Effectiveness of early essential newborn care implementation in four counties of western China

Abstract

Background Neonatal survival is a public health concern globally. However, the regional disparity in neonatal mortality between rural counties of western China and urban areas of eastern provinces remains high. Early essential newborn care (EENC), recommended by World Health Organization, refers to a set 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 counties of western China. Methods Pre- and post-intervention investigations were conducted in four selected EENC intervention counties and four control counties of four western provinces of China, from June to August 2017 and from 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 via a post-intervention face-to-face questionnaire survey with postpartum mothers before hospital discharge. Hospital-reported data on neonatal health indicators were obtained through mail surveys in both investigations. We also performed semi-structured interviews with policymakers, health staff and postpartum mothers to understand their perceptions about the usefulness of EENC implementation. Results Overall, 599 mother-newborn pairs in the intervention group and 699 pairs in the control group participated in the post-intervention survey. Controlling for the confounding factor of province, the proportion of newborns receiving EENC interventions was higher in the intervention group than in the control group (P < 0.05). Intervention groups in four provinces had higher coverage of: any skin-to-skin contact (99.50% vs. 49.07%); early breastfeeding initiation (within 60 min of birth) (90.84% vs. 80.35%); no medicine applied 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%). EENC implementation was associated with decreased risk of neonatal diarrhea (OR: 0.326, 95% CI: 0.123, 0.865) and eye infection (OR: 0.147, 95% CI: 0.045, 0.483). Policymakers, health staff and postpartum mothers expressed satisfaction with the EENC interventions, noting a willingness among staff and policymakers to implement and sustain these interventions; the promotion of these interventions within hospital policy; the positive emotions experienced by postpartum mothers; perceived improvements in health; and improvements in support for health workers. Conclusion EENC-recommended core practices (except kangaroo mother care) have been successfully introduced in pilot hospitals. The efficacy of EENC implementation should be highly recognized to accelerate the progress towards its national roll out.

Measuring experience of and satisfaction with newborn care: a scoping review of tools and measures

“…Most of the studies covered the care between birth and discharge or birth to 72 hours,14 18–20 23 26 27 30 33–35 41 43 46 49 51–58 61 62 64 67 69–73 76 78–80 82–85 four studies reported on follow-up care at home,16 47 48 50 one on care during ground ambulance transport37 and five studies covered end-of-life care 25 36 42 72 84. We found no studies that reported on home birth.…”

“…Satisfaction with care was covered in 25 studies,14–17 27 38 43 45 48 55 71–85 but only 15 had it as primary aim,14 15 38 43 45 55 72 74–77 79 81–83 with seven focused on overall satisfaction and the remaining focused on the care received during stay in neonatal intensive care unit (NICU) or on other specific aspects such as rooming-in, infrastructure, education at discharge, the administration of routine interventions or home-based care.…”

“…Continuity of care during newborns’ stay in the healthcare facility, during transfer to another facility, or after discharge (n=7 articles)16 28 30 37 47 48 50 was also examined, as was the facility environment including access, physical space and lightning (n=1 article) 14. Finally, 14 studies explored the experience or satisfaction with care in the context of family-integrated or family-centred care, including staff support, parental involvement in care, information sharing, discharge preparation and feeding support,22 25 27 29 44 46 49 55 respectful newborn care69 70 or overall quality of care 24 38 82 85…”

Barriers and facilitators in implementing early essential newborn care of well‐born babies in low‐ and middle‐income countries: A mixed‐method systematic review

“…A survey conducted in Cambodia and Lao PDR showed that the rates of EENC practice 15 min after birth were low (Kitamura et al 2022). The practice of skin-to-skin contact was not successfully introduced in China (Wang et al 2022). In addition, the executive criteria in some hospitals have not strictly corresponded to the EENC guidelines (Peven et al 2020).…”

“…The practice of skin‐to‐skin contact was not successfully introduced in China (Wang et al. 2022). In addition, the executive criteria in some hospitals have not strictly corresponded to the EENC guidelines (Peven et al.…”