Is essential newborn care provided by institutions and after home births? Analysis of prospective data from community trials in rural South Asia

Christina Pagel,Audrey Prost,Swati Sarbani Roy,Kishwar Azad,Sonya Crowe,Abdul Kuddus,Munir Hossen,Prasanta Tripathy,Dharma S Manandhar,Nirmala Nair,Anthony Costello,Aman Sen,Naomi Saville,Catherine Sikorski

doi:10.1186/1471-2393-14-99

Abstract

BackgroundProvision of essential newborn care (ENC) can save many newborn lives in poor resource settings but coverage is far from universal and varies by country and place of delivery. Understanding gaps in current coverage and where coverage is good, in different contexts and places of delivery, could make a valuable contribution to the future design of interventions to reduce neonatal mortality. We sought to describe the coverage of essential newborn care practices for births in institutions, at home with a skilled birth attendant, and at home without a skilled birth attendant (SBA) in rural areas of Bangladesh, Nepal, and India.MethodsWe used data from the control arms of four cluster randomised controlled trials in Bangladesh, Eastern India and from Makwanpur and Dhanusha districts in Nepal, covering periods from 2001 to 2011. We used these data to identify essential newborn care practices as defined by the World Health Organization. Each birth was allocated to one of three delivery types: home birth without an SBA, home birth with an SBA, or institutional delivery. For each study, we calculated the observed proportion of births that received each care practice by delivery type with 95% confidence intervals, adjusted for clustering and, where appropriate, stratification.ResultsAfter exclusions, we analysed data for 8939 births from Eastern India, 27 553 births from Bangladesh, 6765 births from Makwanpur and 15 344 births from Dhanusha. Across all study areas, coverage of essential newborn care practices was highest in institutional deliveries, and lowest in home non-SBA deliveries. However, institutional deliveries did not provide universal coverage of the recommended practices, with relatively low coverage (20%-70%) across all study areas for immediate breastfeeding and thermal care. Institutions in Bangladesh had the highest coverage for almost all care practices except thermal care. Across all areas, fewer than 20% of home non-SBA deliveries used a clean delivery kit, the use of plastic gloves was very low and coverage of recommended thermal care was relatively poor. There were large differences between study areas in handwashing, immediate breastfeeding and delayed bathing.ConclusionsThere remains substantial scope for health facilities to improve thermal care for the newborn and to encourage immediate and exclusive breastfeeding. For unattended home deliveries, increased handwashing, use of clean delivery kits and basic thermal care offer great scope for improvement.

Highlights

Provision of essential newborn care (ENC) can save many newborn lives in poor resource settings but coverage is far from universal and varies by country and place of delivery
Increased access to some components of newborn care for women giving birth at home without a skilled birth attendant (SBA) can be an effective strategy to reduce neonatal morbidity and mortality [5,6,13], for instance through the use of clean delivery kits [14,15]. Both strategies are based on the knowledge that increasing the coverage of essential newborn care practices in South Asia is essential to achieving the millennium development goals for child survival [16,17,18]
Because the role and training of traditional birth attendant (TBA) varies between countries, we present a secondary analysis of care practices within home non-SBA deliveries separated by whether the main attendant was a TBA

Summary

Introduction

Provision of essential newborn care (ENC) can save many newborn lives in poor resource settings but coverage is far from universal and varies by country and place of delivery. Increased access to some components of newborn care for women giving birth at home without a SBA can be an effective strategy to reduce neonatal morbidity and mortality [5,6,13], for instance through the use of clean delivery kits [14,15]. Both strategies are based on the knowledge that increasing the coverage of essential newborn care practices in South Asia is essential to achieving the millennium development goals for child survival [16,17,18]

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