Abstract
Neonatal mortality remains very high in Zimbabwe (29/1,000 live births). Service-related factors have been linked to the care-giver knowledge and newborn care practices. In Manicaland Province, care-seeking behaviors for fever (the main symptom for childhood infections) and knowledge levels of neonatal danger signs remains unacceptably lower than the national averages. A cross-sectional descriptive and analytic design was carried out to determine service-related factors to newborn care practices and their association with neonatal outcomes in Mutare District. Purposive sampling was used to select health facilities and systematic random sampling was used to select participants. A structured interviewer administered questionnaire was used to collect data which was then entered and analyzed using Epi-Info version 7.2. Descriptive and multivariate analysis were performed on data collected from 349 participants. Practice of the five assessed recommended newborn care practices was high. Exclusive breastfeeding (62%), early initiation of breastfeeding (74%), good cord care (73%), care-seeking for neonatal illness within 24hrs of onset of fever (82%) and keeping baby warm was at 58%. Statistically significant independent factors associated with the recommended newborn care practices were post-natal stay for more than 72 hours at the clinic (AOR=0.56; 95%CI: 0.12-0.87, p=0.000), and delivery at the health facility (AOR=0.43; 95%CI: 0.21-0.77; p=0.000). Service delivery had a substantial influence on newborn care practices in Mutare district and influenced neonatal outcomes. Improving newborn care outcomes requires both effective service delivery and community health system strengthening to promote good newborn care.
Highlights
Significant progress and gains have been noted in child survival
Inequities to access and utilisation of material, neonatal and child health services have been associated with health facility related factors such as the quality of service rendered and the distance to the nearest health facility especially in rural areas and peri-urban areas, leading to low prevalence of essential newborn care practices (Karim et al, 2015; Tegene et al, 2015 and Berhane et al, 2014)
The results of this study reveal that attending at least 4 ANC visits (OR: 32.03; Cl 95% 13.22-80.35; p=0.003) was associated with early initiation of breast feeding with women who had attended at least four ANC visits being 32.03 times more likely to initiate breast feeding within the first hour after delivery than those who had less number of visits of who had not attended ANC
Summary
Significant progress and gains have been noted in child survival. The decline in neonatal mortality has been very slow between 1990 and 2015 compared to that of post-neonatal under-5 mortality, with 99% of maternal and newborn mortality occurring in the developing world (WHO, 2016). About 1.16 million African babies die in the first 28 days of life and the highest burden of neonatal mortality is among marginalised and poorest populations in Sub-Saharan Africa (Tura et al, 2014). These deaths are attributed to conditions of labour, intrapartum and poor immediate newborn care practices (Warren et al, 2015). Inequities to access and utilisation of material, neonatal and child health services have been associated with health facility related factors such as the quality of service rendered and the distance to the nearest health facility especially in rural areas and peri-urban areas, leading to low prevalence of essential newborn care practices (Karim et al, 2015; Tegene et al, 2015 and Berhane et al, 2014)
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