Risk Factors associated with unsafe neonatal practices in rural area of Nadia district of West Bengal

Abstract

Introduction: Neonatal mortality is the main barrier to reduction of infant mortality in West Bengal. Home based simple newborn care by mothers in the neonatal period can reduce neonatal mortality. The practices of mothers in this aspect in Nadia are not known. A cross sectional survey of mothers of Nadia with the objectives of describing their neonatal care practices, determine factors associated with it. Methods: Nadia district has a population of 5 million and estimated pregnancies of 74000. We used PPS method cluster sampling technique. We needed 575 mothers in 23 clusters assuming 52% prevalence at 5% precision, 95% Confidence interval and design effect 1.48.Structured questionnaire was used for data collection on different socio-demographic and health system related factors and mothers’ newborn care practices. Data was analysed using Epi info 3.5 software. Results: Among 575 mothers, 518 (90.1%) kept the neonates cord stump clean. Delaying the first bath of the neonate was least practiced 292 (50.8%). Only 39 (6.8%) mothers had all safe practices. Living below poverty line (Adjusted OR 5.2, C.I. 3.4-7.8), not registering in the first trimester (Adjusted OR 2.6, C.I 1.6-4.2), maternal education not more than secondary level (Adjusted OR 2.3, C.I. 1.3-3.9) and having home delivery(Adjusted OR 3.2, C.I. 1.5-6.8) were significant factors for non-adoption of at least five safe practices. The overall neonatal morbidity rate was 57 per 1000 live births (33 /575) and neonatal mortality rate was 10 per 1000 live birth (6/575). Median contacts with the health system in the mothers having unsafe practices was 6 (range 0-11) compared to 10(range 1-11) in the other group. Out of 33 sick neonates 26(78.8%) were from mothers with unsafe practices. Conclusion: Poor and uneducated were unaware of safe newborn care practices especially for hypothermia. They had more neonatal sickness and deaths. They had less contact with the health system. There is a need to reach out to such vulnerable group and improve their coverage in existing facilities. Training of ASHA in Home based newborn care and educating mothers can be cost effective option for this section to save neonates by promoting best neonatal practices. Keywords: Risk factors, Unsafe practices, Neonatal morbidity, ASHA, Rural Nadia, West Bengal