Facility level factors that determine consistent delivery of essential newborn care at health centers in Ethiopia

Background Essential newborn care (ENC) is a package of interventions which should be provided for every newborn baby regardless of body size or place of delivery immediately after birth and should be continued for at least the seven days that follows. Even though Ethiopia has endorsed the implementation of ENC, as other many counties, it has been challenged. This study was conducted to measure the level of essential newborn care practice and identify health facility level attributes for consistent delivery of ENC services by health care providers. Methods This study employed a retrospective cross-sectional study design in 425 facilities. Descriptive statistics were formulated and presented in tables. Binary logistic regression was employed to assess the statistical association between the outcome variable and the independent variables. All variables with p < 0.2 in the bivariate analysis were identified as candidate variables. Then, multiple logistic regression analysis was performed using candidate variables to determine statistically significant predictors of the consistent delivery of ENC by adjusting for possible confounders. Results A total of 273, (64.2%), of facilities demonstrated consistent delivery of ENC. Five factors—availability of essential obstetrics drugs in delivery rooms, high community score card (CSC) performances, availability of maternity waiting homes, consistent partograph use, and availability of women-friendly delivery services were included in the model. The strongest predictor of consistent delivery of essential newborn care (CD-ENC) was consistent partograph use, recording an odds ratio of 2.66 (AOR = 2.66, 95%CI: 1.71, 4.13). Similarly, providing women-friendly services was strongly associated with increased likelihood of exhibiting CD-ENC. Furthermore, facilities with essential obstetric drugs had 1.88 (AOR = 1.88, 95%CI: 1.15, 3.08) times higher odds of exhibiting consistent delivery of ENC. Conclusion The delivery of essential newborn care depends on both health provider and facility manager actions and availability of platforms to streamline relationships between the clients and health facility management.

The level of Community-Based Essential Newborn Care utilization and associated factors among rural women in Southern Ethiopia, 2020: Based on the updated Community-Based Essential Newborn Care guideline

Background: A Community-Based Essential Newborn Care is a national initiative that incorporates a newborn care program into the continuum of maternal and child health care through enhancing community participation to reduce child morbidity and mortality and encourage healthy growth and development. This study aimed at assessing the level of Community-Based Essential Newborn Care service uptake and its associated factors among rural women in the Guraghe zone, Southern Ethiopia, 2020. Methods: A community-based cross-sectional study was conducted in the rural districts of Southern Ethiopia, from 1 to 31 May 2020. A multistage sampling technique was applied. Using a systematic random sampling technique, a total of 818 respondents were selected. The data collected by a pretested structured questionnaire were entered into EpiData 3.1 and exported to the Statistical Package for Social Sciences (Version 23) for analysis. To identify significant predictors of Community-Based Essential Newborn Care utilization, a multivariable logistic regression analysis was fitted. Adjusted odds ratios with 95% confidence intervals were used to estimate the strength of associations, and statistical significance was declared at a p value <0.05. Results: One-third, 269 (33.1%) (95% confidence interval = 30.0–36.2), of women and their newborns got the entire packages of the Community-Based Essential Newborn Care program. Desire on the last pregnancy (adjusted odds ratio = 2.66, 95% confidence interval = 1.56–4.51), birth preparedness and complication readiness plan (adjusted odds ratio = 4.82, 95% confidence interval = 3.26–7.12), timing of the postpartum visit (adjusted odds ratio = 3,56, 95% confidence interval = 2.00–6.34), attending monthly pregnant women conference (adjusted odds ratio = 3.01, 95% confidence interval = 1.99–4.57), and being a certified model household (adjusted odds ratio = 1.88, 95% confidence interval = 1.24–2.85) were identified as key predictors of Community-Based Essential Newborn Care utilization. Conclusion: The uptake of the full Community-Based Essential Newborn Care packages in the study area was low. Health care providers at the health institution and community level should give due emphasis to improve contraceptive service delivery. Besides, health extension workers at the community level should work on providing immediate postpartum visits, creating model households, and strengthening pregnant women conferences.

Effectiveness of Early Essential Newborn Care Implementation In Four Provinces of Western China

Introduction: Neonatal survival remains a public health concern globally. Early Essential Newborn Care (EENC) recommended by World Health Organization is a package of cost-effective interventions to improve neonatal health and development outcomes. In this study we aimed to explore the effectiveness of EENC implementation in four provinces of western China.Methods: A pre- and post-intervention investigations were conducted in 4 selected EENC intervention counties and 4 control counties of four western provinces of China, during June to August 2017 and December 2020 to April 2021 respectively. A mixed quantitative and qualitative approach was used for data collection and analysis. Data on the coverage of EENC practices were collected through post-intervention face-to-face questionnaire interview with postpartum mothers before hospital discharge. Hospital-reported data on neonatal health outcomes were obtained through mail surveys in both investigations. We also performed semi-structured interviews with stakeholders of policymakers, health staff, and postpartum mothers to learn their perceived usefulness of EENC implementation. Results: 599 mother-newborn pairs in the intervention group and 699 pairs in the control group participated in the post-intervention survey. With the confounding factor of province being controlled for, proportions of newborns receiving any skin to skin contact (99.50% vs. 49.07%), exclusive breastfeeding before discharge (92.57% vs. 63.80%), no applied medicine to the umbilical cord (98.50% vs. 9.73%), routine eye care (93.16% vs. 8.73%), and vitamin K1 administration (98.33% vs. 88.98%) were higher in the intervention group compared with the control group (P<0.05). Lower incidences of neonatal diarrhea (0.07% vs. 0.22%) and eye infection (0.04% vs. 0.29%) were reported in the intervention group than the control group (P<0.05). The enhanced satisfaction of stakeholders primarily manifests in belief acknowledgement, policy promotion, emotional support, health improvement, widely-acknowledged sustainability, and work support. Conclusion: EEEC-recommended core practices have been successfully introduced in pilot hospitals. The efficacy of EENC implementation should be highly recognized to accelerate the progress towards its national rolling out.

Evaluation of a two-way SMS messaging strategy to reduce neonatal mortality: rationale, design and methods of the Mobile WACh NEO randomised controlled trial in Kenya

IntroductionGlobally, approximately half of the estimated 6.3 million under-5 deaths occur in the neonatal period (within the first 28 days of life). Kenya ranks among countries with the highest number of neonatal deaths, at 20 per 1000 live births. Improved identification and management of neonates with potentially life-threatening illness is critical to meet the WHO’s target of ≤12 neonatal deaths per 1000 live births by 2035. We developed an interactive (two-way) short messaging service (SMS) communication intervention, Mobile Solutions for Neonatal Health (Mobile women’s and children’s health (WACh) NEO), focused on the perinatal period. Mobile WACh NEO sends automated tailored SMS messages to mothers during pregnancy and up to 6 weeks post partum. Messages employ the Information-Motivation-Behaviour Skills framework to promote (1) maternal implementation of essential newborn care (ENC, including early, exclusive breast feeding, cord care and thermal care), (2) maternal identification of neonatal danger signs and care-seeking, and (3) maternal social support and self-efficacy. Participants can also send SMS to the study nurse, enabling on-demand remote support.Methods and analysisWe describe a two-arm unblinded randomised controlled trial of the Mobile WACh NEO intervention. We will enrol 5000 pregnant women in the third trimester of pregnancy at 4 facilities in Kenya and randomise them 1:1 to receive interactive SMS or no SMS (control), and conduct follow-up visits at 2 and 6 weeks post partum. Neonatal mortality will be compared between arms as the primary outcome. Secondary outcomes include care-seeking, practice of ENC and psychosocial health. Exploratory analysis will investigate associations between maternal mental health, practice of ENC, care-seeking and SMS engagement.Ethics and disseminationThis study received ethical approval from the University of Washington (STUDY00006395), Women and Infants Hospital (1755292-1) and Kenyatta National Hospital/University of Nairobi (P310/04/2019). All participants will provide written informed consent. Findings will be published in peer-reviewed journals and international conferences.Trial registration numberNCT04598165

KNOWLEDGE ONESSENTIAL NEWBORN CARE AMONG POST NATAL MOTHERS

The birth of the baby is one of the wondrous moments in their life. A newborn is a continuum of foetal life and an important transient time to adopt extrauterine life. Essential Newborn care refers to the care provided by the mother or caregiver regarding breastfeeding, care o cord and eyes, maintaining body temperature, immunization, and controllingthe infection.Objectives: To assessthe knowledge level of postnatal mothers regarding Essential Newborn Care. Materials and methods: A non-experimental descriptive study was conducted in a selected hospital, Idukki to assess the knowledge of post-natal mothers regarding essential newborn care. A total of 50 post-natal mothers were selected with a non-probability convenience sampling technique. A quantitative research approach was used in this study. A self-structured questionnaire was used to gather the data, and appropriate statistics were performed to analyse the data. Results: The data results revealed that 50% of samples are in the age group of 19-27 yrs. and 50% were 28-36 years of age. The majority of the samples(72%) were Christians. Half of the samples(58%) were graduates and 22% were postgraduates. Concerning the level of knowledge, 10% of them had poor, 60% had average and 22% had good knowledge regarding essential newborn care.

The shadow challenges to improve the state essential newborn care practices in healthcare providers: evidence from a multicentre cross-sectional study in Ethiopia

Background Neonatal mortality can be reduced by providing essential newborn care. However, it is overlooked by most healthcare providers in Ethiopia. Hence, this study aims to examine immediate essential newborn care practices and associated factors among healthcare providers in Ethiopia. Methods Institution-based cross-sectional study was conducted among 214 healthcare providers from November 11 to December 19, 2020, at a selected South Gondar health facility. Data were entered into Epi-data 4.2 and then exported to STATA14.0 for analysis. Both bivariable and multivariable logistic regression with a 95% confidence interval were computed. The variable that had a p-value less than 0.25 in bivariable logistic regression was entered into the multivariable logistic regression. In multivariable logistic regression, variables having a p-value < 0.05 were considered a statistically significant association with the poor practice of essential newborn care practice. Results The overall essential newborn care practice among healthcare providers was found to be 74.8% (95% CI: 68.4, 80.2). Diploma educational status (AOR = 7.8, 95% CI:2.80–21.9), presence of workload (AOR = 9.7, 95% CI: 2.76–23.9), unavailability of drugs and vaccines (AOR = 9.8, 95% CI: 6.95–17.7), and having no training (AOR = 3.9, 95% CI: 1.73–8.92) were found to be predictors for poor essential newborn care practices. Conclusion Essential newborn care practice among healthcare providers at South Gondar health institutions was found to be low. Being diploma educational status, presence of workload, unavailability of drugs and vaccines, and having no training were found to be independent predictors for poor practice of essential newborn care. Hence, periodic evaluation and strategies are needed for those predictor variables to address the gaps.