Newborn Danger Signs Research Articles

A Linked Community and Health Facility Intervention to Improve Newborn Health in Cambodia: the NICCI Stepped-Wedge Cluster-Randomized Controlled Trial.

Background: Newborn mortality in Cambodia remains high, with sepsis and complications of delayed care-seeking important contributing factors. Intervention study objectives were to improve infection control behavior by staff in health centers; improve referral of sick newborns; increase recognition of danger signs, and prompt care-seeking at an appropriate health facility; and appropriate referral for sick newborns by mothers and families of newborn infants. Methods: The stepped-wedge cluster-randomized controlled trial took place in rural Cambodia from February 2015 to November 2016. Sixteen clusters consisted of public health center catchment areas serving the community. The intervention included health center staff training and home visits to mothers by community health volunteers within 24 h of birth and on days 3 and 7 after delivery, including assessment of newborns for danger signs and counselling mothers. The trial participants included women who had recently delivered a newborn who were visited in their homes in the first week, as well as health center staff and community volunteers who were trained in newborn care. Women in their last trimester of pregnancy greater than 18 years of age were recruited and were blinded to their group assignment. Mothers and caregivers (2494) received counseling on handwashing practices, breastfeeding, newborn danger signs, and prompt, appropriate referral to facilities. Results: Health center staff in the intervention group had increased likelihood of hand washing at recommended key moments when compared with the control group, increased knowledge of danger signs, and higher recall of at least three hygiene messages. Of mother/caregiver participants at 14 days after delivery, women in the intervention group were much more likely to know at least three danger signs and to have received messages on care-seeking compared with controls. Conclusions: The intervention improved factors understood to be associated with newborn survival and health. Well-designed training, followed by regular supervision, enhanced the knowledge and self-reported behavior of health staff and health volunteers, as well as mothers’ own knowledge of newborn danger signs. However, further improvement in newborn care, including care-seeking for illness and handwashing among mothers and families, will require additional involvement from broader stakeholders in the community.

Awareness of Fathers Regarding Newborn Danger Signs: Evidence from a Tertiary Level Hospital of Kathmandu, Nepal

The neonatal period is a critical period of childhood carrying the highest risk of mortality per day than any other period during the childhood. In Nepal, a country where a neonatal mortality rate is high, raising awareness among fathers regarding newborn danger signs is crucial. This research aims to measure the awareness of fathers regarding newborn danger signs. A hospital based cross sectional descriptive study was done in maternity ward and birthing center of Tribhuvan University Teaching Hospital (TUTH) hospital. Non-probability purposive sampling technique was used to select fathers of neonate. The study was conducted on 103 fathers having newborn baby up to 7 days admitted in Maternity Ward and Birthing Center. Respondents were selected without any discrimination of education, ethnicity, economical status, marital status, religion, etc. The findings of the study showed that out of 103 respondents, most of the respondents had moderate level of awareness (63.1%), 28.2% had low level and minority of the respondents had high level of awareness (8.7%). The researcher concluded that most of the respondents had a moderate level of awareness and minority of the respondents had a high level of awareness on newborn danger signs. The findings show greater need of health education to increase awareness about newborn danger signs among fathers.

A Study to Assess the Effectiveness of Structured Teaching Programme on knowledge regarding selected Newborn Danger Signs among Post-natal mothers in Jayanagar General Hospital, Bangalore, Karnataka

The grim track of mysterious new illness has already killed scores of children. In less developed countries, there should be moves towards preventive measures, educating mothers and actions to reduce newborn mortality rate. Significant progress has to be made in reducing death of babies during first month of life.1 The aim of the study was to determine the effectiveness of structured teaching programme on knowledge regarding newborn danger signs. The objectives were to assess the pretest and posttest knowledge score, determine the effectiveness of structured teaching programme and to find out association between pretest knowledge scores of post-natal mothers with selected demographic variables. An evaluative approach was adopted and a quasi-experimental design was used for the study. Post-natal mothers at Jayanagar General Hospital, Bangalore were the samples and the sample size was 50. The Post-natal mothers were selected by purposive sampling technique. Findings of the study revealed that the overall post-test mean score was 36.86 (89.32%) with standard deviation 3.89 and the respondents knowledge were significantly higher than, the overall mean pre-test knowledge scores 9.76 (25.87%) with standard deviation 1.3 and computed paired t ‘value 23.78 is higher than table value 2.56 at P 0.05. Data was analyzed using descriptive and inferential statistics.

Predictors of neonatal mortality: development and validation of prognostic models using prospective data from rural Bangladesh

ObjectiveTo assess the extent to which maternal histories of newborn danger signs independently or combined with birth weight and/or gestational age (GA) can capture and/or predict postsecond day (age>48 hours)...

Knowledge, Attitude and Practice on Identification of Newborn Danger Signs and Associated Factors Among Mothers attending Postnatal Clinics at Dessie Referral Hospital, North East Ethiopia, 2019

Knowledge, Attitude and Practice on Identification of Newborn Danger Signs and Associated Factors Among Mothers attending Postnatal Clinics at Dessie Referral Hospital, North East Ethiopia, 2019

Knowledge of neonatal danger signs among recently delivered mothers in Mekedella woreda, Northeast Ethiopia, in 2017: a cross-sectional study

ObjectiveThis study was conducted with the aim of assessing mothers' level of knowledge of neonatal danger signs and its associated factors in Mekedella woreda, Northeast Ethiopia. Study designThis is a community-based cross-sectional study. MethodsThe study was conducted among 757 mothers who were selected by stratified simple random sampling between November 1, 2017, and December 30, 2017. A structured interviewer-administered pretested questionnaire was used to collect the data. Data were entered into EpiData, version 3.1, and then exported into SPSS (statistical package for social science), version 20, for analysis. Independent predictors of women's level of knowledge were identified by multivariable logistic regression analysis. ResultsIn total, only 28.2% of mothers were knowledgeable about neonatal danger signs. Significant predictors of a good level of knowledge on newborn danger signs included those who attended secondary education, were urban residents, attended 2–3 antenatal care visits, had an institutional delivery, attended postnatal care visit(s), had a higher decision-making ability to seek neonatal health care, completed up-to-date immunisation of the infant, had heard about neonatal danger signs from health workers and had a history of neonatal death. ConclusionsEducating women, increasing mothers' health service use and providing health education for mothers who attend pregnancy-related services showed a positive impact on their knowledge of neonatal danger signs and should therefore be promoted.

Knowledge in Tracking Danger Signs in Newborns and their Referrals by ASHA in Uttar Pradesh, India

When ASHAs were introduced in NRHM in 2005, their primary aim was to visit homes of newborns as the first program in UP operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all deliveries and all the newborns are an integral part of the work of ASHAs in all the primary health care programs operated by the NHM in UP.
 The current study explores some of the crucial variables of the danger signs in newborns and their subsequent referrals by the ASHAs in four districts of UP. Through this profile, the knowledge of ASHAs on these danger signs and the action that they take after identification is detailed out. 
 The relevance of the study assumes significance as data on the details of targeted activities on high risk newborns done by ASHAs in comparison to their performance are usually not available in various studies.
 A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions. In addition, in-depth interviews were also conducted amongst the ASHAs and a total 250 respondents had participated in the study.

Prevalence, care-seeking behaviors and treatment cost for neonatal morbidities in Karnataka (India)

Purpose Around three million infants die within the first four weeks of life each year – nearly all (98%) of these deaths occur in developing countries. Approximately one million newborns die each year in India. Therefore, this study aims to determine the patterns of reported neonatal morbidity and care-seeking behavior and identify factors associated with it. Design/methodology/approach A cross-sectional study was conducted during November 2016. A systematic random sampling technique was used to select the sample. Statistical techniques like Binary Logistic regression and chi-square test were used. Findings The results of the study showed that around 31% mothers of neonates reported that their neonates suffered from some kind of morbidity. Fever, jaundice, cough and cold, the low birth-weight and difficulty in breathing were the most common dangers signs reported. Birth order and mother’s knowledge of neonatal danger signs were found to be significantly associated with reporting of neonatal morbidity. In all 95% of the mothers sought care for their newborns. Among those who had problems, 59% consulted private hospitals/clinics, 30% visited District Hospital/Taluka Hospital or higher facilities and another 9% to Primary Health Centers/Community Health Centers. Further, findings show that nearly half of the neonates taken to government facilities have got free treatment, whereas an average cost of 7,156 INR were recorded for treatment, 935 INR for outpatient department and 13,774 INR for inpatient department cases. Originality/value There is an urgent need to implement intervention modalities that focus on increasing the level of parental education and access to treatment, and advocating the message regarding newborn danger signs during pregnancy is pinpointed.

PNS91 ACCESS AND UTILIZATION OF MATERNAL HEALTHCARE IN A RURAL DISTRICT IN THE FOREST BELT OF GHANA

The objective of this study was to investigate the access and utilization of maternal healthcare in Amansie-West district in the Ashanti Region of Ghana. Methods: An analytical cross-sectional study, involving 720 pregnant women systematically sampled from antenatal clinics in five sub-districts was conducted from February to May 2015 in the Amansie-West district. Data on participants’ socio-economic characteristics, knowledge level and access and utilization of maternal health care services were collected with a structured questionnaire. Odds ratios were estimated to describe the association between explanatory variables and maternal healthcare using generalized estimating equations (GEE). 68.5, 83.6 and 33.6% of the women had >3 antenatal care visits, utilized skilled delivery and postnatal care services respectively. The mothers’ knowledge level of pregnancy emergencies and newborn danger signs was low. Socio-economic characteristics and healthcare access influenced the utilization of maternal healthcare. Compared to the lowest wealth quintile, being in the highest wealth quintile was associated with higher odds of receiving postnatal care (adjusted odds ratio [aOR]; 95%CI: 2.84; 1.63, 4.94). Use of health facility as a main source of healthcare was also associated with higher odds of antenatal care and skilled delivery. This study demonstrates suboptimal access and utilization of maternal healthcare in rural districts of Ghana, which are influenced by socio-economic characteristics of pregnant mothers. This suggests the need for tailored intervention to improve maternal healthcare utilization for mothers in this and other similar settings. Keywords: Maternal healthcare, Antenatal care, Postnatal care, Skilled delivery, Limited-resource setting, Rural Ghana, Amansie west district

Newborn Infection Control and Care Initiative for Health Facilities to Accelerate Reduction of Newborn Mortality (NICCI): Results of a Stepped Wedge Cluster-Randomized Controlled Trial

Objectives: The intervention study objectives were to improve infection control behavior by staff in health centers; improve referral of sick newborns, increase recognition of danger signs, and prompt care seeking at appropriate health facility; and appropriate referral for sick newborns by mothers and families of newborn infants Methods: The stepped wedge cluster randomized controlled trial in 16 Health Centers (HC) took place from February 2015 and November 2016. Each cluster was one HC its catchment area. Eligible HCs were those with greater than 20 birth deliveries per month. Eligible participants in each cluster included women in their last trimester of pregnancy who were healthy and able to participate in the intervention activities, such as home visits and data collection, could adhere to the study protocol, and were greater than 18 years of age. Participants enrolled in the study who met all inclusion criteria were blinded to their group assignment and interviewed by the study during the last trimester of her pregnancy (enrollment), the 14th day after delivery, and on the 28th day after delivery. The study team was not blinded to group assignment. At the HCs, the intervention included training on hand washing, infection prevention control, newborn danger signs, breastfeeding, and newborn care. Health workers were trained to conduct home visits within 24 hours of birth and on days 3 and 7 after delivery, including assessment of newborns for danger signs, counselling mothers at home visits, and use of equipment (e.g. thermometers). At home visits, mothers and caregivers received counseling on hygiene and handwashing practices, breastfeeding, newborn danger signs, and prompt, appropriate referral to facilities. Results: HC staff in the intervention group had 14.6 times (7.73-31.47; p<0.0001) the likelihood of hand washing at the recommended key moments when compared to the control group, and 98% of HC staff in the intervention group knew six danger signs compared to 15% in the control group (p<0.0001), while 95% recalled at least three hygiene messages compared to 54% in the control group (p<0.0001). 60.58% of VHSG volunteers in the intervention group knew at least six danger signs compared to 2.11% of VHSG in the control group (p<0.0001). Of 2,494 mother participants in the trial, at 14th days after delivery, women in the intervention group were more than twice as likely to know at least 3 danger signs compared to women in the control group (OR=2.35, p=0.0104), with no effect on care seeking behavior. However, 35.01% of mothers in the intervention group received messages on care seeking from VHSG volunteers compared to 5.35% in the control group (p<0.0001). Conclusions: Well-designed training followed by regular supervision improved the knowledge and self-reported behavior of HC staff and VHSG volunteers as well as mothers' knowledge of newborn danger signs. However, further improvement in hygiene behavior among mothers and families will require involvement from broader stakeholders in the community. Trial Registration Number: ClinicalTrials.gov, Identifier: NCT02271737 Funding Statement: United States Agency for International Development under prime agreement number AID-OAAA-A-11-00012 with the National Academy of Sciences (NAS). Declaration of Interests: All authors declare that there are no conflicts of interest. Ethics Approval Statement: The trial protocol was approved by the National Ethics Committee Health Research of the Cambodia Ministry of Health and by the Institutional Review Boards of Tulane University.

Early initiation of breastfeeding and severe illness in the early newborn period: An observational study in rural Bangladesh

BackgroundIn Bangladesh, neonatal sepsis is the cause of 24% of neonatal deaths, over 65% of which occur in the early-newborn stage (0–6 days). Only 50% of newborns in Bangladesh initiated breastfeeding within 1 hour of birth. The mechanism by which early initiation of breastfeeding reduces neonatal deaths is unclear, although the most likely pathway is by decreasing severe illnesses leading to sepsis. This study explores the effect of breastfeeding initiation time on early newborn danger signs and severe illness.Methods and findingsWe used data from a community-based trial in Bangladesh in which we enrolled pregnant women from 2013 through 2015 covering 30,646 newborns. Severe illness was defined using newborn danger signs reported by The Young Infants Clinical Science Study Group. We categorized the timing of initiation as within 1 hour, 1 to 24 hours, 24 to 48 hours, ≥48 hours of birth, and never breastfed. The analysis includes descriptive statistics, risk attribution, and multivariable mixed-effects logistic regression while adjusting for the clustering effects of the trial design, and maternal/infant characteristics. In total, 29,873 live births had information on breastfeeding among whom 19,914 (66.7%) initiated within 1 hour of birth, and 4,437 (14.8%) neonates had a severe illness by the seventh day after birth. The mean time to initiation was 3.8 hours (SD 16.6 hours). The proportion of children with severe illness increased as the delay in initiation increased from 1 hour (12.0%), 24 hours (15.7%), 48 hours (27.7%), and more than 48 hours (36.7%) after birth. These observations would correspond to a possible reduction by 15.9% (95% CI 13.2–25.9, p < 0.001) of severe illness in a real world population in which all newborns had breastfeeding initiated within 1 hour of birth. Children who initiated after 48 hours (odds ratio [OR] 4.13, 95% CI 3.48–4.89, p < 0.001) and children who never initiated (OR 4.77, 95% CI 3.52–6.47, p < 0.001) had the highest odds of having severe illness. The main limitation of this study is the potential for misclassification because of using mothers’ report of newborn danger signs. There could be a potential for recall bias for mothers of newborns who died after being born alive.ConclusionsBreastfeeding initiation within the first hour of birth is significantly associated with severe illness in the early newborn period. Interventions to promote early breastfeeding initiation should be tailored for populations in which newborns are delivered at home by unskilled attendants, the rate of low birth weight (LBW) is high, and postnatal care is limited.Trial registrationTrial Registration number: anzctr.org.au ID ACTRN12612000588897.

Assessing knowledge and behavioural changes on maternal and newborn health among mothers following post-earthquake health promotion in Nepal.

IntroductionDisasters can disrupt the existing health system affecting the whole population, but especially vulnerable people such as pregnant women, new mothers and their babies. Despite the global progress in maternal, newborn and child health (MNCH) programmes over the years, emergency responses after a disaster are often poor. Post-disaster health promotion could play an important role in improving MNCH outcomes. However, evidence remains limited on the effect of post disaster health promotion activities in low-income countries such as Nepal.MethodsThis is an uncontrolled before and after study conducted in Dhading district which was severely affected by the 2015 earthquake in Nepal. The study participants were mothers who had a child in the previous 12 months. The intervention was implemented between 2016 and 2018 and included community-engagement health promotion activities where the local stakeholders and resources were mobilized. The outcome variables included: knowledge of danger signs of pregnancy, childbirth and in newborns; and behaviours including ever attending antenatal care (ANC), a minimum of four ANC sessions and having an institutional delivery. Data were analysed using chi-squared tests, independent sample t-tests and multiple logistic regression models.ResultsIn total 364 mothers were recruited in the pre-intervention group and 377 in the post-intervention group. The post-intervention group was more likely to have knowledge of at least three danger signs in pregnancy (AOR [Adjusted Odds Ratio] = 2.96, P<0.001), at least three danger signs in childbirth (AOR = 3.8, P<0.001), and at least five danger signs in newborns (AOR = 1.56, P<0.001) compared to the pre-intervention group. The mothers in the post-intervention group were also more likely to ever attend ANC (AOR = 7.18, P<0.001), attend a minimum of four ANC sessions (AOR = 5.09, P<0.001), and have institutional deliveries (AOR = 2.56, P<0.001). Religious minority groups were less likely to have knowledge of all danger signs compared to the majority Hindu group. Mothers from poorer households were also less likely to attend four ANC sessions. Mothers with higher education were more likely to have knowledge of all the danger signs. Mothers whose husbands had achieved higher education were also more likely to have knowledge of danger signs and have institutional deliveries.ConclusionHealth promotion intervention helped the disaster-affected mothers in improving the knowledge and behaviours related to MNCH. However, the vulnerable population would need more support to gain benefit from such intervention.

Assessment of awareness regarding obstetric and newborn danger signs among pregnant women and recently delivered mothers in urban slums of Raipur city, Chhattisgarh

Background: Knowledge regarding danger signs has been found helpful to reduce delays in seeking, reaching and obtaining care during obstetric emergencies. Aims &amp; Objectives: To assess the awareness regarding obstetric and newborn danger signs among pregnant and recently delivered mothers residing in urban slums of Raipur city. Material &amp; Methods: Observational study was conducted among 160 pregnant and 70 recently delivered women residing in urban slums. The assessment of awareness regarding danger signs was done by adding the marks obtained in various phases. Appropriate statistical tests were applied for any association between knowledge score and socio-demographic variables. Results: Subjects knowing at least one key danger sign during pregnancy, labour, postpartum and newborn period was 54.3%, 51.9%, 7.4%, and 11.3 % respectively. Those with age more than 20 years (p value 0.000), joint family (p value 0.000), educated more than 5 years (p value 0.009), and having married and getting first time pregnant after 20 years (p values 0.001 and 0.022 respectively) were found to have significantly more knowledge about danger signs. Conclusions: Knowledge regarding danger signs should be given at the time of every ANC visit and also at follow up visit after delivery.

Effectiveness of Structured Teaching Program on Knowledge of Antenatal Mothers Regarding Selected Newborn Danger Signs

Effectiveness of Structured Teaching Program on Knowledge of Antenatal Mothers Regarding Selected Newborn Danger Signs

Access and utilization of maternal healthcare in a rural district in the forest belt of Ghana

BackgroundPoor maternal health delivery in developing countries results in more than half a million maternal deaths during pregnancy, childbirth or within a few weeks of delivery. This is partly due to unavailability and low utilization of maternal healthcare services in limited-resource settings. The aim of this study was to investigate the access and utilization of maternal healthcare in Amansie-West district in the Ashanti Region of Ghana.MethodsAn analytical cross-sectional study, involving 720 pregnant women systematically sampled from antenatal clinics in five sub-districts was conducted from February to May 2015 in the Amansie-West district. Data on participants’ socio-economic characteristics, knowledge level and access and utilization of maternal health care services were collected with a structured questionnaire. Odds ratios were estimated to describe the association between explanatory variables and maternal healthcare using generalized estimating equations (GEE).Results68.5, 83.6 and 33.6% of the women had > 3 antenatal care visits, utilized skilled delivery and postnatal care services respectively. The mothers’ knowledge level of pregnancy emergencies and newborn danger signs was low. Socio-economic characteristics and healthcare access influenced the utilization of maternal healthcare. Compared to the lowest wealth quintile, being in the highest wealth quintile was associated with higher odds of receiving postnatal care (adjusted odds ratio [aOR]; 95%CI: 2.84; 1.63, 4.94). Use of health facility as a main source of healthcare was also associated with higher odds of antenatal care and skilled delivery.ConclusionThis study demonstrates suboptimal access and utilization of maternal healthcare in rural districts of Ghana, which are influenced by socio-economic characteristics of pregnant mothers. This suggests the need for tailored intervention to improve maternal healthcare utilization for mothers in this and other similar settings.

Assessment of Health Knowledge on Pregnancy, After Delivery and Newborn Baby Danger Signs among Migrant Mothers in Tak Province at Thailand-Myanmar Border

Assessment of Health Knowledge on Pregnancy, After Delivery and Newborn Baby Danger Signs among Migrant Mothers in Tak Province at Thailand-Myanmar Border

Mothers treatment seeking intention for neonatal danger signs in northwest Ethiopia: A structural equation modeling.

BackgroundNeonatal mortality contributes to nearly half of under-five mortality in Ethiopia. Treatment seeking for newborn danger signs remains low despite correlations with neonatal mortality. This study tests a theoretical model of factors affecting mothers’ treatment seeking intention for neonatal danger signs in northwest Ethiopia.MethodA cross sectional study was conducted from March 3–18, 2016 in northwest Ethiopia. A total of 2,158 pregnant women and women who had delivered in the past 6 months were interviewed. Latent variables; knowledge of neonatal danger signs (KDS), household level women empowerment (HLWE) and positive perception toward the behavior of health care providers (PPBHCP) were measured using a Five Point Likert Scale. Socioeconomic status (SES), number of antenatal care attendance, perceived cost of treatment (PCT), average distance to health facilities (ADHF) and treatment seeking intention (TSI) were observed variables in the study. A structural equation modeling was applied to test and estimate the hypothesized model of relationships among latent and observed variables and their direct and indirect effects on TSI.ResultKDS, PPBHCP, HLWE, and PCT showed direct, positive and significant association with TSI (β = 0.41, p<0.001, β = 0.08, p<0.002, β = 0.18, p<0.001, and β = 0.06, p<0.002, respectively). SES was not directly associated with TSI. However, it indirectly influenced TSI through three pathways; KDS, number of ANC attendance and HLWE (β = 0.05, p<0.05, β = 0.08, p<0.001 and β = 0.13, p<0.001, respectively). Number of antenatal care was not directly associated with TSI. But indirectly, it affected TSI through its direct effect on KDS and PPBHCP (β = 0.05, p<0.05, β = 0.14, p<0.001, respectively). PPBHCP and HLWE also showed indirect association with TSI through their direct effect on KDS (β = 0.37, p<0.001, β = 0.36, p<0.001, respectively). All in all, the model fitted the sample data and explained 31% of the variance in TSI.ConclusionPPBHCP, HLWE, PCT and KDS were associated with mothers’ TSI for newborn danger signs.

THE EFFECTIVENESS OF "PEER GROUP DISCUSSION" IN IMPROVING HEALTH CADRE'S KNOWLEDGE ABOUT DANGER SIGNS IN THE MATERNAL PERIODS

Limited health literacy is one of the causes of late detection related to danger signs in pregnancy, postpartum and newborns. Health cadres are one of the main resources for early detection and dissemination of health information in the community. The purpose of this study was to determine the effectiveness of the peer group discussion method in increasing the knowledge of health cadres about danger signs in pregnancy, postpartum and new-borns (maternal periods). This research was Quasi-experimental study with a pre-test and post-test design. The stages of intervention in this study included training on danger signs with the lecture method followed by small group discussions (5-6 people) for 30 minutes, and practicing early warning signs detection. Questionnaires were given before and after training. The population in the study were all health cadres at Penanjung Health Center, while the sample was 32 health cadres from the health post (POSYANDU) Sari Asih. The Wilcoxon test was used to determine whether there was a difference in knowledge before and after training. The results showed the midpoint of the pregnancy danger signs before intervention 66.7 and after the intervention was 100. Middle value of postpartum danger signs knowledge before intervention 70 and after intervention 100. Midpoint knowledge of danger signs in newborns before intervention 75 and after intervention 100. The results of the bivariate analysis of the Wilcoxon Test before and after the intervention showed a p-value of 0,000 which means that there were significant differences before and after the intervention related to the danger signs in the maternal periods. Training on health cadres with this method increases cadres’ knowledge about danger signs in pregnancy, postpartum and newborns.Keywords: Danger sign, health care, newborns, postpartum, pregnancy, training

Essential newborn care practices and associated factors among home delivered mothers in Damot pulasa Woreda, southern Ethiopia

BackgroundGlobally 3.1 million children die each year in their neonatal period (first 28 days of life) according to World Health Organization (WHO) 2011 report. Half of these surprisingly occur within the first 24 h of delivery and 75% occur in the early neonatal period.MethodsA community based cross-sectional study design was carried out from March 2016 to April, 2016 in Damot Pulasa district, Wolaita zone, Southern Ethiopia to assess selected essential newborn care practices and associated factors among home delivered mothers in Damot pulasa district. Data were entered into Epi Info version 3.5.1 and exported to SPSS version 20 software for analysis. Multiple logistic analyses were done to control possible confounding variable. A P-value less than 0.05 was taken as a significant association.ResultThe study showed that the prevalence of essential newborn care practice was 24%. Multivariate logistic regression analysis revealed that variables like ANC visit (AOR =0.213,P = 0.015,CI = 0.102–0.446),PNC visit (AOR = 0.209, P = 0.00,CI = 0.110–0.399), advice about essential newborn care practice (AOR =0.114,P = 0.0001, CI = 0.058–0.221),urban areas women (AOR =2,P = 0.042, CI = 1.024–3.693), planned pregnancy (AOR = 7, P = 0.00, CI =3.732–11.813), and knowledge about newborn danger signs (AOR = 0.277, P = 0.006, CI = 0.110–0.697) were the independent predictors of ENBC practices.ConclusionGenerally, coverage of essential newborn care practices was low. ANC visit, advice about ENBC, PNC visit, residence, planned pregnancy and knowledge about newborn danger signs were predictors of essential newborn care practice in the study area. Therefore, Health facilities should enhance linkage with health posts to increase ANC and PNC service utilization. Health extension workers should also promote and give health education about pre-lacteal feeding, early bathing, planned pregnancy, newborn danger signs and application of materials on the newborn stump.

Early Initiation of Breastfeeding Protects Against Early-Onset Sepsis Among Newborns: Evidence from Rural Bangladesh

Background: In Bangladesh, neonatal sepsis is the cause of 24% of neonatal deaths, over 65% of which occur in the early-newborn stage (0-7 days). Only 50% of women initiate breastfeeding their newborn within 1 hour of birth. The mechanism by which early initiation of breastfeeding reduces neonatal deaths is unclear, although the most likely pathway is by decreasing neonatal sepsis. This study explores the effect of breastfeeding initiation time on early-onset newborn sepsis. Methods: We used data from a large community-based trial in Bangladesh where we enrolled pregnant women from 2013-2015 covering 30,646 newborns. Syndromic sepsis was defined using newborn danger signs reported by “The Young-Infants Clinical Science Study Group.” We categorized the timing of initiation of breastfeeding as within 1 hour, 1-24 hours, 24-48 hours, ≥48 hours of birth, and never breastfed. The analysis includes descriptive statistics, risk attribution, and binomial logistic-regression while adjusting for clustering effects of the trial design, and maternal and infant characteristics. Findings: 29,873 live-births had information on breastfeeding initiation among whom 4,437 (14·8%) neonates had signs of sepsis by the 7th day after birth. Two-thirds of the newborns [66·7%, (n=19,914)] had breastfeeding initiated within 1hr of birth. The mean time to initiation was 3·8 hours (±16·6 hours), and by the end of 48 hours, all but 5·7% of neonates were breastfed. The proportion of children with syndromic sepsis increased as the initiation of breastfeeding was delayed from 1 hour (12·0%), 24 hours (15·7%), 48 hours (27·7%), to more than 48 hours (36·7%) after birth. It would be possible to avert 15·9%, 10·6% and 8·5% of early-onset sepsis cases if all children initiated breastfeeding within 1, 24 or 48 hours of birth respectively. The odds of having sepsis is significantly higher among late initiators. Children who initiated after 48 hours (OR 4·13, 95% CI 3·48-4·89) and children who never initiated (OR 4·77, 95% CI 3·52-6·47) had the highest odds of having signs of sepsis. Interpretation: Our findings indicate that the timing of initiation of breastfeeding, especially within the first hour of birth, has a significant protective effect on early-onset sepsis among newborns. Community-based interventions to promote early initiation of breastfeeding should be tailored to suit the needs of populations where newborns are delivered at home by unskilled attendants, the rate of LBW is high, and post-natal care is limited. Clinical Trial Number: Australia New Zealand Clinical Trials Registry (ANZCTR): The registration ID is ACTRN12612000588897. Funding Statement: National Health and Medical Research Council [NHMRC] (of Australia) funded this study (#1026864). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The Ethical Review Committee (ERC) of the icddr,b, and the Human Research Ethics Committee (HREC) of the University of Sydney have granted ethics approval for the parent study. We obtained written informed consent, from pregnant women during enrollment into the study, which provided full disclosure regarding the study.