A Large Cross-Sectional Community-Based Study of Newborn Care Practices in Southern Tanzania

Penfold, Suzanne; Hill, Zelee; Mrisho, Mwifadhi; Manzi, Fatuma; Tanner, Marcel; Mshinda, Hassan; Schellenberg, David; Schellenberg, Joanna

doi:10.1371/journal.pone.0015593

Cited by 62 publications

(96 citation statements)

References 20 publications

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“…This survey adds to a small but growing literature on newborn care practices at community level in Sub-Saharan Africa [18,28-32]. In the population served by the health facilities included in this study, the majority of women made one antenatal care visit to a health facility, but less than half made four or more visits.…”

Section: Discussionmentioning

confidence: 99%

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

Callaghan-Koru

Seifu²,

Tholandi³

et al. 2013

BMC Pediatr

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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.

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Section: Discussionmentioning

confidence: 99%

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

Callaghan-Koru

Seifu²,

Tholandi³

et al. 2013

BMC Pediatr

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“…Qualitative themes are contrasted to household survey data (243,612) on thermal care, although the methods and main results of the survey are fully reported elsewhere [20]. The qualitative study took place 2008 (September to December) and was preceded by the quantitative survey carried out in 2007 (June and October).…”

Section: Methodsmentioning

confidence: 99%

“…Survey findings are reported elsewhere [20]; for the purpose of the current paper we re-analysed the thermal care data disaggregated into (a) deliveries taking place in a facility (meaning hospital, health centre or dispensary) and (b) at home (meaning the woman’s own home, and excluding deliveries in other households).…”

Section: Methodsmentioning

confidence: 99%

Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change

Shamba

Schellenberg

Hildon

et al. 2014

BMC Pregnancy Childbirth

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BackgroundHypothermia contributes to neonatal morbidity and mortality in low-income countries, yet little is known about thermal care practices in rural African settings. We assessed adoption and community acceptability of recommended thermal care practices in rural Tanzania.MethodsA multi-method qualitative study, enhanced with survey data. For the qualitative component we triangulated birth narrative interviews with focus group discussions with mothers and traditional birth attendants. Results were then contrasted to related quantitative data. Qualitative analyses sought to identify themes linked to a) immediately drying and wrapping of the baby; b) bathing practices, including delaying for at least 6 hours and using warm water; c) day to day care such as covering the baby’s head, covering the baby; and d) keeping the baby skin-to-skin. Quantitative data (n = 22,243 women) on the thermal care practices relayed by mothers who had delivered in the last year are reported accordingly.Results42% of babies were dried and 27% wrapped within five minutes of birth mainly due to an awareness that this reduced cold. The main reason for delayed wrapping and drying was not attending to the baby until the placenta was delivered. 45% of babies born at a health facility and 19% born at home were bathed six or more hours after birth. The main reason for delayed bathing was health worker advice. The main reason for early bathing believed that the baby is dirty, particularly if the baby had an obvious vernix as this was believed to be sperm. On the other hand, keeping the baby warm and covered day-to-day was considered normal practice. Skin-to-skin care was not a normalised practice, and some respondents wondered if it might be harmful to fragile newborns.ConclusionMost thermal care behaviours needed improving. Many sub-optimal practices had cultural and symbolic origins. Drying the baby on birth was least symbolically imbued, although resisted by prioritizing of the mothers. Both practical interventions, for instance, having more than one attendant to help both mother and baby, and culturally anchored sensitization are recommended.

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“…The total population was 890,939 in 2002 [41] and there were 22,243 live births in 2007 [15]. The districts are predominantly rural and people live from subsistence farming, fishing and small scale trading.…”

Section: Methodsmentioning

confidence: 99%

Health system support for childbirth care in Southern Tanzania: results from a health facility census

et al. 2013

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BackgroundProgress towards reaching Millennium Development Goals four (child health) and five (maternal health) is lagging behind, particularly in sub-Saharan Africa, despite increasing efforts to scale up high impact interventions. Increasing the proportion of birth attended by a skilled attendant is a main indicator of progress, but not much is known about the quality of childbirth care delivered by these skilled attendants. With a view to reducing maternal mortality through health systems improvement we describe the care routinely offered in childbirth at dispensaries, health centres and hospitals in five districts in rural Southern Tanzania. We use data from a health facility census assessing 159 facilities in five districts in early 2009. A structural and operational assessment was undertaken based on staff reports using a modular questionnaire assessing staffing, work load, equipment and supplies as well as interventions routinely implemented during childbirth.ResultsHealth centres and dispensaries attended a median of eight and four deliveries every month respectively. Dispensaries had a median of 2.5 (IQR 2–3) health workers including auxiliary staff instead of the recommended four clinical officer and certified nurses. Only 28% of first-line facilities (dispensaries and health centres) reported offering active management in the third stage of labour (AMTSL). Essential childbirth care comprising eight interventions including AMTSL, infection prevention, partograph use including foetal monitoring and newborn care including early breastfeeding, thermal care at birth and prevention of ophthalmia neonatorum was offered by 5% of dispensaries, 38% of health centres and 50% of hospitals consistently. No first-line facility had provided all signal functions for emergency obstetric complications in the previous six months.ConclusionsEssential interventions for childbirth care are not routinely implemented in first-line facilities or hospitals. Dispensaries have both low staffing and low caseload which constrains the ability to provide high-quality childbirth care. Improvements in quality of care are essential so that women delivering in facility receive “skilled attendance” and adequate care for common obstetric complications such as post-partum haemorrhage.

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A Large Cross-Sectional Community-Based Study of Newborn Care Practices in Southern Tanzania

Cited by 62 publications

References 20 publications

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

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

Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change

Health system support for childbirth care in Southern Tanzania: results from a health facility census

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