Trends, determinants, and newborn mortality related to thermal care and umbilical cord care practices in South Asia

Abstract

Background Although child mortality has decreased over the last several decades, neonatal mortality has declined less substantially. In South Asia, neonatal deaths account for the majority of all under-five deaths, calling for further study on newborn care practices. We assessed five key practices: immediate drying and wrapping, delayed bathing, immediate skin-to-skin contact after birth, cutting the umbilical cord with a clean instrument, and substances placed on the cord. Methods Using data from Demographic and Health Surveys conducted in Bangladesh, India, and Nepal between 2005 and 2016, we examined trends in coverage of key practices and used multivariable logistic regression to analyze predictors of thermal care and hygienic cord care practices and their associations with neonatal mortality among home births. The analysis excluded deaths on the first day of life to ensure that the exposure to newborn care practices would have preceded the outcome. Given limited neonatal mortality events in Bangladesh and Nepal, we pooled data from these countries. Results We found that antenatal care and skilled birth attendance was associated with an increase in the odds of infants' receipt of the recommended practices among home births. Hygienic cord care was significantly associated with newborn survival. After controlling for other known predictors of newborn mortality in Bangladesh and Nepal, antiseptic cord care was associated with an 80% reduction in the odds of dying compared with dry cord care. As expected, skilled care during pregnancy and birth was also associated with newborn survival. Missing responses regarding care practices were common for newborns that died, suggesting that recall or report of details surrounding the traumatic event of a loss of a child may be incomplete. Conclusions This study highlights the importance of maternal and newborn care and services for newborn survival in South Asia, particularly antenatal care, skilled birth attendance, and antiseptic cord care. Electronic supplementary material The online version of this article (10.1186/s12887-019-1616-2) contains supplementary material, which is available to authorized users.

Coverage and factors associated with mother and newborn skin-to-skin contact in Nigeria: a multilevel analysis

“…Also, mothers who had attended ANC visits had increased odds of having SSC with their newborns immediately after delivery, compared with those who had no ANC visits. Similar findings have been reported in other studies [ 17 , 35 ]. ANC is an avenue to educate, counsel and prepare pregnant women for delivery.…”

“…This is consistent with the findings from previous studies which showed that the practice of SSC between the mother and the newborn was significantly more common in health facility based delivery compared with home births [ 32 , 33 ]. Skilled birth attendants at health facilities may be more knowledgeable about SSC than traditional birth attendants, making it more likely to be practiced in hospital deliveries [ 34 , 35 ]. Furthermore, the mode of delivery was significantly associated with SSC between mothers and their newborn immediately after birth.…”

“…Women are educated on healthy behaviours to adopt during pregnancy and what to expect during and after delivery. At ANC visit, women can be sensitized about SSC and its benefits [ 35 , 39 ]. In addition, mothers who had LBW newborns were more likely to practice SSC with their newborn immediately after birth.…”

Assessment of Neonatal Thermal Cares: Practices and Beliefs Among Rural Women in West Guji Zone, South Ethiopia: A Cross-Sectional Study

“…However higher prevalence of skin to skin care was reported from south Asian countries. In Bangladesh and Nepal about 25% and 38% of women reported practicing skin to skin care of newborns respectively [16]. Studied women do not believe that skin to skin care is helpful to keep newborn warm.…”

“…of newborns in Nepal receive immediate drying and wrapping [16]. In current study area, commonly drying and wrapping are done after newborn bath except in the circumstance of health facility delivery, where limited access to water and/or health workers' advice might have hindered early newborn bath.…”