / Care Givers’ and Their Knowledge about Signs of Sickness of Neonates

2012 ◽  
Vol 35 (3) ◽  
pp. 90-96 ◽  
Author(s):  
Md Mahbubul Hoque ◽  
Mohammad Faizul Haque Khan ◽  
Jotsna Ara Begum ◽  
MAK Azad Chowdhury ◽  
Lars Ake Persson
Keyword(s):  
Neonatal Mortality ◽  
Newborn Care ◽  
Cost Effective ◽  
Home Delivery ◽  
Prelacteal Feeding ◽  
Cross Sectional ◽  
Institutional Deliveries ◽  
Home Deliveries ◽  
Care Practices ◽  
At Home

Background: Despite proven cost effective intervention, there has been little change in neonatal mortality. In Bangladesh neonatal mortality accounts for two third of infants death. About 90% deliveries take place in home and majority of neonatal death are taking place within 7 days of birth. Information about reasons for delivering at home and newborn care practices will be useful to undertake simple intervention measures by policy makers.Aims and objective: To see the knowledge, perception and behaviour of mothers towards their normal and sick newborn.Methods: A cross sectional study was carried out in Dhaka Shishu Hospital from June to November, 2007. A semistructured, pretested questionnaire was used to interview mothers attending inpatient (IPD) and outpatient department (OPD) of hospital.Results: A total 198 mothers were interviewed. Home deliveries were 35.5% and Institutional were 64.5%. Among the Institutional deliveries 35% (44 out of 127) were planned and tried first at home, but when failed mothers were taken to hospital. Majority (86%) of home deliveries were conducted by Dai/relatives. Umbilical cord was cut with new/boiled blade in 85% of home deliveries and household knife was used in 4% cases. Birth place were not at all heated in all home deliveries. In 32 % of home deliveries babies were given bath within 1 hour of birth and it was 15% in case of hospital deliveries. Forty-eight percent babies of home deliveries were wrapped within 10 minutes. Prelacteal feed was given in 51% of home deliveries in comparison to 23% of institutional deliveries. The rate of initiation of breast feeding within one hour of birth was 52% in home and 35% in institutional deliveries. In all cases breast milk was given within 48 hours. Main reasons cited for delivering at home were preference (43%) and fear about hospital (39%). In case of educated (graduate) mothers 72% deliveries took place at hospital. Less feeding (56%), vomiting (42%), less movement (32%), fever (29%) and cough (27%) could be recognized by mothers as signs of sickness.Conclusion: Home deliveries and poor newborn care practices are commonly found in this study. Traditional birth attendants should be adequately trained as they are conducting majority of home deliveries. Female education is very important to reduce home delivery as it is seen that deliveries of educated mothers are taking place in hospital. High risk traditional newborn care practices like delayed wrapping, early bathing, use of oil in umbilical stump and prelacteal feeding need to be addressed. This study also found that knowledge to identify sickness in newborn is still poor.DOI: http://dx.doi.org/10.3329/bjch.v35i3.10497  Bangladesh J Child Health 2011; Vol 35 (3): 90-96

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