Newborn care refers to the care that is provided to the baby from birth to one-month-old by a caregiver or by the mothers including thermal care, hygienic care, cord care, eye care, breastfeeding, immunization, and identification of newborn danger signs. According to Ethiopian Demographic and Health Survey (EDHS) 2016, the neonatal mortality rate was 29 deaths per 1000 live births, and the postneonatal mortality rate was 19 deaths per 1000 live births with neonates contributing 48 deaths per 1000 of the infant mortality. Neonatal mortality accounts for approximately two-thirds of all infant mortality worldwide.
Essential newborn care is the basic care required for every baby and comprises thermal care (delayed bathing, drying, and keeping the baby warm through skin-to-skin contact), infection prevention (promoting and supporting handwashing for all caregivers and providing hygienic umbilical cord and skin care), feeding support (early and exclusive breastfeeding), and postnatal care, including monitoring of newborns for danger signs of serious infections and identifying babies requiring additional care [
There is a global underfive mortality rate of 42.5 per 1000 live births; of those deaths, 45% were newborns, with a neonatal mortality rate of 19 per 1000 live births [
In Ethiopia, neonatal morbidity and mortality rates were among the highest in the world [
Even only 26% of births occur in a health facility, there is an increase in neonatal death [
The objective of this study was to assess newborn care practice and associated factors among mothers of one-month-old infants in Hossana town, Hadiya zone, southern Ethiopia, 2018.
To assess newborn care practice among mothers with babies aged one month To identify factors associated with newborn care practice among mothers with babies aged one month
Hossana town is the capital city of Hadiya zone, Southern Nations, Nationalities, and Peoples’ Region (SNNPR), which was located 194 km from Hawassa, the capital city of the region, and 230 km from Addis Ababa, the capital city of the country.
Hossana town is a purely woinedega agroeconomic zone, situated at an altitude of 1800-2950 meters above sea level, and has an average temperature ranging from 10 to 24 degree centigrade. The annual rainfall is 1250 mm per year.
Based on the 2007 Ethiopian national population and housing census, the population of the town was 78,432: male 38,800 and female 39,632; the number of childbearing age women (15-49 years) was 18,275 (Hossana town administrative office report 2007).
A community-based cross-sectional study was conducted from January 20 to February 19, 2018, in Hossana town, southwest Ethiopia.
A community-based cross-sectional study design was conducted.
The source population is all women in the reproductive age group, who had one-month age infants in Hossana town.
Study populations were all sampled mothers who had one-month age infants during the data collection period in Hossana town.
Mothers resident in the area for six or more months before this study was conducted were included in the study.
Mothers who were unable to feed breast milk and too sick or critically ill during the data collection period were excluded in the study.
The sample size was determined by using a single population proportion formula:
where
Then, to get the final sample size (
A survey was conducted among 422 women having a one-month infant in Hossana town. A multistage sampling technique was used to select study participants, and the study was conducted in all kebeles found in the town. A proportional allocation to the size of the population was done to decide the number of women required from each kebeles.
Finally, a simple random sampling technique was applied to identify women to be included in the survey. When more than one eligible respondent is present in a selected household, one respondent is selected on the spot by a lottery method.
Newborn care practice (early breastfeeding, thermal care, and cord care)
Sociodemographic and socioeconomic factors (parity, occupation, education status, and place of delivery) Mothers’ knowledge on newborn care practice (knowledge on newborn care practice and knowledge on newborn danger signs) Health service and obstetric factors (attendance of ANC, health education during ANC and PNC, health extension worker home visit, and neonatal death)
The data were collected using a structured interviewer-administered questionnaire adapted from the EDHS, and other relevant literatures were used to collect data. The questionnaire had included all the questions that assess the knowledge and practice of newborn care of mothers. The tool was prepared in English version and translated to Hadiyisa (local language) and then translated back to English language to check for consistency. Finally, the data were collected by Hadiyisa language.
Seven diploma midwives and five diploma nurses were recruited from other kebeles. Training was given for both data collectors and supervisors for two days before the actual data collection about data collection techniques go through the questionnaire questions with questions, ways of data collection, supervision and final clarification was given to those who have doubts.
Newborn care: it refers to the care provided to the baby from birth to 28 days of age by a caregiver or by the mothers including thermal care, hygienic care, cord care, eye care, breastfeeding, immunization, and identification of newborn danger signs.
Practice of newborn care: a mother was asked questions that cover the practice of newborn care which includes early initiation of breastfeeding and providing colostrums, cord care, and thermal care. The investigator developed composite index questions in the above issues that assigned a score of one [1] = correct response (consistent with the WHO essential newborn care guidelines) and 0 = incorrect response (inconsistent with the WHO/Unicef essential newborn care guidelines); any mother who did not know the answer is considered to have an incorrect response.
Good knowledge of mothers on newborn care: those mothers who respond correctly above 50% of knowledge-related questions.
Poor knowledge of mothers on newborn care: those mothers who respond correctly less than or equal to 50% of knowledge-related questions.
Newborn care practice: good newborn care practice: those mothers who mentioned three newborn care practices; poor newborn care practice: those who reported two or less newborn care practices.
Kebele: it is the smallest administrative unit, similar to a ward, a neighborhood, or a localized and delimited group of people and a part of woreda (district).
Data quality was assured by using a pretested data collection tool, and training was given for data collectors and supervisors before actual data collection. Supervisors were engaged in continuous supervision and monitoring during data collection. Completeness and consistency of data were checked by supervisors, data clerks, and investigators before and during data entry.
Collected data was checked for its completeness and then coded and entered into EpiData version 3.1, and entered data was exported to SPSS version 20 for analysis. Binary and multivariate logistic regressions were employed. Frequencies and proportions were computed. A significant association was determined by odds ratios with
A total of 422 mothers who had one-month infants were involved in the study, yielding a 100% response rate. The majority of respondents, 289 (68.5%), were between 25 and 34 years of age, 213 (50.5%) were housewives, 418 (99.1%) were married, 258 (61.1%) were protestant religion, 279 (66.1%) were Hadiya ethnicity, 378 (89.6%) had a formal education, and 46 (10.9%) had a high income (Table
Sociodemographic variables of mothers with babies of one-month-old in Hossana town, southwest Ethiopia, 2018 (
Variables ( | Frequency ( | Percent (%) |
---|---|---|
Age (year) | ||
15-24 | 76 | 18.0 |
25-34 | 289 | 68.5 |
≥35 | 57 | 13.5 |
Religion | ||
Protestant | 258 | 61.1 |
Orthodox | 106 | 25.1 |
Other | 58 | 13.7 |
Ethnicity | ||
Hadiya | 279 | 66.1 |
Kembata | 60 | 14.2 |
Other | 83 | 19.7 |
Marital status | ||
Married | 418 | 99.1 |
Others | 4 | .9 |
Educational level | ||
Primary | 137 | 32.5 |
College and above | 129 | 30.6 |
Secondary | 112 | 26.5 |
No formal education | 44 | 10.4 |
Occupation | ||
Housewife | 213 | 50.5 |
Governmental employee | 117 | 27.7 |
Others | 92 | 21.8 |
Wealth index | ||
Lowest | 261 | 61.8 |
Middle | 115 | 27.3 |
Highest | 46 | 10.9 |
From the participants, 303 (71.8%) had a home visit in the last one month and had health educations; 369 (87.4%) had knowledge on handwashing with soap and clean water before handling their neonate, 347 (82.2%) on keeping neonate dry and wrapping after delivery, 402 (95.3%) on breastfeeding immediately after birth within an hour, 383 (90.8%) on danger sign, 373 (88.4%) on immunization, and 361 (85.5%) on how to care for low-birth-weight baby by HEW.
The majority of participants, 351 (83.2%), had no history of neonatal death before this delivery, 411 (97.4%) had ANC follow-up when they were pregnant, and 405 (96.0%) had given birth at health facilities (Table
Health care service utilization and obstetrics information of mothers with babies of one-month-old in Hossana town, southwest Ethiopia, 2018 (
Variables ( | Frequency ( | Percent (%) |
---|---|---|
HEW home visit | ||
Yes | 303 | 71.8 |
No | 119 | 28.2 |
Health education | ||
Yes | 369 | 87.4 |
No | 53 | 12.6 |
Keeping immediately dry and wrapping | ||
Yes | 347 | 82.2 |
No | 75 | 17.8 |
BF immediately within an hour | ||
Yes | 402 | 95.3 |
No | 20 | 4.7 |
HEW advice on danger signs | ||
Yes | 383 | 90.8 |
No | 39 | 9.2 |
HEW advice on immunization | ||
Yes | 373 | 88.4 |
No | 49 | 11.6 |
HEW advice on LBW care | ||
Yes | 361 | 85.5 |
No | 61 | 14.5 |
History of neonatal death | ||
Yes | 71 | 16.8 |
No | 351 | 83.2 |
ANC follow-up | ||
Yes | 411 | 97.4 |
No | 11 | 2.6 |
Place of current ANC visit | ||
Governmental health facility | 376 | 89.1 |
Private health facility | 46 | 10.9 |
Place of current delivery | ||
Home | 17 | 4.0 |
Health facility | 405 | 96.0 |
HEW = health extension workers; LBW = low birth weight; ANC = antenatal care.
From the total participants, 409 (96.9%) gave the first breast milk for their baby, 352 (85.4%) initiated breast milk within an hour after birth, 336 (79.6%) did not apply anything on the cord of the newborn baby, 214 (50.7%) took care of bleeding to keep the cord clean and safe, 144 (34.1%) kept the cord dry and clean to keep the cord clean and safe, and 64 (15.2%) took the newborn baby to a health facility in order to keep umbilical cord clean and safe.
More than half of the respondents, 215 (50.9%), had given the first bath for newborn baby within the first 24 hours of delivery, and 293 (69.4%) placed the newborn baby to skin-to-skin contact always until the baby becomes stable (Table
Practice of initiation of breastfeeding, cord care, and thermal care of mothers with babies of one-month-old in Hossana town, southwest Ethiopia, 2018 (
Variables ( | Frequency ( | Percent (%) |
---|---|---|
Did you give/feed colostrum | ||
Yes | 409 | 96.9 |
No | 13 | 3.1 |
When did you initiate breast milk | ||
Within an hour | 352 | 85.4 |
After one hour | 70 | 14.6 |
Did you apply anything on the cord | ||
Yes | 86 | 20.4 |
No | 336 | 79.6 |
What did you do to keep the cord safe | ||
Taking care of bleeding | 214 | 50.7 |
Keeping it dry and clean | 144 | 34.1 |
Taking to a health facility | 64 | 15.2 |
When did you give a bath to baby | ||
Within 24 hours | 215 | 50.9 |
After 24 hours | 207 | 49.1 |
Was placed in skin-to-skin 1st | ||
Not at all | 129 | 30.6 |
Always | 293 | 69.4 |
Among the 422 study participants, 406 (96.2%) had known about care for their newborn, 331 (78.4%) applied nothing to the cord immediately after cutting up to 7 days except ordered medication, 294 (69.7%) handled umbilical cord after cutting without dressing, 327 (77.5%) bathed her newborn baby after 24 hours after delivery, 372 (88.2%) breastfed their baby within 1 hour after delivery, 368 (87.2%) believed feeding breast milk as the first food for a newborn baby after delivery, and 367 (87.0%) had knowledge about newborn danger sign (Table
Knowledge on newborn care and danger signs of mothers with babies of one-month-old in Hossana town, southwest Ethiopia, 2018 (
Variables ( | Frequency ( | Percent (%) |
---|---|---|
Mother care to newborn baby | ||
Yes | 406 | 96.2 |
No | 16 | 3.8 |
What substance was applied to the cord | ||
Nothing applied | 331 | 78.4 |
Butter applied | 91 | 21.6 |
How long was the cord handled after cutting | ||
With dressing/cover | 128 | 30.3 |
Without dressing | 294 | 69.7 |
How long after birth was the baby washed for the 1st time | ||
Within 24 hours | 95 | 22.5 |
After 24 hours | 327 | 77.5 |
How long after birth should the baby be breastfed | ||
Within one hour | 372 | 88.2 |
After one hour | 50 | 11.8 |
What should mother feed baby first | ||
Breast milk | 368 | 87.2 |
Other than breast milk | 54 | 12.8 |
Newborn danger sign | ||
Yes | 367 | 87.0 |
No | 55 | 13.0 |
From the total of 422 participants, the mentioned danger signs of a newborn baby are as follows: 84.8% were poor sucking, 77% were fast breathing, 64% had hypothermia, 64.7% had fever, 46% had drowsiness (unconscious), and 66.1% had cord bleeding and infection (Figure
Identified newborn danger sign by mothers with babies of one-month-old after delivery in the community of Hossana town, southwest Ethiopia, 2018.
In this study, the proportion of newborn care practices was 130 (30.8%) of the respondents in terms of the three composite practices, namely, 354 (83.9%) were early breastfeeding initiation, 139 (32.9%) were safe cord care, and 129 (30.6%) were thermal care (delay bathing) (Figure
Identified three composite newborn care practices separately by mothers with babies of one-month-old after delivery in the community of Hossana town, southwest Ethiopia, 2018.
In this study, education of the mothers, mothers who had practice handwashing, and knowledge of mothers on newborn care practice were significantly associated with newborn care practice.
Hence, those who had primary, secondary, and college and above educational status had three times (
Factors that are associated with newborn care practice of mothers with babies of one-month-old in Hossana town, southwest Ethiopia, 2018.
Variables ( | Good practice of NBC | Poor practice of NBC | AORs (95% CI) | |
---|---|---|---|---|
Education level | ||||
Primary | 46 (33.6%) | 91 (66.4%) | 2.801 (1.027-7.637) | 0.044 |
Secondary | 33 (29.5%) | 79 (70.5%) | 2.596 (0.921-7.316) | 0.071 |
College and above | 46 (35.7%) | 83 (64.3%) | 3.633 (1.056-12.492) | 0.041 |
No education | 6 (13.6%) | 38 (86.4%) | 1 | 1 |
Health education (hand wash) | ||||
Yes | 123 (33.3%) | 246 (66.7%) | 2.552 (1.092-5.963) | 0.030 |
No | 8 (15.1%) | 45 (84.9%) | 1 | 1 |
Mothers’ knowledge on newborn care practice | ||||
Good | 129 (35.4%) | 235 (64.6%) | 15.638 (3.599-67.943) | <0.001 |
Poor | 2 (3.4%) | 56 (96.6%) | 1 | 1 |
In this study, one-third of the participants had good newborn care practice based on three composite variables such as early breastfeeding initiation 83.9%, safe cord care 32.9%, and thermal care 30.6%.
Good newborn care practice was almost nearly similar to study done in Aksum Town, North Ethiopia (26.7%) [
Breastfeeding 83.9% which was higher than study done in Hoima District, western Uganda 31% dry cord care 60.5% [15], Mandura District, Northwest Ethiopia (48.1%) [
Safe cord care was 32.9% and similar to the study done in Hoima District, western Uganda (31%) [
Thermal care was 30.6% in this study and nearly similar to the study done in Aksum Town, North Ethiopia (32.6%) [
Knowledge of the mother on newborn care practice had a significant association with newborn care practice and similar to the study in Hoima District, western Uganda, Gulomekada District, Eastern Tigray, and Mekelle City, North Ethiopia [
Education of the mothers (primary, secondary, and college and above) also has a significant association with newborn care practice and was similar to the study done in Mandura District, Northwest Ethiopia, and Mekelle City, North Ethiopia [
Mothers who had health education on hygiene (hand) had a significant association with newborn care practice in this study, but no study was similar to this result.
In this study, almost one-third of the mothers had good newborn care practice and it was very low when compared with other studies done in the country. Mothers’ educational status, mothers who had health education on hygiene, and knowledge of mothers on newborn care practice were independent predictors of newborn care practice.
Based on the findings of this study, we recommend the following: Hadiya Zone Health Bureau: to work hard on the promotion of health facility delivery system and to increase the level of newborn care practice and involve health extension workers to apply home-to-home visit program to convince all childbearing women on the positive outcome of health facility delivery service to have good newborn care practice Health care providers: to provide ongoing education and counseling to mothers to give birth at a health facility to have good newborn care practice during ANC follow-up Health care planners: to provide health education during ANC and PNC regarding these predictors Future researcher: we suggest researchers to undertake repeatable studies in this area, and as this study lacks qualitative information that can underpin the quantitative study results, we recommend that the researcher have to do qualitative study design and other methods
The cross-sectional nature of the study is impossible to establish a temporal relationship between newborn care practice and identified risk factors.
Antenatal care
Central Statistical Agency
Ethiopian Demographic and Health Survey
Essential newborn care
Health extension worker
Infant and children feeding
Institutional Health Research Ethics Review Committee
Postnatal care
United States Agency for International Development
Village Development Communities.
The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.
Ethical clearance letters were obtained from the Institutional Health Research and Ethics Review Committee (IHRERC) of Haramaya University College of Health and Medical Science, and the letter was submitted to the Hadiya zone for permission.
Participants were informed clearly, and their consent was obtained, their confidentiality was maintained by giving code, personal privacy and cultural norms were respected, and the respondent had the right not to participate in the study or withdraw from the study at any time.
The authors declare that there is no competing interest.
The authors’ contribution to this study is conducting and preparing the manuscript.
First of all, we would like to thank Haramaya University College of Health Science and Medicine for providing this opportunity. Then, we would like to thank our study participants, data collectors, and supervisors.