Maternal and community failures in newborn care and high rural neonatal mortality

Abstract

Background: The neonatal mortality rate (NNMR) is more in rural India (54.3 in males; 49.0 in females) than in urban India (37.8 in males; 28.8 in females). Objectives: To what extent the rural mothers and the communities are responsible for this situation? Methods: A cross-sectional community based comparative study in urban and rural settings .Statistical techniques: Cluster sampling; proportions; Chi-square tests. Method: Three hundred mothers (150 urban and 150 rural) were surveyed regarding 40 selected newborn care (NBC) practices by a pediatrician and three resident doctors using a predesigned questionnaire. Results: Rural mothers were falling behind urban mothers in 25 out of 40 selected NBC practices. The major lapses with rural mothers were with regard to Early initiation of breast feeding, Exclusive breast feeding practice (Urban 52% Rural 15% P<0.0000), Colostrums feeding (Urban 79% Rural 7% P<0.0000), Poor drying and wrapping the child (Urban 90% Rural 48% P<0.00000), poor thermal protection (Urban 81% Rural 31% P<0.00000), mother- child skin contact ( P<0.00001), poor cord care (P<0.00000), inappropriate treatment when child is sick (Urban (7 % Rural 23% P<0.00000), delay in seeking medical help ( P<0.00000). Community level failures were: Preferring home deliveries (P<0.000084), Delivery by untrained Dai (P<0.0110), lack of early new born checkups (Urban 42% Rural 15% P<0.00000), less affordability of treatment (P<0.000005), and poor community awareness about NBC (P<0.00001) etc. Conclusion: Rural mothers new borne care practices were deficient in most of the aspects in this study.