Abstract
BackgroundMore than a quarter of global neonatal deaths are reported from India, and a large proportion of these deaths are preventable. However, in the absence of robust public health care systems in several states in India, informal health care providers (IHCPs) with no formal medical education are the first contact service providers. The aim of this study was to assess the knowledge of IHCPs in basic evidence-based practices in neonatal care in Ujjain district and investigated factors associated with differences in levels of knowledge.MethodsA cross-sectional survey was conducted using a questionnaire with multiple-choice questions covering the basic elements of neonatal care. The total score of the IHCPs was calculated. Multivariate quantile regression model was used to look for association of IHCPs knowledge score with: the practitioners’ age, years of experience, number of patients treated per day, and whether they attended children in their practice.ResultsOf the 945 IHCPs approached, 830 (88%) participated in the study. The mean ± SD score achieved was 22.3 ± 7.7, with a median score of 21 out of maximum score of 48. Although IHCPs could identify key tenets of enhancing survival chances of neonates, they scored low on the specifics of cord care, breastfeeding, vitamin K use to prevent neonatal hemorrhage, and identification and care of low-birth-weight babies. The practitioners particularly lacked knowledge about neonatal resuscitation, and only a small proportion reported following up on immunizations. Results of quantile regression analysis showed that more than 5 years of practice experience and treating more than 20 patients per day had a statistically significant positive association with the knowledge score at higher quantiles (q75th and q90th) only. IHCPs treating children had significantly better scores across quantiles accept at the highest quantile (90th).ConclusionsThe present study highlighted that know-do gap exists in evidence-based practices for all key areas of neonatal care tested among the IHCPs. The study provides the evidence that some IHCPs do possess knowledge in basic evidence-based practices in neonatal care, which could be built upon by future educational interventions. Targeting IHCPs can be an innovative way to reach a large rural population in the study setting and to improve neonatal care services.
Highlights
More than a quarter of global neonatal deaths are reported from India, and a large proportion of these deaths are preventable
The present study highlighted that know-do gap exists in evidence-based practices for all key areas of neonatal care tested among the informal health care providers (IHCPs)
The study provides the evidence that some IHCPs do possess knowledge in basic evidence-based practices in neonatal care, which could be built upon by future educational interventions
Summary
More than a quarter of global neonatal deaths are reported from India, and a large proportion of these deaths are preventable. Under-5 mortality (U5M) decreased by 53% during the Millennium Development Goals era between 1990 and 2015, from 91 to 43 per 1000 live births, mainly due to reduction in post neonatal deaths [1]. Global neonatal mortality declined by 47%, from 36 to 19 per 1000 live births, but still accounted for 45% of the total U5M [1]. The South Asian region contributed to approximately 1 million deaths in 2015 [3], with approximately 3000 deaths per day in the region, despite a 51% decrease in neonatal mortality from 1990 to 2015 [3]. Pakistan, and Afghanistan have made the slowest progress in reducing neonatal mortality rates (NMRs) [4]. India contributes to one-fifth of global live births and more than a quarter of neonatal deaths [3, 5]. NMR in rural areas is twice as that in urban areas (27 versus 14 per 1000 live births) [6]
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