Spatial variation and determinants of mother and newborn skin-to-skin contact care practices in Ethiopia: A spatial and multilevel mixed-effect analysis.

Abstract

Skin-to-skin contact care practice is placing a naked baby on the mother's chest with no cloth separating them, in a prone position covered by a cloth or blanket. It improves the survival of newborns by preventing hypothermia, improving breastfeeding, and strengthening mother-to-child bonding. Nevertheless, it remains under-practiced in many resource-constrained settings. Therefore, the main objective of this study is to explore the spatial variation and determinants of mother and newborn skin-to-skin contact care practices in Ethiopia. The study was done using the 2016 Ethiopian Demographic and Health Survey data. A weighted sample of 10417 mothers who gave live birth before the five-year survey was extracted for the analysis. Arc GIS version 10.3 and SaTscan version 10.0.2 were used for the spatial analysis. A multilevel mixed logistic regression model was fitted to identify factors associated with skin-to-skin contact care practices of mothers and newborns. Finally, a statistically significant association was declared at a P-value of < 0.05. In this study, skin-to-skin contact care practice of mothers and newborns was non-random across Ethiopia with Moran's I: 0.48, p < 0.001. The most likely significant primary and secondary clusters were found in Addis Ababa (RR = 2.39, LLR = 116.80, p <0.001) and Dire Dewa and Harari (RR = 2.02, LLR = 110.45, p <0.001), respectively. In this study, place of delivery (AOR = 12.29, 95%CI:10.41, 14.54), rich wealth index (AOR = 1.29, 95% CI: 1.05,1.59), medium wealth index (AOR = 1.38, 95% CI:1.17, 1.68), having 1-3 antenatal care visits(AOR = 1.86,95% CI: 1.56, 2.29), having ≥4 antenatal care visits (AOR = 1.93,95% CI: 1.56, 2.39), initiating breastfeeding within the first hour (AOR = 1.75,95% CI:1.49,2.05) and media exposure (AOR = 1.20,95%CI 1.02,1.41) were factors associated with skin to skin contact care practice of mothers and newborns. This study concludes that the Skin-to-skin contact care practices of mother and newborn is not random in Ethiopia. Therefore, the implementation of essential newborn care packages should be regularly monitored and evaluated, particularly in the cold spot areas of skin-to-skin contact care practices. Besides, media advertising regarding the importance of Skin-to-skin contact care practices for mothers and newborns should be scaled up to increase the practices.