Abstract
Reliable measurement of newborn postnatal care is essential to understand gaps in coverage and quality and thereby improve outcomes. This study examined gaps in coverage and measurement of newborn postnatal care in the first 2 days of life. We analyzed Demographic and Health Survey data from 15 countries for 71,366 births to measure the gap between postnatal contact coverage and content coverage within 2 days of birth. Coverage was a contact with the health system in the first 2 days (postnatal check or newborn care intervention), and quality was defined as reported receipt of 5 health worker-provided interventions. We examined internal consistency between interrelated questions regarding examination of the umbilical cord. Reported coverage of postnatal check ranged from 13% in Ethiopia to 78% in Senegal. Report of specific newborn care interventions varied widely by intervention within and between countries. Quality-coverage gaps were high, ranging from 26% in Malawi to 89% in Burundi. We found some internally inconsistent reporting of newborn care. The percentage of women who reported that a health care provider checked their newborn's umbilical cord but responded "no" to the postnatal check question was as high as 16% in Malawi. Reliable measurement of coverage and content of early postnatal newborn care is essential to track progress in improving quality of care. Postnatal contact coverage is challenging to measure because it may be difficult for women to distinguish postnatal care from intrapartum care and it is a less recognizable concept than antenatal care. Co-coverage measures may provide a useful summary of contact and content, reflecting both coverage and an aspect of quality.
Highlights
Progress in reducing neonatal mortality has been slower than progress in reducing older child mortality[1] despite the availability of evidence-based interventions that could reduce deaths.[2]
The analysis focused on the postnatal check and 5 health care provider-initiated specific newborn care interventions and Health Survey Program (DHS) core questionnaire in 2015 provide an opportunity to further evaluate the quality-coverage gap for newborns.[17]
We examine the concordance between the global postnatal care indicator—reported receipt of a newborn postnatal check (A)—and reported receipt of specific newborn care interventions (B) using nationally representative DHS surveys in sub-Saharan Africa and South Asia (Box)
Summary
Progress in reducing neonatal mortality has been slower than progress in reducing older child mortality[1] despite the availability of evidence-based interventions that could reduce deaths.[2]. Reliable measurement of newborn postnatal care is essential to understand gaps in coverage and quality and thereby improve outcomes. Methods: We analyzed Demographic and Health Survey data from 15 countries for 71,366 births to measure the gap between postnatal contact coverage and content coverage within 2 days of birth. Coverage was a contact with the health system in the first 2 days (postnatal check or newborn care intervention), and quality was defined as reported receipt of 5 health worker-provided interventions. The percentage of women who reported that a health care provider checked their newborn’s umbilical cord but responded “no” to the postnatal check question was as high as 16% in Malawi. Conclusion: Reliable measurement of coverage and content of early postnatal newborn care is essential to track progress in improving quality of care. Co-coverage measures may provide a useful summary of contact and content, reflecting both coverage and an aspect of quality
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