scholarly journals Community And Individual Factors Associated With Maternal And Neonatal Care Practices In Low Resource Settings. A Case Of Zimbabwe

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
E. Chiwawa ◽  
M. Mhlanga ◽  
A. Munodawafa ◽  
F. Mukora-Mutseyekwa
Keyword(s):  
Neonatal Mortality ◽  
Health Facility ◽  
Breast Feeding ◽  
Newborn Care ◽  
Neonatal Care ◽  
Care Seeking ◽  
District Health ◽  
Live Births ◽  
Factors Associated ◽  
Care Practices

Neonatal mortality has been increasing in Zimbabwe from 20/1,000 live births between 2000 and 2004 to 29 /1,000 live births between 2010 and 2014.Suboptimal newborn care practices are the predisposing factors to neonatal mortality. In Manicaland Province, care seeking behaviours for fever which is the main symptom of majority of infections in children and knowledge levels of danger signs that should cause the mother to take a child immediately to a health facility remains unacceptably lower than the national averages. A cross sectional descriptive and analytic design was carried out to explore the factors associated with the practice of the recommended newborn care practices by women of child bearing age in Mutare District. Health facilities were purposively sampled and participants were systematically sampled. Structured interviews were used to collect data which was analysed in Epi-Info version 7.2. Descriptive and multivariate analysis was performed on data collected from 349 participants. Practice of the five assessed recommended newborn care practices was high. Exclusive breast feeding (62%), early initiation of Breast feeding (74%), good code care (73%), care seeking for neonatal illness within 24hrs of onset of fever (82%) and keeping baby warm was at 58%. Statistically significant independent factors associated with the recommended newborn care practices were post-natal stay for more than 72 hours at the clinic (AOR=0.56; 95%CI: 0.12-0.87, p=0.000), and delivery at the health facility (AOR=0.43; 95%CI: 0.21-0.77; p=0.000). Cultural practices that impact negatively on neonatal care in Mutare district include; asking for permission to seek treatment for the child when ill, feeding the baby immediately after delivery and applying substances and mixed traditional herbs on the cord stump of the newborn. Improving newborn care outcomes require approaches addressing demand and supply factors to reach communities with correct information on good newborn care.

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 Newborn Care Practices in Rural Communities of Nawalparasi District, Nepal

2019 ◽  
Vol 3 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Hari Prasad Kaphle ◽  
Dipendra Kumar Yadav ◽  
Nirmala Neupane ◽  
Bimala Sharma ◽  
Dilip Kumar Yadav ◽  
...  
Keyword(s):  
Breast Feeding ◽  
Newborn Care ◽  
Health Facilities ◽  
Rural Setting ◽  
Delivery Care ◽  
Cord Care ◽  
Factors Associated ◽  
New Born ◽  
Thermal Care ◽  
Care Practices

Most of the new born deaths in the developing countries occur due to lack of access to care, as majority of the deliveries occur at home. Even deliveries conducted in health facilities are prone to suffering from traditional care practice after discharge from health facilities. Most of these deaths could be avoided with changes in antenatal, delivery and newborn care practices. This study was conducted to explore the newborn care practices related to cord care, thermal care and breast feeding in rural setting and to identify socio-demographic, antenatal and delivery care factors associated with these practices. A cross sectional study in rural setting of Nawalparasi district included 296 women who had delivered live baby at home or discharged within 24 hours of delivery from hospital proceeding four months of data collection. Chi squire test was applied to compare sociodemographic, antenatal and delivery care factors associated with cord care, thermal care and breast feeding practices. Of the total 296 mother interviewed, only 65.54% have completed ANC visit at least 4 times and 29.05% have received counselling on newborn care during pregnancy. More than half deliveries (53.38%) were home deliveries and Clean Home Delivery Kit was used only one third (39.91%) of these deliveries. Of the three selected newborn care practices, clean cord keeping practice was found in only one fourth (25.70%) of deliveries. However early initiation of breast feeding and delayed bathing practice was found in about half of the deliveries (51.35% and 58.45% respectively). There is strong need to implement the community-based interventions to improve the new born care practices in community level and to reduce the high-risk newborn care practices like unsafe cord care, delayed breast feeding, early bathing, prelacteal feeding and discarding colostrum need through the community level health workers and volunteers. Key words: Newborn care, Safe cord care, Early breast feeding, Thermal care, Delayed bathing.

scholarly journals Service-Related Factors Associated With Newborn Care Practices by Mothers in Mutare, Zimbabwe: A Cross-Sectional Study

2020 ◽  
Vol 12 (6) ◽  
pp. 37
Author(s):  
Edhina Chiwawa ◽  
Maxwell Mhlanga ◽  
Auxillia Munodawafa ◽  
Fadzayi Mutseyekwa
Keyword(s):  
Service Delivery ◽  
Newborn Care ◽  
Cross Sectional Study ◽  
Neonatal Outcomes ◽  
Health System Strengthening ◽  
Care Seeking ◽  
Related Factors ◽  
Cross Sectional ◽  
Factors Associated ◽  
Care Practices

Neonatal mortality remains very high in Zimbabwe (29/1,000 live births). Service-related factors have been linked to the care-giver knowledge and newborn care practices. In Manicaland Province, care-seeking behaviors for fever (the main symptom for childhood infections) and knowledge levels of neonatal danger signs remains unacceptably lower than the national averages. A cross-sectional descriptive and analytic design was carried out to determine service-related factors to newborn care practices and their association with neonatal outcomes in Mutare District. Purposive sampling was used to select health facilities and systematic random sampling was used to select participants. A structured interviewer administered questionnaire was used to collect data which was then entered and analyzed using Epi-Info version 7.2. Descriptive and multivariate analysis were performed on data collected from 349 participants. Practice of the five assessed recommended newborn care practices was high. Exclusive breastfeeding (62%), early initiation of breastfeeding (74%), good cord care (73%), care-seeking for neonatal illness within 24hrs of onset of fever (82%) and keeping baby warm was at 58%. Statistically significant independent factors associated with the recommended newborn care practices were post-natal stay for more than 72 hours at the clinic (AOR=0.56; 95%CI: 0.12-0.87, p=0.000), and delivery at the health facility (AOR=0.43; 95%CI: 0.21-0.77; p=0.000). Service delivery had a substantial influence on newborn care practices in Mutare district and influenced neonatal outcomes. Improving newborn care outcomes requires both effective service delivery and community health system strengthening to promote good newborn care.

scholarly journals Neonatal care practices in Buikwe District, Uganda: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marte Bodil Roed ◽  
Ingunn Marie Stadskleiv Engebretsen ◽  
Robert Mangeni
Keyword(s):  
Health Workers ◽  
Post Partum ◽  
Newborn Care ◽  
Neonatal Care ◽  
Sub Saharan Africa ◽  
Cord Clamping ◽  
Care Practices ◽  
Sub Saharan ◽  
Skin To Skin ◽  
User Perspectives

Abstract Background Sub-Saharan Africa is the region with the highest neonatal mortality rate, with Uganda reporting 20 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period. The objective of the study was to identify provider and user perspectives regarding the knowledge of and adherence to the UCG recommendations in aspects of delivery and newborn care, both in cases of normal as well as complicated births. Methods The study used qualitative methods with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis. Results The study found low knowledge about the UCG among the health workers. Various discrepancies between performed hands-on-procedures and the UCG were found related to neonatal care practices, including low use of partograms, uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of skin-to-skin care. Conclusions Continued focus on systemic strategies for further implementation of the UCG is recommended.

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 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

scholarly journals Health facility structure and maternal characteristics related to essential newborn care in Brazil: a cross-sectional study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021431 ◽  
Author(s):  
Maria Alexsandra Silva Menezes ◽  
Ricardo Gurgel ◽  
Sonia Duarte Azevedo Bittencourt ◽  
Vanessa Eufrazino Pacheco ◽  
Rosana Cipolotti ◽  
...  
Keyword(s):  
Health Facility ◽  
Breast Feeding ◽  
Perinatal Care ◽  
Newborn Care ◽  
Health Facilities ◽  
Cross Sectional ◽  
Essential Newborn Care ◽  
Skin Contact ◽  
Postnatal Women ◽  
Skin To Skin

ObjectivesTo assess the use of the WHO’s Essential Newborn Care (ENC) programme items and to investigate how the non-use of such technologies associates with the mothers' characteristics and hospital structure.DesignA cross-sectional observational health facility assessment.SettingThis is a secondary analysis of the ‘Birth in Brazil’ study, a national population-based survey on postnatal women/newborn babies and of 266 publicly and privately funded health facilities (secondary and tertiary level of care).ParticipantsData on 23 894 postnatal women and their newborn babies were analysed.Main outcome measuresThe facility structure was assessed by evaluating the availability of medicines and equipment for perinatal care, a paediatrician on call 24/7, a neonatal intensive care unit (NICU) and kangaroo mother care. The use of each ENC item was assessed according to the health facility structure and the mothers’ sociodemographic characteristics.ResultsThe utilisation of ENC items is low in Brazil. The factors associated with failure in pregnant woman reference were: pregnant adolescents (ORadj1.17; 95% CI 1.06 to 1.29), ≤7 years of schooling (ORadj1.47; 95% CI 1.22 to 1.78), inadequate antenatal care (ORadj1.67; 95% CI 1.47 to 1.89). The non-use of corticosteroids was more frequently associated with the absence of an NICU (ORadj3.93; 95% CI 2.34 to 6,66), inadequate equipment and medicines (ORadj2.16; 95% CI 1.17 to 4.01). In caesarean deliveries, there was a less frequent use of a partograph (ORadj4,93; 95% CI 3.77 to 6.46), early skin-to-skin contact (ORadj3.07; 95% CI 3.37 to 4.90) and breast feeding in the first hour after birth (ORadj2.55; 95% CI 2.21 to 2.96).ConclusionsThe coverage of ENC technologies use is low throughout Brazil and shows regional differences. We found a positive effect of adequate structure at health facilities on antenatal corticosteroids use and on partograph use during labour. We found a negative effect of caesarean section on early skin-to-skin contact and early breast feeding.

scholarly journals Essential Medicine and Equipment for Emergency Obstetric and Newborn Care in Zanzibar: Situation at a Glance

2019 ◽  
pp. 1-7
Author(s):  
Andrea B. Pembe ◽  
Bruno Sunguya ◽  
Stella Mushy ◽  
Sebalda Leshabari ◽  
George Kiwango ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Essential Medicine ◽  
Newborn Care ◽  
Newborn Health ◽  
Structure Interview ◽  
Essential Medicines ◽  
Maternal And Newborn Health ◽  
Cross Sectional ◽  
Live Births ◽  
Delivery Services

Background:Maternal and neonatal mortality are unacceptably high in Zanzibar. Maternal mortality and neonatal mortality ratio stand at 350 per 100,000 live births and 29 per 1,000 live births respectively as of 2018. Addressing challenges facing maternal and newborn health requires among others, the assurance of essential medicine and equipment to deliver evidence based interventions. This paper reports evidence gathered on the availability of essential medicines and equipment in providing Emergency Obstetric and Newborn Care (EmoNC) services in Zanzibar. Methods:A cross-sectional mixed methods study design was used to collect information on the availability of drugs and equipment from all health facilities providing delivery services in Zanzibar. Semi-structure interview guide was used to carry in-depth interviews (IDIs) with health facility in-charges while observation on availability of essential medicine and equipment for EmONC was carried using standard observation guide as adopted from Averting Maternal Death and Disability program.

scholarly journals Neonatal care practices in Buikwe District, Uganda: A qualitative study

2021 ◽  
Author(s):  
Marte Bodil Roed ◽  
Ingunn Marie Stadkleiv Engebretsen ◽  
Robert Mangeni
Keyword(s):  
Health Workers ◽  
Post Partum ◽  
Newborn Care ◽  
Neonatal Care ◽  
Sub Saharan Africa ◽  
Cord Clamping ◽  
Care Practices ◽  
Sub Saharan ◽  
Skin To Skin ◽  
User Perspectives

Abstract Background: Sub-Saharan Africa is the region with the highest neonatal mortality rate, with Uganda reporting 20 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period. The objective of the study was to identify provider and user perspectives regarding the knowledge of and adherence to the UCG recommendations in aspects of delivery and newborn care, both in cases of normal as well as complicated births. Methods: The study used qualitative methods with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis. Results: The study found low knowledge about the UCG among the health workers. Various discrepancies between performed hands-on-procedures and the UCG were found related to neonatal care practices, including low use of partograms, uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of skin-to-skin care. Conclusions: Continued focus on systemic strategies for further implementation of the UCG is recommended.

scholarly journals Prevalence and risk factors of short birth interval in Bangladesh: Evidence from the linked data of population and health facility survey

2021 ◽  
Author(s):  
Mohammad Zahidul Islam ◽  
M Mofizul Islam ◽  
Md Mostafizur Rahman ◽  
Md Nuruzzaman Khan
Keyword(s):  
Health Facility ◽  
Rural Women ◽  
Birth Interval ◽  
Wealth Quintile ◽  
World Health ◽  
Short Intervals ◽  
Live Births ◽  
Factors Associated ◽  
Modern Contraceptives ◽  
Short Birth Interval

Background: The Sustainable Development Goals target significant reductions in maternal and under-five deaths by 2030. The prevalence of these deaths is significantly associated with short birth interval (SBI). Identification of factors associated with SBI is pivotal for intervening with appropriate programmes to reduce these adverse consequences. This study aimed to determine the factors associated with SBI in Bangladesh. Methods: The Bangladesh Demographic and Health Survey 2017/18 and Bangladesh Health Facility Data 2017 were linked and analysed. SBI was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization. We used descriptive statistics to summarise characteristics of respondents and multilevel Poisson regression to assess the predictors of SBI. Results: Around 26% of live births occurred in short intervals, with a further higher prevalence among younger, uneducated, or rural women. The likelihoods of SBI were lower among women aged 20-34 years (PR, 0.14, 95% CI, 0.11-0.17) and more than or equal to 35 years (PR, 0.03, 95% CI, 0.02-0.05) as compared to the women aged 19 years or less. Women from households with the richest wealth quintile experienced lower odds of SBI (PR, 0.61, 95% CI, 0.45-0.85) compared to those from the poorest wealth quintile. The prevalences of SBI were higher among women for whom the children born from the second most pregnancies died (PR, 5.23, 95% CI, 4.18-6.55), those who were living in Chattogram (PR, 1.52, 95% CI, 1.12-2.07) or Sylhet (PR, 2.83, 95% CI, 2.08-3.86) divisions. Availability of modern contraceptives at the nearest healthcare facilities was 66% protective to the occurrence of SBI (PR, 0.34, 95% CI, 0.22-0.78). Also, the prevalence of SBI increased around 85% (PR, 1.85, 95% CI, 1.33-2.18) for every kilometer increase in the distance of nearby health facilities from homes of women. Conclusion: More than a quarter of live births in Bangladesh occurred in short intervals. This relatively high prevalence is a challenge for Bangladesh in reducing pregnancy-related adverse consequences, including maternal and child mortality. Policies and programmes are needed to increase awareness of SBI and associated adverse health outcomes and expand access to modern contraceptives.

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