Essential newborn care practice at four primary health facilities in conflict affected areas of Bossaso, Somalia: a cross-sectional study

Ribka Amsalu,Sabine Baunach,Kingsley Chukwumalu,Alexia Couture,Catherine N Morris,Shehryar Janjua,Michelle Hynes,Aimee Summers,Amy Cannon,Erin N Hulland

doi:10.1186/s13031-019-0202-4

Abstract

BackgroundNewborn mortality is increasingly concentrated in contexts of conflict and political instability. However, there are limited guidelines and data on the availability and quality of newborn care in conflict settings. In 2016, an interagency collaboration developed the Newborn Health in Humanitarian Settings Field Guide- Interim version (Field Guide). In this study, we sought to understand the baseline availability and quality of essential newborn care in Bossaso, Somalia as part of an investigation to determine the feasibility and effectiveness of the Field Guide in improving newborn care in humanitarian settings.MethodsA cross-sectional study was conducted at four purposely selected health facilities serving internally displaced persons affected by conflict in Bossaso. Essential newborn care practice and patient experience with childbirth care received at the facilities were assessed via observation of clinical practice during childbirth and the immediate postnatal period, and through postnatal interviews of mothers. Descriptive statistics and logistic regression were employed to summarize and examine variation by health facility.ResultsOf the 332 pregnant women approached, 253 (76.2%) consented and were enrolled. 97.2% (95% CI: 94.4, 98.9) had livebirths and 2.8% (95% CI: 1.1, 5.6) had stillbirths. The early newborn mortality was 1.7% (95% CI: 0.3, 4.8). Nearly all [95.7%, (95% CI: 92.4, 97.8)] births were attended by skilled health worker. Similarly, 98.0% (95% CI: 95.3, 99.3) of newborns received immediate drying, and 99.2% (95% CI: 97.1, 99.9) had delayed bathing. Few [8.6%, (95% CI: 5.4, 12.9)] received immediate skin-to-skin contact and the practice varied significantly by facility (p < 0.001). One-third of newborns [30.1%, (95% CI: 24.4, 36.2)] received early initiation of breastfeeding and there was significant variation by facility (p < 0.001). While almost all [99.2%, (95% CI: 97.2, 100)] service providers wore gloves while attending births, handwashing was not as common [20.2%, (95% CI: 15.4, 25.6)] and varied by facility (p < 0.001). Nearly all [92%, (95% CI: 86.9, 95.5)] mothers were either very happy or happy with the childbirth care received at the facility.ConclusionEssential newborn care interventions were not universally available. Quality of care varied by health facility and type of intervention. Training and supervision using the Field Guide could improve newborn outcomes.

Highlights

Newborn mortality is increasingly concentrated in contexts of conflict and political instability
Essential newborn care by health facility (Table 4) The first category of essential newborn care, thermal care, had two of three components - drying immediately after birth and delayed bathing - practiced nearly universally in all the health facilities with an overall proportion of 98.0% and 99.2%, respectively
Our study, conducted in a protracted conflict setting of Bossaso, Somalia, found that while the majority of the childbirths were attended by skilled health workers, the observed quality of care varied

Summary

Introduction

Newborn mortality is increasingly concentrated in contexts of conflict and political instability. There are limited guidelines and data on the availability and quality of newborn care in conflict settings. Protracted crises are defined as “those environments in which a significant proportion of the population is acutely vulnerable to death, disease and disruption of livelihoods over a prolonged period of time. The governance of these environments is usually very weak, with the state having a limited capacity to respond to, and mitigate, the threats to the population, or provide adequate levels of protection.” [3]. Humanitarian crises have intensified in terms of complexity and scale, resulting in the largest global numbers of refugees and internally displaced persons (IDPs) seen in decades [4]

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