Abstract
BackgroundAlthough child mortality has decreased over the last several decades, neonatal mortality has declined less substantially. In South Asia, neonatal deaths account for the majority of all under-five deaths, calling for further study on newborn care practices. We assessed five key practices: immediate drying and wrapping, delayed bathing, immediate skin-to-skin contact after birth, cutting the umbilical cord with a clean instrument, and substances placed on the cord.MethodsUsing data from Demographic and Health Surveys conducted in Bangladesh, India, and Nepal between 2005 and 2016, we examined trends in coverage of key practices and used multivariable logistic regression to analyze predictors of thermal care and hygienic cord care practices and their associations with neonatal mortality among home births. The analysis excluded deaths on the first day of life to ensure that the exposure to newborn care practices would have preceded the outcome. Given limited neonatal mortality events in Bangladesh and Nepal, we pooled data from these countries.ResultsWe found that antenatal care and skilled birth attendance was associated with an increase in the odds of infants' receipt of the recommended practices among home births. Hygienic cord care was significantly associated with newborn survival. After controlling for other known predictors of newborn mortality in Bangladesh and Nepal, antiseptic cord care was associated with an 80% reduction in the odds of dying compared with dry cord care. As expected, skilled care during pregnancy and birth was also associated with newborn survival. Missing responses regarding care practices were common for newborns that died, suggesting that recall or report of details surrounding the traumatic event of a loss of a child may be incomplete.ConclusionsThis study highlights the importance of maternal and newborn care and services for newborn survival in South Asia, particularly antenatal care, skilled birth attendance, and antiseptic cord care.
Highlights
Child mortality has decreased over the last several decades, neonatal mortality has declined less substantially
The models explained only 1 to 4% of the deviance in thermal care or hygienic cord care. These fit statistics indicate that our models omit other factors of relative importance to receipt of care; across the interventions, we found a pattern of significant associations between care during pregnancy and birth, and receipt of newborn care practices
We further explored associations between recommended newborn care practices and neonatal mortality for babies born in a home setting, pooling data from Bangladesh and Nepal to increase the sample size
Summary
Child mortality has decreased over the last several decades, neonatal mortality has declined less substantially. The low impact of SBAs may be attributable to selection bias: women with higher-risk pregnancies seeking out facility delivery where most births are attended by SBAs [6, 7]. These newborns have lower odds of surviving, offsetting the hoped-for reduction in mortality [8]. Even though the benefit of delivering in a health facility is well-known, and facility birth is encouraged through national policies, women continue to deliver at home These women are impeded by lack of access to facilities in terms of distance or cost, or fear of poor quality of care at nearby facilities [9].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
