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

Abstract

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.

Early breastfeeding practices: Descriptive analysis of recent Demographic and Health Surveys

“…Specific components of delivery care which are rapidly increasing in many middle‐income countries, such as increased use of analgesia, labour induction and augmentation, and caesarean delivery, may negatively impact on breastfeeding and contribute to a narrowing of the advantage conferred by facility care. An investigation of delivery setting and essential newborn care using data from prospective trials in South Asia reported that the proportion of women experiencing skin‐to‐skin contact with their infant within 30 min of birth was lower in institutional delivery settings compared to home (Pagel et al, ). Among facility births, we consistently observed a higher prevalence of optimal early breastfeeding practices in public sector births compared to births in private facilities.…”

Women’s education and coverage of skilled birth attendance: An assessment of Sustainable Development Goal 3.1 in the South and Southeast Asian Region

“…An educated woman is more likely to understand the consequences of traditional medicines or services from TBA, usually in rural areas that lead to unattended home deliveries [18,71]. To rise above the long-established mindset of the community and rebel against the conventional flow to seek modern medical help, higher education would be necessary to avert maternal deaths [72].…”

Generating Insights from Trends in Newborn Care Practices from Prospective Population-Based Studies: Examples from India, Bangladesh and Nepal

“…Detailed questionnaires were used to collect information regarding the intrapartum care of all enrolled women. In this study, we use information regarding newborn care practices gathered in the control clusters of the trials to examine how these practices changed over time in the absence of the trial interventions; we were not evaluating the trial interventions, so did not use data from the women’s group intervention clusters [ 15 ].…”

“…There have also been efforts to improve aspects of newborn care for women giving birth at home without an SBA, for example through the promotion of clean delivery kits [ 7 , 8 ]. However the coverage of protective birth practices remains incomplete and variable across settings [ 9 – 15 ]. Observed improvement in the coverage of essential newborn care could be due to more women having a skilled attendant at delivery, improvements in the quality of skilled attendance, improvement in practices at unattended deliveries at home or a combination of all three.…”

“…Over the last decade, community trials aimed at testing interventions to improve maternal and neonatal health have generated detailed information about birthing care practices in rural South Asia. In a recent publication [ 15 ], we used information from the control arms of four cluster randomised controlled trials conducted in rural areas of Nepal, Bangladesh and India [ 16 – 20 ] to describe the coverage of newborn care practices for births at home and within health facilities in these areas. This revealed shortfalls in the coverage of newborn care that varied markedly between geographical areas and according to attendance at birth.…”