Newborn Care Practices Research Articles

Local understandings of care during delivery and postnatal period to inform home based package of newborn care interventions in rural Ethiopia: a qualitative study.

BackgroundDespite a substantial decrease in child mortality in Ethiopia over the past decade, neonatal mortality remains unchanged (37/1000 live-births). This paper describes a qualitative study on beliefs and practices on immediate newborn and postnatal care in four rural communities of Ethiopia conducted to inform development of a package of community-based interventions targeting newborns.MethodsThe study team conducted eight key informant interviews (KII) with grandmothers, 27 in-depth interviews (IDI) with mothers; seven IDI with traditional birth attendants (TBA) and 15IDI with fathers, from four purposively selected communities located in Sidama Zone of Southern Nationalities, Nations, and Peoples (SNNP) Region and in East Shewa and West Arsi Zones of Oromia Region.ResultsIn the study communities deliveries occurred at home. After cutting the umbilical cord, the baby is put to the side of the mother, not uncommonly with no cloth covering. This is largely due to attendants focusing on delivery of the placenta which is reinforced by the belief that the placenta is the ‘house’ or ‘blanket’ of the baby and that any “harm” caused to the placenta will transfer to the newborn. Applying butter or ointment to the cord “to speed drying” is common practice. Initiation of breastfeeding is often delayed and women commonly report discarding colostrum before initiating breastfeeding. Sub-optimal breastfeeding practices continue, due to perceived inadequate maternal nutrition and breast milk often leading to the provision of herbal drinks. Poor thermal care is also demonstrated through lack of continued skin-to-skin contact, exposure of newborns to smoke, frequent bathing—often with cold water baths for low-birth weight or small babies; and, poor hygienic practices are reported, particularly hand washing prior to contact with the newborn.ConclusionCultural beliefs and newborn care practices do not conform to recommended standards. Local perspectives related to newborn care practices should inform behaviour change messages. Such messages should target mothers, grandmothers, TBAs, other female family members and fathers.

Newborn care knowledge and practices among mothers attending pediatric outpatient clinic of a hospital in Karachi, Pakistan.

To assess newborn care knowledge and practices among mothers. A cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. A total of 170 mothers accompanying their infants attending the Paediatric Out Patient Department were interviewed through a structured questionnaire. Areas of inquiry included Antenatal care seeking, delivery care, cord care, eye care, bathing and breastfeeding practices. Ninety-two percent mothers reported at least one antenatal care visit. Tetanus Toxoid coverage was 88%. Home deliveries were 18%. Seventy-four percent reported applying various substances like coconut oil, mustard oil, purified butter and turmeric to the cord stump. Kohl application to newborn's eyes was 68%, while 86% reported first bath within 24 hrs of birth. 48% mothers initiated breastfeeding within 2 hours of delivery. Colostrum was discarded by 43% and prelacteal feeds given by 73%. Exclusive Breast Feeding rate was 26%. Family income of Rs. 10, 000 (USD120) or less/month and maternal education level of primary or less were significantly associated with home delivery, unhygienic cord care and kohl application to the newborn's eyes. Home delivery was a risk factor for poor cord care (OR=4.07) and discarding colostrum (OR= 3.18). Antenatal care coverage was good, but knowledge regarding newborn care was poor. Harmful practices regarding newborn care were prevalent among mothers. Institutional deliveries did not guarantee optimal practices. Tradition and culture played a significant role. Health education can improve the mothers' knowledge regarding newborn care practices.

Is antenatal care preparing mothers to care for their newborns? A community-based cross-sectional study among lactating women in Masindi, Uganda

BackgroundNeonatal mortality has remained resistant to change in the wake of declining child mortality. Suboptimal newborn care practices are predisposing factors to neonatal mortality. Adherence to four ANC consultations is associated with improved newborn care practices. There is limited documentation of this evidence in sub-Saharan Africa where suboptimal newborn care practices has been widely reported.MethodsStructured interviews were held with 928 women having children under-five months old at their homes in Masindi, Uganda, from October-December 2011. Four/more ANC consultations (sufficient ANC) was considered the exposure variable. Three composite variables (complete cord care, complete thermal care and complete newborn vaccination status) were derived by combining related practices from a list of recommended newborn care practices. Logistic regression models were used to assess for associations.ResultsOne in five women 220(23.7%) were assessed to practice complete cord care. Less than ten percent 57(6.1%) were considered to practice complete thermal care and 611(65.8%) were assessed to have complete newborn vaccination status. Application of substance on the cord 744 (71.6%) and early bathing 816 (87.9%) were main drivers of sub-optimal newborn care practices. Multivariable logistic models did not demonstrate significant association between four/more ANC consultations and complete cord care, complete thermal care or complete newborn vaccination status. Secondary or higher education was associated with complete cord care [adjusted Odds Ratio (aOR): 2.72; 95% CI: 1.63-4.54] and complete newborn vaccination [aOR: 1.37; 95% CI: 1.04-1.82]. Women who reported health facility delivery were more likely to report complete thermal care [aOR: 3.63; 95% CI: 2.21-5.95] and newborn vaccination [aOR: 1.84; 95% CI: 1.23-2.75], but not complete cord care. Having the first baby was associated with complete thermal care [aOR: 2.00; 95% CI: 1.24-3.23].ConclusionResults confirm suboptimal newborn care practices in Masindi. Despite being established policy, adherence to four or more ANC consultations was not associated with complete cord care, complete thermal care or complete newborn vaccination. This finding has important implications for the implementation of focused ANC to improve newborn care practices. Future ANC interventions should focus on addressing application of substance on the cord and early bathing of the baby during the immediate neonatal period.

Patterns and Determinants of Essential Newborn Care Practices in Rural Areas of Northern Ghana

Background. This study was designed to understand the patterns and determinants of three essential newborn care practices: safe cord care, optimal thermal care, and neonatal feeding practices. Methods. A community-based cross-sectional study was carried out on a sample of 404 lactating mothers who have delivered a live baby at home within the past one year prior to the study. Results. Overall, the prevalence of essential newborn practices on safe cord care and optimal thermal care was exceptionally low. Of the 404 newborns, only 0.2% (1) had safe cord care, 5.2% (21) optimal thermal care, and 50.2% (203) were considered to have had adequate neonatal feeding. In logistic regression analysis, the main predictors of good neonatal feeding were maternal age, timing of the first antenatal care (ANC), and maternal knowledge of newborn danger signs. Women who could mention at least 4 danger signs of the neonate were 4 times more likely to give good neonatal feeding to their babies (AOR = 4.7, Cl: 2.43–9.28), P<0.001. Conclusion. Evidence from this study strongly suggests that the expected essential newborn care practices are not available to a substantial number of the newborns. Efforts should therefore be made by the Ghana Health Service (GHS) to expand essential newborn care interventions beyond institutional level into the communities.

Is essential newborn care provided by institutions and after home births? Analysis of prospective data from community trials in rural South Asia

BackgroundProvision of essential newborn care (ENC) can save many newborn lives in poor resource settings but coverage is far from universal and varies by country and place of delivery. Understanding gaps in current coverage and where coverage is good, in different contexts and places of delivery, could make a valuable contribution to the future design of interventions to reduce neonatal mortality. We sought to describe the coverage of essential newborn care practices for births in institutions, at home with a skilled birth attendant, and at home without a skilled birth attendant (SBA) in rural areas of Bangladesh, Nepal, and India.MethodsWe used data from the control arms of four cluster randomised controlled trials in Bangladesh, Eastern India and from Makwanpur and Dhanusha districts in Nepal, covering periods from 2001 to 2011. We used these data to identify essential newborn care practices as defined by the World Health Organization. Each birth was allocated to one of three delivery types: home birth without an SBA, home birth with an SBA, or institutional delivery. For each study, we calculated the observed proportion of births that received each care practice by delivery type with 95% confidence intervals, adjusted for clustering and, where appropriate, stratification.ResultsAfter exclusions, we analysed data for 8939 births from Eastern India, 27 553 births from Bangladesh, 6765 births from Makwanpur and 15 344 births from Dhanusha. Across all study areas, coverage of essential newborn care practices was highest in institutional deliveries, and lowest in home non-SBA deliveries. However, institutional deliveries did not provide universal coverage of the recommended practices, with relatively low coverage (20%-70%) across all study areas for immediate breastfeeding and thermal care. Institutions in Bangladesh had the highest coverage for almost all care practices except thermal care. Across all areas, fewer than 20% of home non-SBA deliveries used a clean delivery kit, the use of plastic gloves was very low and coverage of recommended thermal care was relatively poor. There were large differences between study areas in handwashing, immediate breastfeeding and delayed bathing.ConclusionsThere remains substantial scope for health facilities to improve thermal care for the newborn and to encourage immediate and exclusive breastfeeding. For unattended home deliveries, increased handwashing, use of clean delivery kits and basic thermal care offer great scope for improvement.

Coverage and determinants of newborn feeding practices in rural Burkina Faso

ObjectivesNewborn feeding practices are important to neonatal health and survival, but understudied in sub-Saharan Africa. We assessed the prevalence and determinants of newborn feeding practices in Burkina Faso.Study designAn 18 000 household survey was conducted in rural Burkina Faso in 2010–2011. Women of reproductive age were asked about antenatal, delivery, and newborn care practices for their most recent live birth. Coverage of newborn feeding practices was estimated and multivariate regression was used to assess determinants of these practices.ResultsSeventy-six percent of live births were breastfed within 24 hours of birth, 84% were given colostrum, and 21% received prelacteals. Facility delivery and antenatal care attendance were associated with positive feeding practices.ConclusionsPositive newborn feeding practices were common in rural Burkina Faso, relative to other low-income settings. Interventions are needed to improve feeding practices among home-born babies, and to encourage earlier initiation of breastfeeding among facility-born newborns.

Fostering maternal and newborn care in India the Yashoda way: does this improve maternal and newborn care practices during institutional delivery?

BackgroundThe Yashoda program, named after a legendary foster-mother in Indian mythology, under the Norway-India Partnership Initiative was launched as a pilot program in 2008 to improve the quality of maternal and neonatal care at facilities in select districts of India. Yashodas were placed mainly at district hospitals, which are high delivery load facilities, to provide support and care to mothers and newborns during their stay at these facilities. This study presents the results from the evaluation of this intervention in two states in India.MethodsData collection methods included in-depth interviews with healthcare providers and mothers and a survey of mothers who had recently delivered within a quasi-experimental design. Fifty IDIs were done and 1,652 mothers who had delivered in the past three months were surveyed during 2010 and 2011.ResultsA significantly higher proportion of mothers at facilities with Yashodas (55 percent to 97 percent) received counseling on immunization, breastfeeding, family planning, danger signs, and nutrition compared to those in control districts (34 percent to 66 percent). Mothers in intervention facilities were four to five times more likely to receive postnatal checks than mothers in control facilities. Among mothers who underwent cesarean sections, initiation of breastfeeding within five hours was 50 percent higher in intervention facilities. Mothers and families also reported increased support, care and respect at intervention facilities.ConclusionYashoda as mothers' aide thus seems to be an effective intervention to improve quality of maternal and newborn care in India. Scaling up of this intervention is recommended in district hospitals and other facilities with high volume of deliveries.

Community-based Study on Newborn Care Practices and its Determinants in Rural Pondicherry, India

Background: Globally, around 86% of neonatal deaths occurred are due to infections and preterm births. To prevent newborn infection, clean delivery and newborn carepractices should be adopted. Understanding of the community and traditional new-born care practices is necessary to implement the effective programme for promotion of newborns health. Objectives: To study the new-born care practices and its determinants in a rural area of Puducherry, India. Methodology: A cross sectional study done in Bahour commune from 1st April 2012 to 31st June 2012. Information regarding background details and new-born care practices were recorded in semi-structured questionnaire by house to house visit. Total of 136 infants born during Jan-March 2012 were enrolled. Data were presented as percentages, ratios and Chi-square test was used to find association among variables. p-value<0.05 was considered statistically significant. Results: Among 136 newborns, 46.3% were male and 53.7% were female. Around 65% newborns were breastfed within an hour after birth and 5.9% were prelacteally fed. There was significant difference between male and female newborns in terms of wrapping after birth and day of first bath (p value 0.04 and 0.007 respectively). Out of 37 mothers who belonged to poor socio-economic status, 24.3% mothers practiced application on cord with significant association (p=0.03). Majority (70.6%) of mothers gave bath to their newborn’s on third day or beyond. In the present study, mothers age at marriage and day of first bath to newborn’s was significantly associated (p=0.02). Conclusions: The overall practices like giving pre-lacteal feed; application on umbilical cord and giving bath immediately after bath of newborn are still practiced in the study area. Therefore, faulty newborn care practices need to be addressed.

Newborn care practices of mothers in rural areas of Navsari district

Background: Newborn mortality is one of the world’s most neglected health problems. It is estimated that globally four million newborns die before they reach 1 month of age and another four million are stillborn every year. Aims & Objectives: (1) To study the maternal care in terms of Antenatal, Intranatal and Postnatal care practices; (2) To assess newborn care practices in rural areas. Materials and Methods: A cross-sectional study in rural areas of Navsari district, Gujarat, included 243 women who had one child aged 12 to 23 months preceding data collection. Data were analyzed using statistical software Epi Info 6. Results: All the mothers under study had adequate ANC check-ups. All the mothers had received Iron supplements during ANC but 72.8% of them completed it for 3 months. Majority (99.2%) had institutional delivery. Regarding thermal care practices, half of the women reported that the baby was dried and wrapped within 15 minutes of birth. More than one third (37.8%) of babies were bathed in less than 24 hours of birth. Most of the mothers (93.4%) had put substances on the umbilical cord. About 32% of the infants had received pre-lacteals feeds. The colostrum was fed by 90.9% of mothers. Only 56.4% mothers initiated breast-feeding within 1 hour of birth. Conclusion: In majority of cases, correct practices regarding newborn care were observed among mothers and this should be promoted through improved coverage with existing health services.

Knowledge of common problems of newborn among primi mothers admitted in a selected hospital for safe confinement.

Background:Among the almost 3.9 million newborn deaths that occur worldwide, about 30% occur in India. Children are our future and utmost precious resources. After birth the health of the child depends upon the health care practice adopted by the family, especially by the mothers. Information about neonatal problems and newborn care practices will help in reducing mortality and morbidity during the neonatal period. This study was conducted to identify the knowledge of primi mothers with regard to the common problems of normal neonates.Materials and Methods:This descriptive study was carried out among the mothers of neonates in the Maternity Unit of a Medical College Hospital in Mangalore. A pretested structured knowledge questionnaire was used to collect information from 60 primi mothers, who were admitted for safe confinement for a one-month period.Results:The findings of the study show that the majority, that is, 27 (45%) of the primi mothers had a good knowledge of all the areas such as vomiting, regurgitation, diaper rash, umbilical cord infection, fever, constipation, and diarrhea. About 20 (33.3%) had very good knowledge and about 13 (21.67%) had an average level of knowledge on the common problems of newborns. Knowledge about vomiting was average among 34 (56.67%), poor in 21 (35%), and good in five (8.33%). Knowledge about diaper rash was average among 36 (60%), good among 21 (35%), and poor among three (5%). Knowledge on umbilical cord infection was average in 29 (48.33%), good in 27 (45%), and poor in 4 (6.67%). Knowledge on fever was good in 38 (63.33%), average in 19 (31.66%), and poor in three (5%). Knowledge on constipation and diarrhea were average in 38 (63.34%), good in 11 (18.33%), and poor in 11 (18.33%). No association was found between the knowledge of primi mothers and selected baseline variables, such as, age, education, religion, occupation, type of family or area of dwelling.Conclusion:The study concludes that there is a need to provide adequate information to first-time mothers about common newborn problems and this will help mothers care for their newborns better.

Reducing Maternal and Perinatal Mortality Through a Community Collaborative Approach: Introduction to a Special Issue on the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP)

Reducing Maternal and Perinatal Mortality Through a Community Collaborative Approach: Introduction to a Special Issue on the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP)

Traditional Newborn Care Practices in Home Births among Muslim Women in Urban Slum of Meerut UP

Traditional Newborn Care Practices in Home Births among Muslim Women in Urban Slum of Meerut UP

Pattern of Newborn care and associated Health Problems among home delivered children

Background and Objectives: Newborn Care practices during neonatal period contribute to risk of mortality and morbidity. It is estimated that in Nepal nearly 50,000 children under one year of age die every twelve months. This study aims to identify newborn care and practices in rural area in the study population. Methodology: 248 mothers having children of age &lt; 6 months having delivery at home were selected from ten VDCs of Sunsari district using multistage random sampling. Standardized questionnaire were filled through interview with mothers/ female head of the family who assisted the delivery. Data were analyzed by using statistical package for social sciences (SPSS) version 17. Chi-square test was conducted and p-value &lt; 0.05 considered as statistically significant. Results: More than half (53.6%) of the newborns were assisted with Clean Home Delivery Kit. However, only 32.6% of the newborn babies applied antiseptic disinfectant to umbilical stump. Majority (76.6%) of the newborns bathed within 24 hour after birth. Less than half of respondents (41.9%) started breast feeding within 1 hour of birth and majority of the respondents (82.7%) fed colostrums to the newborn. Majority (37.9%) of children suffered from Acute Respiratory tract Infection, jaundice, redness and discharge around the cord, skin rashes and eye discharge. The methods used to make room warm was significantly associated (χ2 = 13.68, p- value = 0.001) with the occurrence of ARI. Materials applied for dressing of cord was significantly associated with problems of cord in babies (χ2 = 10.89, p- value = 0.004). Discharge from eye was found more among the babies who applied kajal however it was statistically insignificant. (χ2 = 0.60 p=0.439). Conclusion: High-risk traditional newborn care practices are common and need to be addressed. Janaki Medical College Journal of Medical Sciences (2013) Vol. 1 (2): 11-16 DOI: http://dx.doi.org/10.3126/jmcjms.v1i2.9262

Newborn care practices at home and in health facilities in 4 regions of Ethiopia

BackgroundEthiopia is one of the ten countries with the highest number of neonatal deaths globally, and only 1 in 10 women deliver with a skilled attendant. Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can be delivered in communities as well as facilities. This article describes newborn care practices reported by recently-delivered women (RDWs) in four regions of Ethiopia.MethodsWe conducted a household survey with two-stage cluster sampling to assess newborn care practices among women who delivered a live baby in the period 1 to 7 months prior to data collection.ResultsThe majority of women made one antenatal care (ANC) visit to a health facility, although less than half made four or more visits and women were most likely to deliver their babies at home. About one-fifth of RDWs in this survey had contact with Health Extension Workers (HEWS) during ANC, but nurse/midwives were the most common providers, and few women had postnatal contact with any health provider. Common beneficial newborn care practices included exclusive breastfeeding (87.6%), wrapping the baby before delivery of the placenta (82.3%), and dry cord care (65.2%). Practices contrary to WHO recommendations that were reported in this population of recent mothers include bathing during the first 24 hours of life (74.7%), application of butter and other substances to the cord (19.9%), and discarding of colostrum milk (44.5%). The results suggest that there are not large differences for most essential newborn care indicators between facility and home deliveries, with the exception of delayed bathing and skin-to-skin care.ConclusionsImproving newborn care and newborn health outcomes in Ethiopia will likely require a multifaceted approach. Given low facility delivery rates, community-based promotion of preventive newborn care practices, which has been effective in other settings, is an important strategy. For this strategy to be successful, the coverage of counseling delivered by HEWs and other community volunteers should be increased.

Contribution of community-based newborn health promotion to reducing inequities in healthy newborn care practices and knowledge: evidence of improvement from a three-district pilot program in Malawi

BackgroundInequities in both health status and coverage of health services are considered important barriers to achieving Millennium Development Goal 4. Community-based health promotion is a strategy that is believed to reduce inequities in rural low-income settings. This paper examines the contributions of community-based programming to improving the equity of newborn health in three districts in Malawi.MethodsThis study is a before-and-after evaluation of Malawi’s Community-Based Maternal and Newborn Care (CBMNC) program, a package of facility and community-based interventions to improve newborn health. Health Surveillance Assistants (HSAs) within the catchment area of 14 health facilities were trained to make pregnancy and postnatal home visits to promote healthy behaviors and assess women and newborns for danger signs requiring referral to a facility. “Core groups” of community volunteers were also trained to raise awareness about recommended newborn care practices. Baseline and endline household surveys measured the coverage of the intervention and targeted health behaviors for this before-and-after evaluation. Wealth indices were constructed using household asset data and concentration indices were compared between baseline and endline for each indicator.ResultsThe HSAs trained in the intervention reached 36.7% of women with a pregnancy home visit and 10.9% of women with a postnatal home visit within three days of delivery. Coverage of the intervention was slightly inequitable, with richer households more likely to receive one or two pregnancy home visits (concentration indices (CI) of 0.0786 and 0.0960), but not significantly more likely to receive a postnatal visit or know of a core group. Despite modest coverage levels for the intervention, health equity improved significantly over the study period for several indicators. Greater improvements in inequities were observed for knowledge indicators than for coverage of routine health services. At endline, a greater proportion of women from the poorest quintile knew three or more danger signs for pregnancy, delivery, and postpartum mothers than did women from the least poor quintile (change in CI: -0.1704, -0.2464, and -0.4166, respectively; p < 0.05). Equity also significantly improved for coverage of some health behaviors, including delivery at a health facility (change in CI: -0.0591), breastfeeding within the first hour (-0.0379), and delayed bathing (-0.0405).ConclusionsAlthough these results indicate promising improvements for newborn health in Malawi, the extent to which the CBMNC program contributed to these improvements in coverage and equity are not known. The strategies through which community-based programs are implemented likely play an important role in their ability to improve equity, and further research and program monitoring are needed to ensure that the poorest households are reached by community-based health programs.

Comparison of high- versus low-intensity community health worker intervention to promote newborn and child health in Northern Nigeria

BackgroundIn Northern Nigeria, infant mortality rates are two to three times higher than in the southern states, and, in 2008, a partnership program to improve maternal, newborn, and child health was established to reduce infant and child mortality in three Northern Nigeria states. The program intervention zones received government-supported health services plus integrated interventions at primary health care posts and development of community-based service delivery (CBSD) with a network of community volunteers and community health workers (CHWs), who focus on educating women about danger signs for themselves and their infants and promoting appropriate responses to the observation of those danger signs, consistent with the approach of the World Health Organization Integrated Management of Neonatal and Childhood Illness strategy. Before going to scale in the rest of the state, it is important to identify the relative effectiveness of the low-intensity volunteer approach versus the more intensive CBSD approach with CHWs.MethodsWe conducted stratified cluster sample household surveys at baseline (2009) and follow-up (2011) to assess changes in newborn and sick child care practices among women with births in the five prior years (baseline: n = 6,906; follow-up: n = 2,310). The follow-up respondents were grouped by level of intensity of the CHW interventions in their community, with “low” including group activities led only by a trained community volunteer and “high” including the community volunteer activities plus CBSD from a CHW providing one-on-one advice and assistance. t-tests were used to test for significant differences from baseline to follow-up, and F-statistics, which adjust for the stratified cluster design, were used to test for significant differences between the control, low-intensity, and high-intensity intervention groups at follow-up. These analyses focused on changes in newborn and sick child care practices.ResultsAnti-tetanus vaccination coverage during pregnancy increased from 69.2% at baseline to 85.7% at follow-up in the intervention areas. Breastfeeding within 24 hours increased from 42.9% to 59.0% in the intervention areas, and more newborns were checked by health workers within 48 hours (from 16.8% at baseline to 26.8% at follow-up in the intervention areas). Newborns were more likely to be checked by trained health personnel, and they received more comprehensive newborn care. Compared to the control communities, more than twice as many women in intervention communities knew to watch for specific newborn danger signs. Compared to the control and low-intensity intervention communities, more mothers in the high-intensity communities learned about the care of sick children from CHWs, with a corresponding decline those seeking advice from family or friends or traditional birth attendants. Significantly fewer mothers did nothing when their child was sick. High-intensity intervention communities experienced the most decline. Those who did nothing for children with fever or cough declined from 35% to 30%, and with diarrhea from 40% to 31%. Use of medications, both traditional and modern, increased from baseline to follow-up, with no differentiation in use by intervention area.ConclusionThe community-based approach to promoting improved newborn and sick child care through community volunteers and CHWs resulted in improved newborn and sick child care. The low-intensity approach with community volunteers appears to have been as effective as the higher-intensity CBSD approach with CHWs for several of the key newborn and sick child care indicators, particularly in the provision of appropriate home care for children with fever or cough.

Exploring the focus of prenatal information offered to pregnant mothers regarding newborn care in rural Uganda

BackgroundNeonatal death accounts for one fifth of all under-five mortality in Uganda. Suboptimal newborn care practices resulting from hypothermia, poor hygiene and delayed initiation of breastfeeding are leading predisposing factors. Evidence suggests focused educational prenatal care messages to mitigate these problems. However, there is a paucity of data on the interaction between the service provider and the prenatal service user. This study aims to understand the scope of educational information and current practices on newborn care from the perspectives of prenatal mothers and health workers.MethodsA qualitative descriptive methodology was used. In-depth interviews were conducted with lactating mothers (n = 31) of babies younger than five months old across Masindi in western Uganda. Additional interviews with health workers (n = 17) and their employers or trainers (n = 5) were conducted to strengthen our findings. Data were audio-taped and transcribed verbatim. A thematic content analysis was performed using NVivo 8.ResultsVertical programmes received more attention than education for newborn care during prenatal sessions. In addition, attitudinal and communication problems existed among health workers thereby largely ignoring the fundamental principles of patient autonomy and patient-centred care. The current newborn care practices were largely influenced by relatives’ cultural beliefs rather than by information provided during prenatal sessions. There is a variation in the training curriculum for health workers deployed to offer recommended prenatal and immediate newborn care in the different tiers of health care.ConclusionsFindings revealed serious deficiencies in prenatal care organisations in Masindi. Pregnant mothers remain inadequately prepared for childbirth and newborn care, despite their initiative to follow prenatal sessions. These findings call for realignment of prenatal care by integrating education on newborn care practices into routine antenatal care services and be based on principles of patient-centred care.

Emollient therapy for preterm newborn infants--evidence from the developing world.

IntroductionApplication of emollients is a widespread traditional newborn care practice in many low and middle-income countries (LMICs) and may have the potential to decrease infection and consequent mortality in preterm neonates.MethodsWe systematically reviewed literature published up to December 2012 to identify studies describing the effectiveness of emollient therapy. We used a standardized abstraction and grading format to estimate the effect of emollient therapy by applying the standard Child Health Epidemiology Reference Group (CHERG) rules.ResultsWe included seven studies and one unpublished trial in this review. Topical emollient therapy significantly reduced neonatal mortality by 27% (RR: 0.73, 95% CI: 0.56, 0.94) and hospital acquired infection by 50% (RR: 0.50, 95% CI: 0.36, 0.71). There were significant increases in weight (g) (MD: 98.04, 95% CI: 42.64, 153.45) and weight gain (g/kg/day) (MD: 1.57, 95% CI: 0.79, 2.36), whereas the impacts were non-significant for length and head circumference.ConclusionEmollient therapy is associated with improved weight gain, reduced risk of infection and associated newborn mortality in preterm neonates and is a potentially promising intervention for use in low resource settings. Large scale effectiveness trials are required to further assess the impact of this intervention.

Determinants of Immediate Essential Newborn Care Practice in Eastern Rural Nepal

Neonatal mortality remains high in Nepal. Improvement in immediate essential newborn care practices such as "use of clean instrument to cut the umbilical cord ”, "drying and wrapping the baby before placenta was delivered”, "initiation of breastfeeding within an hour of delivery" and "first bathing of neonate after 24 hours of delivery" can reduce neonatal deaths. However, this can only be accomplished if factors associated with reduced neonatal mortality can be identified. A regional study was carried out with 252 randomly selected women having child aged 11 months or younger; of which about 70 percent, 18 percent and 20 percent had received delivery assistance with skilled birth attendant, trained health professional and untrained friend/relatives respectively. Skilled Birth Attendant appeared as the determinant of the use of clean instrument to cut the umbilical cord (OR=164.33), first bathing of neonate after 24 hours of delivery (OR= 5.14) and drying and wrapping the baby before placenta was delivered (OR= 50.75) whereas Trained Health Professionals turned out to be the determinant of the use of clean instrument to cut the umbilical cord (OR=3.81) and first bathing of neonate after 24 hours of delivery (OR=3.14) only (Reference: Untrained relatives/friends). Maternal age (OR= &lt;20:10.59 and 20-30: 6.39; Ref: &gt;30 years) and education (OR=Primary-21.81; Secondary-20.11; Ref-Higher) appeared the determinant of initiation of breastfeeding within an hour of delivery. The time gap between delivery and the mother receiving the baby was also significantly positively associated with initiation of breastfeeding within an hour of delivery. This result indicates the need to increase the coverage of health facilities which can provide SBA, empower women to involve a SBA in delivery and provide newborn care education to women and family members. In order to better understand how to decrease neonatal mortality, further study should focus on understanding why there were better newborn care practices in births assisted by a SBA than THPs.

Factors Affecting Newborn Care Practices Among Tharu Mothers in Selected Vilalge Development Committees of Chitwan Distract

Although under five and infant mortality has been reducing in Nepal, neonatal mortality remains largely unchanged. New­born care practices in the family and in the community acts as contributing factors which could be improved by adopting simple interventions at community level. The objective of the study was to identify newborn care practices (cord care, breastfeeding, and bathing) and factors affecting it. The study is crosssectional descriptive and analytical conducted at Bachauli and Khairahani VDCs of Chitwan district from July to December 2012. A total 181 Tharu mothers were inter­viewed using semi structured interview schedule. Data processing and analysis was done using SPSS. The study revealed that 99.4% newborns had cord care (cutting, tying and applying nothing or using antiseptic). All newborns were breastfed and given colostrums as first feed but initiation of breastfeeding within one hour of delivery was only 52.5 %. Ninety seven per cent were bathed after 24 hours of delivery. Mothers who knew about newborn care were more likely to practice cord care (OR=0.10, 95% CI=0.02-0.41) in comparison to mothers who do not know about it. Compared to mothers with second­ary and primary education, mothers having higher education were breastfeeding within one hour of delivery (OR= 2.06, 95% CI=1.12-3.81). Delaying in bathing was more practiced in institutional deliveries compared to home deliveries (OR= 12.11, 95% CI=1.65-88.64). Overall newborn care practices were acceptable as per the findings of this study. Awareness programs regarding initiation of breastfeeding within one hour of delivery should be strengthening. Journal of Chitwan Medical College 2013; 3(1): 42-45 DOI: http://dx.doi.org/10.3126/jcmc.v3i1.8465