Essential newborn care practices in Zambia

  • Journal of Public Health in Africa, Volume 13, No. 2, Year 2022

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Study Justification:
The study aimed to assess the adoption of essential newborn care (ENC) practices in Zambia in order to address the high neonatal mortality rate. The findings of the study provide valuable insights into the current practices and identify areas where improvements can be made to reduce neonatal mortality.
Highlights:
– 95.4% of babies were dried immediately after birth.
– 96.5% of babies were wrapped in a cloth or blanket.
– 76.7% of babies were put skin to skin on the mother’s torso.
– 68.5% of babies had their heads covered.
– 85.6% of baby’s cords were cut with a sharp and clean instrument.
– 46% of cords were kept dry.
– 42.1% of cords were kept clean.
– 96.9% of babies were breastfed.
– 89.3% of babies were breastfed within one hour.
– 93% of babies were exclusively breastfed for the first 3 days post-delivery.
Recommendations:
– Scale-up appropriate newborn care practices in Zambia, particularly focusing on improving thermal and cord care practices.
– Skilled birth attendance (SBA) should be promoted as it is associated with better newborn care practices.
– Increase the number of antenatal care (ANC) visits to improve cord care and breastfeeding practices.
– Provide support and education to mothers and caregivers on the importance of early and exclusive breastfeeding.
Key Role Players:
– Ministry of Health: Responsible for implementing and coordinating newborn care programs.
– Healthcare Providers: Including doctors, nurses, and midwives who play a crucial role in providing essential newborn care.
– Community Health Workers: They can educate and support mothers and caregivers in adopting appropriate newborn care practices.
– Non-Governmental Organizations (NGOs): Organizations working in the field of maternal and child health can contribute to implementing and scaling up newborn care interventions.
Cost Items for Planning Recommendations:
– Training and Capacity Building: Budget for training healthcare providers and community health workers on essential newborn care practices.
– Awareness and Education Campaigns: Allocate funds for campaigns to raise awareness among mothers, caregivers, and communities about the importance of newborn care practices.
– Equipment and Supplies: Budget for the procurement of necessary equipment and supplies for newborn care, such as clean instruments for cord cutting and warm blankets.
– Monitoring and Evaluation: Allocate resources for monitoring and evaluating the implementation and impact of newborn care interventions.
Please note that the cost items provided are general categories and not actual cost estimates. The actual budget will depend on the specific context and implementation plan.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on cross-sectional data and provides specific percentages for various essential newborn care practices in Zambia. However, the abstract does not mention the methodology used to collect the data, such as sampling techniques or data analysis methods. To improve the strength of the evidence, the abstract could include more details about the study design, sample size calculation, and statistical analysis methods used. Additionally, it would be helpful to provide information on the representativeness of the sample and any potential limitations of the study.

Neonatal mortality remains high in Zambia and is declining slower than infant and under five mortality. Improved adoption of essential newborn care (ENC) could help mitigate this situation. To determine the adoption of ENC practices in Zambia, cross-sectional data was used to assess ENC practices including baby kept warm, umbilical cord care and breastfeeding. Chi-square was used to assess whether maternal and social demographic factors were related to ENC. Households surveyed were 12,507, which included 5,741 women with children under two years. Findings show that 95.4% of babies were dried immediately after birth, 96.5% wrapped in a cloth/blanket, 76.7% put on mother’s torso and 68.5% head covered (51.6% for all four). Eighty-five-point six percent of baby’s cords were cut with a sharp and clean instrument, 46% cord kept dry and 42.1% cord kept clean (31.2% for all three). Ninety-six-point nine percent of babies were breastfed, 89.3% were initiated within one hour and 93% exclusively breastfed for the first 3 days post-delivery (82% for all three). Babies kept warm were associated with skilled birth attendance (SBA) and province, umbilical cord care with SBA, >4 antenatal care (ANC) visits, marital status and province, and breastfeeding with >4 ANC visits, marital status and province. Early and exclusive breastfeeding is widely prac-ticed. However, appropriate thermal and cord care practices are low. There is need for a scale-up of appropriate newborn care practices in Zambia and SBA could play an important role in this regard.

Ethical clearance for the multi-sectoral end of program evaluation was obtained from the Zambia ERES Converge Ethics Committee (reference number 2021-April- 008). Informed consent was obtained from respondents, and confidentiality was maintained throughout the evaluation. Personal identifiers such as names were removed and the data stored safely with only authorised persons allowed access to it. The study used a cross-sectional design to evaluate a multi-sectoral end of program evaluation in Zambia. The study used data collected for an evaluation of 28 Area Programs (APs) implemented by World Vision Zambia between 2016 and 2021 and which are predominantly in rural areas. The programs implemented in the APs included Health and Nutrition, Livelihoods, Education and Water, Sanitation and Hygiene and covered 28 districts. The specific APs evaluated included Buyantashi in Luwingu/Lupososhi District, Bwacha in Mungwi District, Chikomeni in Lundazi/Lumezi District, Chipapa in Kafue District, Chongwe East in Rufunsa District, Chongwe South and Kapuluwe in Chongwe District, Choongo in Monze District, Hamaundu and Moyo in Pemba District, Kawaza in Katete District, Lunga in Mwinlunga District, Luswepo and Suwila in Isoka District, Magoye in Mazabuka District, Makungwa in Kasenengwa District, Manyinga in Manyinga District, Mbala in Mbala/Senga Hill District, Mbeza in Namwala District, Mporokoso in Mporokoso District, Muchila in Namwala District, Mudanyama in Mwinlunga District, Mufumbwe in Mufumbwe District, Musosolokwe in Kapiri Mposhi District, Mwamba in Kasama District, Nkeyema in Nkeyema District, Nyimba in Nyimba District, Sinazongwe in Sinazongwe District, Twachiyanda in Kalomo District, Twikatane in Mungwi District and Keembe in Chibombo District. Data collection was done by the University of Zambia, Institute of Economic and Social Research who were contracted by World Vision Zambia. The collection of data was done between April and June, 2021, using World Visions Caregiver Survey questionnaire for program evaluations first published in 20138 and revised in 2020 with adaptations made to suit the Zambia context. Data was collected using mobile phones, cleaned and then uploaded into the server. The broad target population of the evaluation consisted of parents/caregivers of children aged 3-6 years, mothers or caregivers of children under five years and women aged 18 to 49 years and pregnant women. The specific target population for this study was mothers of children aged 0-23 months. Information on ANC, delivery and ENC was based on the mother’s reports. The sample size was calculated using the World Vision sample size calculator available in the Baseline Field Guide.9 The sample size was calculated with the statistical power to detect change set at 0.84, a design effect of 2, with the default probability of committing a Type-1 error set at 1.96. The minimum sample size required in order to detect statistically significant differences between proportions between 2 survey domains at AP level was 358 giving a total of 11,098 for all the 31 APs. A two-stage cluster sampling was used to select sample households to be interviewed. All the APs and their respective zones were included within the sample. The first stage of sampling entailed random selection of villages from zones; however, Probability Proportion to Size (PPS) Zones was used to ensure larger villages and zones contributed more households compared to smaller ones. The zones included were selected by first listing all zones alphabetically and then using systematic random sampling to choose the ones to be included. In the second stage, households were selected using the random walk method starting from the centre of the village. Cleaned data in the server was exported to SPSS version 25, which was used for the analysis. The ENC characteristics of interest included 1. Baby kept warm, which had four sub-components (i) whether the baby was dried immediately after birth (ii) baby wrapped in a warm cloth or blanket (iii) baby put skin to skin on mother’s torso and (iv) baby’s head covered. 2. Umbilical cord care, which had three sub-components (i) umbilical cord cut with a sharp and clean instrument, (ii) umbilical cord kept dry and (iii) umbilical cord kept clean. 3. Breastfeeding, which consisted of three components (i) breastfed at all (ii) breastfed within the first hour and (iii) breastfed within the first three days. These ENC practices were compared across social and demographic strata to see if there were any differences. Weighting was done during the analysis to adjust for the uniform sample sizes used at the AP level as opposed to proportions based on population size.

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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health in Zambia:

1. Mobile Health (mHealth) Solutions: Develop and implement mobile applications or text messaging services to provide pregnant women and new mothers with information and reminders about essential newborn care practices, including keeping babies warm, umbilical cord care, and breastfeeding. These mHealth solutions can also provide access to teleconsultations with healthcare professionals for guidance and support.

2. Community Health Workers (CHWs): Train and deploy CHWs in rural areas to educate and support pregnant women and new mothers in adopting essential newborn care practices. CHWs can conduct home visits, provide demonstrations, and offer personalized guidance to improve maternal and newborn health outcomes.

3. Maternal Health Education Programs: Develop and implement comprehensive maternal health education programs that target women of reproductive age, their families, and communities. These programs can raise awareness about the importance of essential newborn care practices and provide information on how to implement them effectively.

4. Strengthening Skilled Birth Attendance (SBA): Focus on increasing the availability and accessibility of skilled birth attendants in both rural and urban areas. This can be achieved by training and deploying more midwives and other healthcare professionals, improving infrastructure and equipment in health facilities, and promoting the utilization of maternity services.

5. Integration of Maternal and Child Health Services: Ensure that maternal health services are integrated with other essential healthcare services, such as immunization programs and family planning services. This integration can improve access to comprehensive care for mothers and their newborns, leading to better health outcomes.

6. Quality Improvement Initiatives: Implement quality improvement initiatives in healthcare facilities to ensure that essential newborn care practices are consistently and effectively provided. This can involve regular training and supervision of healthcare providers, the establishment of standardized protocols and guidelines, and the use of quality indicators to monitor and evaluate the delivery of care.

7. Community Engagement and Empowerment: Engage communities and empower women and families to actively participate in decision-making regarding maternal and newborn health. This can be achieved through community dialogues, women’s support groups, and the involvement of community leaders and traditional birth attendants in promoting essential newborn care practices.

It is important to note that the implementation of these innovations should be context-specific and tailored to the needs and resources of the Zambian healthcare system.
AI Innovations Description
Based on the description provided, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Implement a comprehensive newborn care program: Develop and implement a program that focuses on promoting essential newborn care practices in Zambia. This program should include training healthcare providers, community health workers, and caregivers on the importance of practices such as immediate drying of the baby after birth, wrapping the baby in a warm cloth or blanket, skin-to-skin contact with the mother, and keeping the baby’s head covered. Emphasize the use of clean and sharp instruments for cutting the umbilical cord, keeping the cord dry and clean, and promoting early and exclusive breastfeeding.

2. Strengthen skilled birth attendance (SBA): Enhance the availability and accessibility of skilled birth attendants in Zambia. Skilled birth attendants play a crucial role in ensuring that essential newborn care practices are followed during childbirth. This can be achieved by training and deploying more skilled birth attendants, particularly in rural areas where access to healthcare services is limited.

3. Increase antenatal care (ANC) visits: Promote the importance of ANC visits among pregnant women in Zambia. ANC visits provide an opportunity to educate women about essential newborn care practices, including breastfeeding and umbilical cord care. Encourage pregnant women to attend at least four ANC visits to receive comprehensive information and support for newborn care.

4. Raise awareness and education: Conduct community awareness campaigns to educate caregivers, families, and communities about the importance of essential newborn care practices. Utilize various communication channels, such as radio, television, community meetings, and mobile technology, to disseminate information and promote behavior change.

5. Strengthen healthcare infrastructure: Improve the availability and quality of healthcare facilities, particularly in rural areas. This includes ensuring the availability of clean and safe delivery environments, essential supplies and equipment for newborn care, and skilled healthcare providers who can provide appropriate guidance and support to mothers and caregivers.

6. Monitor and evaluate progress: Establish a robust monitoring and evaluation system to track the implementation and impact of the newborn care program. Regularly assess the adoption of essential newborn care practices, identify barriers and challenges, and make necessary adjustments to improve access and effectiveness.

By implementing these recommendations, it is expected that access to maternal health and the adoption of essential newborn care practices will improve in Zambia, leading to a reduction in neonatal mortality rates.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Strengthen Skilled Birth Attendance (SBA) Services: Increase the availability and accessibility of skilled birth attendants in healthcare facilities, especially in rural areas. This can be achieved by training and deploying more midwives and other healthcare professionals to provide quality maternal care during childbirth.

2. Enhance Antenatal Care (ANC) Services: Improve the quality and coverage of ANC services by promoting early and regular ANC visits. This can be done through community outreach programs, education campaigns, and incentivizing pregnant women to seek ANC services.

3. Promote Essential Newborn Care (ENC) Practices: Increase awareness and education about essential newborn care practices, including keeping the baby warm, proper umbilical cord care, and early initiation of breastfeeding. This can be achieved through community-based interventions, antenatal classes, and the involvement of community health workers.

4. Strengthen Health Systems: Invest in improving healthcare infrastructure, equipment, and supplies to ensure that healthcare facilities are well-equipped to provide quality maternal and newborn care. This includes ensuring the availability of essential drugs, equipment for safe deliveries, and proper infection prevention and control measures.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that reflect access to maternal health, such as the percentage of women receiving skilled birth attendance, the percentage of women attending ANC visits, and the percentage of newborns receiving essential newborn care practices.

2. Collect baseline data: Gather baseline data on the selected indicators from a representative sample of the target population. This can be done through surveys, interviews, or data collection from healthcare facilities and community health workers.

3. Develop a simulation model: Create a simulation model that incorporates the identified recommendations and their potential impact on the selected indicators. The model should consider factors such as population size, geographical distribution, healthcare infrastructure, and resources available.

4. Input data and run simulations: Input the baseline data into the simulation model and run multiple simulations to estimate the potential impact of the recommendations on the selected indicators. The simulations can be based on different scenarios, such as varying levels of implementation of the recommendations or different population groups.

5. Analyze results: Analyze the simulation results to assess the potential impact of the recommendations on improving access to maternal health. This can include estimating changes in the selected indicators, identifying key factors influencing the outcomes, and evaluating the cost-effectiveness of the recommendations.

6. Refine and validate the model: Refine the simulation model based on the analysis of the results and validate it using additional data or expert input. This will help ensure the accuracy and reliability of the simulation results.

7. Communicate findings and recommendations: Present the simulation findings and recommendations to relevant stakeholders, such as policymakers, healthcare providers, and community leaders. This can help inform decision-making and guide the implementation of interventions to improve access to maternal health.

It is important to note that the methodology described above is a general framework and can be adapted based on the specific context and available data.

Statistics:
Authors: 4
Identifiers:
DOI: 10.4081/jphia.2022.2078
ISSN: 20389922
Research Areas:
Environmental, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Zambia
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Female
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