Factors associated with adoption of beneficial newborn care practices in rural Eastern Uganda: A cross-sectional study

BMC Pregnancy and Childbirth, Volume 16, No. 1, Year 2016

Interpretação

Background: Beneficial newborn care practices can improve newborn survival. However, little is known about the factors that affect adoption of these practices. Methods: Cross-sectional study conducted among 1,616 mothers who had delivered in the past year in two health sub-districts (Luuka and Buyende) in Eastern Uganda. Data collection took place between November and December 2011. Data were collected on socio-demographic and economic characteristics, antenatal care visits, skilled delivery attendance, parity, distance to health facility and early newborn care knowledge and practices. Descriptive statistics were computed to determine the proportion of mothers who adopted beneficial newborn care practices (optimal thermal care; good feeding practices; weighing and immunizing the baby immediately after birth; and good cord care) during the neonatal period. We conducted multivariable logistic regression to assess the covariates of adoption of all beneficial newborn care practices. Analysis was done using STATA statistical software, version 12.1. Results: Of the 1,616 mothers enrolled, 622 (38.5 %) were aged 25-34; 1,472 (91.1 %) were married; 1,096 (67.8 %) had primary education; while 1,357 (84 %) were laborers or peasants. Utilization of all beneficial newborn care practices was 11.7 %; lower in Luuka (9.4 %, n = 797) than in Buyende health sub-district (13.9 %, n = 819; p = 0.005). Good cord care (83.6 % in Luuka; 95 % in Buyende) and immunization of newborn (80.7 % in Luuka; 82.5 % in Buyende) were the most prevalent newborn care practices reported by mothers. At the multivariable analysis, number of ANC visits (3-4 vs. 1-2: Adjusted (Adj.) Odds Ratio (OR) = 1.69, 95 % CI = 1.13, 2.52), skilled delivery (Adj. OR = 2.66, 95 % CI = 1.92, 3.69), socio-economic status (middle vs. low: Adj. OR = 1.57, 95 % CI = 1.09, 2.26) were positively associated with adoption of all beneficial newborn care practices among mothers. Conclusion: Adoption of all beneficial newborn care practices was low, although associated with higher ANC visits; middle-level socio-economic status and skilled delivery attendance. These findings suggest a need for interventions to improve quality ANC and skilled delivery attendance as well as targeting of women with low and high socio-economic status with newborn care health educational messages, improved work conditions for breastfeeding, and supportive policies at national level for uptake of newborn care practices. This was a cross-sectional household baseline study conducted among 1,616 mothers in two rural health sub-districts of Buyende and Luuka in Eastern Uganda. Both Buyende and Luuka health sub-districts are within Buyende and Luuka districts respectively, which are part of Busoga region contributing 10 % of the population of Uganda. Over 80 % of the population are peasants and live on less than US$1 a day. The crude birth rate in both districts (Buyende and Luuka) averages that of the country at 42 live births per 1,000 populations [3, 38]. Household interviews were conducted between November and December 2011. Mothers, who provided written informed consent, had given birth in the last 1 year, and had live babies, were exhaustively recruited. We excluded those who had stillbirths or whose babies died prior to interview to minimize the social consequences associated with asking mothers about babies that died immediately after birth. Buyende and Luuka are two of the control health sub-districts in Eastern Uganda where The Maternal Newborn Study (MANEST) was implemented. MANEST was a quasi-experimental 30 months study that started July 2011 and ended December 2013. The goal of the study was to learn how to integrate and scale-up interventions aimed at increasing access to institutional deliveries and care of complications through vouchers, and improving newborn care and uptake of Prevention of Mother to Child transmission of HIV (PMTCT) through home visits by community health workers, within the existing health system in Uganda. As part of the baseline assessment, to inform the final design of the intervention, data were collected among 1616 mothers in both health sub-districts who met the eligibility criteria i.e. had given birth in the last 1 year and had provided written informed consent and live babies. Data were collected using paper-based questionnaires by trained research assistants. The quality assurance of data was ensured through daily assessment via questionnaires filled-in by a supervisor; in cases of error or incompleteness of data, corrective measures were implemented immediately i.e. mothers were re-visited to ascertain correctness of the data, except for data they could not recall. The primary outcome was the proportion of women who reported that they adopted beneficial newborn care (NBC) practices. Beneficial NBC practices were grouped into five categories: (i) Optimal thermal care defined as: newborn after birth, was first dried, put skin-to-skin on mothers chest, wrapped in clean dry clothing and delayed bathe (after 24 h or more), (ii) Good cord care defined as: type of instrument used to cut the cord (such as a brand new razor blade, surgical blade or sterilized pair of scissors), type of material used to tie the cord (clean thread), and no medicinal substance (local or not local) put on the cord), (iii) Good feeding practices defined as: initiating breastfeeding within the first 1 h after birth and exclusively breastfeeding in the first month of life, (iv) Weighing the baby immediately after birth, and (v) immunization (if the baby was given oral polio vaccine (OPV) and/or BCG after birth). These NBC practices were further combined into an index of all beneficial NBC practices, which was dichotomized as (“Yes = 1”, if the mother practiced all the beneficial newborn care practices and “No = 0”, if the mother practiced none or just a few). Age distribution was checked for normality and found to be skewed (to the right). We then categorized age as follows: ≤24 (less than or equal to twenty-four years), 25–34 (Twenty-five to thirty-four years) and 35+ (Thirty-five years and above). Parity (number of pregnancies carried beyond 28 weeks) of mother was grouped into 1, 2-4 and 5+, while Trimester at first ANC was categorized according to weeks of gestation when the mother had her first ANC visit as follows: trimester 1 < 13 weeks, trimester 2 = 14–26 weeks and trimester 3 = 27–40 weeks. Number of ANC visits was categorized into 1-2, 3-4, and 5+. Distance to health facility where mother delivered was categorized into (< or =5 km, >5 km and not known). The other variables i.e. Marital Status, education level, occupation, husband’s education, skilled delivery (delivery by midwife, doctor clinical officer or nurse at a facility), delivery mode, ANC visit, were left intact. To generate household socio-economic status (SES), we considered the following variables: floor material, roof material, wall material, fuel used for cooking, source of light and other household possessions (i.e. radio, type of bed, table refrigerator, television set, sound cassette player, and telephone), agricultural land, and farm animals (chicken, goats, cows, pigs, sheep). These variables were screened for relevance and reliability using Cronbach’s alpha (which was found to be 0.628) and acceptable [39]. The final list of variables included agricultural land, type of floor material, type of roof material, wall material, fuel used for cooking, and source of light. We performed Principal Component Analysis (PCA), scored the first principal component, and used it to generate an asset index. The asset index was then used to group all households into wealth quartiles; i.e., <25 % = Lowest, 25–50 % = Low, 50–75 % = Middle and >75 % = High socio-economic status) [40]. We merged the ‘lowest’ and ‘low’ quartiles into “low” because lowest had very few values while “middle” and “high” were left intact. This resulted in three socio-economic status levels, namely: low, middle and high, as presented in the Tables. We computed descriptive statistics to determine the proportion of mothers who adopted beneficial newborn care practices separately for each health sub-district and conducted bivariate analyses using Pearson chi2 test to assess the association between adoption of beneficial newborn care practice and mothers socio-demographic and other characteristics. Before inclusion in the model, we assessed for collinearity of the explanatory variables and there were none. All variables with a p-value less than 0.1 (p < 0.1) at the bivariate analysis were included in the multivariable analysis. We then conducted multivariable logistic regression analyses using the likelihood ratio test to assess the covariates of a mother adopting all beneficial newborn care practices after adjusting for number of ANC visits, skilled delivery, husband’s education status, education; occupation, delivery mode, trimester at first ANC visit, socio-economic status, and health sub-district. Missing values accounting for 2 % in the final model were excluded from the analysis. A p-value less than 0.05 (p < 0.05) was considered significant at the multivariable analysis. While we intended to run separate multivariable regression models for each health sub-district, we were not able to do this due to the limited number of women reporting adoption of all the beneficial newborn care practices in each health sub-district. In order to account for the differences in adoption of beneficial newborn care practices between the two health sub-districts, we controlled for health sub-district of residence in the adjusted analysis. The Hosmer and Lemeshow’s goodness-of-fit test was used to assess how the final multivariable model fit the data and was found to be 0.896, 8 d.f, p = 0.35, which was satisfactory. We estimate that this study had a post-hoc statistical power of 81 % to detect an odds ratio of 0.64 as significant at an alpha-level of 0.05 when comparing adoption of all beneficial newborn care practices between the two health sub-districts. Data were analyzed using STATA version 12.1. Makerere University School of Public Health Institutional Review Board approved the study. Written Informed consent was sought from study participants after reading to them and adequately explaining to them the aim of the study. Participants were informed of their right to withdraw from the study at any stage of the interview.

AI Digest

Study Justification:

This study aimed to investigate the factors associated with the adoption of beneficial newborn care practices in rural Eastern Uganda. The study is important because beneficial newborn care practices can improve newborn survival. However, there is limited knowledge about the factors that affect the adoption of these practices. Understanding these factors can help inform interventions and policies to improve newborn care practices and ultimately reduce newborn mortality.

Study Highlights:

– The study was conducted among 1,616 mothers in two rural health sub-districts in Eastern Uganda.
– The study found that the adoption of all beneficial newborn care practices was low, with only 11.7% of mothers practicing these behaviors.
– Factors positively associated with the adoption of beneficial newborn care practices included the number of antenatal care visits, skilled delivery attendance, and middle-level socio-economic status.
– The most prevalent newborn care practices reported by mothers were good cord care and immunization of the newborn.
– The study suggests a need for interventions to improve the quality of antenatal care and skilled delivery attendance, as well as targeting women with low and high socio-economic status with newborn care health educational messages.
– Supportive policies at the national level are also recommended to promote the uptake of newborn care practices.

Recommendations for Lay Reader:

– The study found that the adoption of beneficial newborn care practices in rural Eastern Uganda is low.
– Factors such as the number of antenatal care visits, skilled delivery attendance, and socio-economic status were found to be associated with the adoption of these practices.
– It is important to improve the quality of antenatal care and skilled delivery attendance to promote the adoption of beneficial newborn care practices.
– Women with low and high socio-economic status should be targeted with newborn care health educational messages.
– Supportive policies at the national level are needed to encourage the uptake of newborn care practices.

Recommendations for Policy Maker:

– The study highlights the need to improve the adoption of beneficial newborn care practices in rural Eastern Uganda.
– Interventions should focus on improving the quality of antenatal care and skilled delivery attendance.
– Targeted health educational messages should be developed for women with low and high socio-economic status.
– Supportive policies at the national level should be implemented to promote the uptake of newborn care practices.
– Collaboration between healthcare providers, community health workers, and policymakers is crucial for the successful implementation of these interventions.

Key Role Players:

– Healthcare providers: They play a vital role in providing quality antenatal care and skilled delivery attendance.
– Community health workers: They can deliver health educational messages to women with low and high socio-economic status.
– Policymakers: They are responsible for implementing supportive policies at the national level.

Cost Items for Planning Recommendations:

– Training and capacity building for healthcare providers and community health workers.
– Development and dissemination of health educational materials.
– Monitoring and evaluation of interventions.
– Advocacy and policy development at the national level.

Força da prova

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study design is cross-sectional, which limits the ability to establish causality. Additionally, the sample size is relatively small, which may affect the generalizability of the findings. To improve the evidence, future studies could consider using a longitudinal design to establish causality and increase the sample size to improve generalizability.

Resumo

This was a cross-sectional household baseline study conducted among 1,616 mothers in two rural health sub-districts of Buyende and Luuka in Eastern Uganda. Both Buyende and Luuka health sub-districts are within Buyende and Luuka districts respectively, which are part of Busoga region contributing 10 % of the population of Uganda. Over 80 % of the population are peasants and live on less than US$1 a day. The crude birth rate in both districts (Buyende and Luuka) averages that of the country at 42 live births per 1,000 populations [3, 38]. Household interviews were conducted between November and December 2011. Mothers, who provided written informed consent, had given birth in the last 1 year, and had live babies, were exhaustively recruited. We excluded those who had stillbirths or whose babies died prior to interview to minimize the social consequences associated with asking mothers about babies that died immediately after birth. Buyende and Luuka are two of the control health sub-districts in Eastern Uganda where The Maternal Newborn Study (MANEST) was implemented. MANEST was a quasi-experimental 30 months study that started July 2011 and ended December 2013. The goal of the study was to learn how to integrate and scale-up interventions aimed at increasing access to institutional deliveries and care of complications through vouchers, and improving newborn care and uptake of Prevention of Mother to Child transmission of HIV (PMTCT) through home visits by community health workers, within the existing health system in Uganda. As part of the baseline assessment, to inform the final design of the intervention, data were collected among 1616 mothers in both health sub-districts who met the eligibility criteria i.e. had given birth in the last 1 year and had provided written informed consent and live babies. Data were collected using paper-based questionnaires by trained research assistants. The quality assurance of data was ensured through daily assessment via questionnaires filled-in by a supervisor; in cases of error or incompleteness of data, corrective measures were implemented immediately i.e. mothers were re-visited to ascertain correctness of the data, except for data they could not recall. The primary outcome was the proportion of women who reported that they adopted beneficial newborn care (NBC) practices. Beneficial NBC practices were grouped into five categories: (i) Optimal thermal care defined as: newborn after birth, was first dried, put skin-to-skin on mothers chest, wrapped in clean dry clothing and delayed bathe (after 24 h or more), (ii) Good cord care defined as: type of instrument used to cut the cord (such as a brand new razor blade, surgical blade or sterilized pair of scissors), type of material used to tie the cord (clean thread), and no medicinal substance (local or not local) put on the cord), (iii) Good feeding practices defined as: initiating breastfeeding within the first 1 h after birth and exclusively breastfeeding in the first month of life, (iv) Weighing the baby immediately after birth, and (v) immunization (if the baby was given oral polio vaccine (OPV) and/or BCG after birth). These NBC practices were further combined into an index of all beneficial NBC practices, which was dichotomized as (“Yes = 1”, if the mother practiced all the beneficial newborn care practices and “No = 0”, if the mother practiced none or just a few). Age distribution was checked for normality and found to be skewed (to the right). We then categorized age as follows: ≤24 (less than or equal to twenty-four years), 25–34 (Twenty-five to thirty-four years) and 35+ (Thirty-five years and above). Parity (number of pregnancies carried beyond 28 weeks) of mother was grouped into 1, 2-4 and 5+, while Trimester at first ANC was categorized according to weeks of gestation when the mother had her first ANC visit as follows: trimester 1 < 13 weeks, trimester 2 = 14–26 weeks and trimester 3 = 27–40 weeks. Number of ANC visits was categorized into 1-2, 3-4, and 5+. Distance to health facility where mother delivered was categorized into (5 km and not known). The other variables i.e. Marital Status, education level, occupation, husband’s education, skilled delivery (delivery by midwife, doctor clinical officer or nurse at a facility), delivery mode, ANC visit, were left intact. To generate household socio-economic status (SES), we considered the following variables: floor material, roof material, wall material, fuel used for cooking, source of light and other household possessions (i.e. radio, type of bed, table refrigerator, television set, sound cassette player, and telephone), agricultural land, and farm animals (chicken, goats, cows, pigs, sheep). These variables were screened for relevance and reliability using Cronbach’s alpha (which was found to be 0.628) and acceptable [39]. The final list of variables included agricultural land, type of floor material, type of roof material, wall material, fuel used for cooking, and source of light. We performed Principal Component Analysis (PCA), scored the first principal component, and used it to generate an asset index. The asset index was then used to group all households into wealth quartiles; i.e., 75 % = High socio-economic status) [40]. We merged the ‘lowest’ and ‘low’ quartiles into “low” because lowest had very few values while “middle” and “high” were left intact. This resulted in three socio-economic status levels, namely: low, middle and high, as presented in the Tables. We computed descriptive statistics to determine the proportion of mothers who adopted beneficial newborn care practices separately for each health sub-district and conducted bivariate analyses using Pearson chi2 test to assess the association between adoption of beneficial newborn care practice and mothers socio-demographic and other characteristics. Before inclusion in the model, we assessed for collinearity of the explanatory variables and there were none. All variables with a p-value less than 0.1 (p < 0.1) at the bivariate analysis were included in the multivariable analysis. We then conducted multivariable logistic regression analyses using the likelihood ratio test to assess the covariates of a mother adopting all beneficial newborn care practices after adjusting for number of ANC visits, skilled delivery, husband’s education status, education; occupation, delivery mode, trimester at first ANC visit, socio-economic status, and health sub-district. Missing values accounting for 2 % in the final model were excluded from the analysis. A p-value less than 0.05 (p < 0.05) was considered significant at the multivariable analysis. While we intended to run separate multivariable regression models for each health sub-district, we were not able to do this due to the limited number of women reporting adoption of all the beneficial newborn care practices in each health sub-district. In order to account for the differences in adoption of beneficial newborn care practices between the two health sub-districts, we controlled for health sub-district of residence in the adjusted analysis. The Hosmer and Lemeshow’s goodness-of-fit test was used to assess how the final multivariable model fit the data and was found to be 0.896, 8 d.f, p = 0.35, which was satisfactory. We estimate that this study had a post-hoc statistical power of 81 % to detect an odds ratio of 0.64 as significant at an alpha-level of 0.05 when comparing adoption of all beneficial newborn care practices between the two health sub-districts. Data were analyzed using STATA version 12.1. Makerere University School of Public Health Institutional Review Board approved the study. Written Informed consent was sought from study participants after reading to them and adequately explaining to them the aim of the study. Participants were informed of their right to withdraw from the study at any stage of the interview.

Materiais

N/A

Inovações

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and reminders about antenatal care visits, skilled delivery attendance, and newborn care practices. These apps can also provide access to telemedicine services for remote consultations with healthcare professionals.

2. Community Health Workers: Train and deploy community health workers to provide education and support to pregnant women and new mothers in rural areas. These workers can provide information on beneficial newborn care practices, assist with antenatal care visits, and promote skilled delivery attendance.

3. Voucher Programs: Implement voucher programs that provide financial assistance for pregnant women to access skilled delivery services and essential maternal health supplies. This can help reduce financial barriers and increase the utilization of skilled delivery services.

4. Health Education Campaigns: Conduct targeted health education campaigns to raise awareness about the importance of antenatal care visits, skilled delivery attendance, and beneficial newborn care practices. These campaigns can use various communication channels, such as radio, community meetings, and posters, to reach women in rural areas.

5. Improving Infrastructure: Invest in improving the infrastructure of healthcare facilities in rural areas, including maternity wards and delivery rooms. This can help ensure that women have access to safe and hygienic delivery environments.

6. Strengthening Health Systems: Implement strategies to strengthen the overall health system, including training healthcare providers on maternal health best practices, ensuring the availability of essential medicines and supplies, and improving the referral system for complicated cases.

These innovations can help address the barriers to accessing maternal health services in rural areas and improve the adoption of beneficial newborn care practices.

AI Innovations Description

The recommendation to improve access to maternal health based on the study is to implement interventions that focus on improving the quality of antenatal care (ANC) and skilled delivery attendance, as well as targeting women with low and high socio-economic status with newborn care health educational messages.

Specifically, the study found that higher number of ANC visits, skilled delivery attendance, and middle-level socio-economic status were positively associated with the adoption of beneficial newborn care practices. Therefore, efforts should be made to increase the number of ANC visits and promote skilled delivery attendance among pregnant women. This can be achieved through community awareness campaigns, providing incentives for ANC visits, and improving the availability and quality of skilled delivery services.

Additionally, the study suggests targeting women with low and high socio-economic status with newborn care health educational messages. This can be done through community health workers or other healthcare providers who can provide information and support to these women. The messages should focus on promoting optimal thermal care, good feeding practices, weighing and immunizing the baby immediately after birth, and good cord care.

Furthermore, the study highlights the need for supportive policies at the national level to encourage the uptake of newborn care practices. These policies can include provisions for breastfeeding support in the workplace, ensuring access to clean and safe delivery supplies, and promoting the importance of early newborn care practices.

Overall, by implementing these recommendations, it is expected that access to maternal health will be improved, leading to better health outcomes for both mothers and newborns.

AI Innovations Methodology

Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Increase the number of antenatal care (ANC) visits: Encourage pregnant women to attend more ANC visits by providing incentives, such as free transportation or small rewards, and by raising awareness about the importance of regular check-ups for both the mother and the baby.

2. Improve skilled delivery attendance: Ensure that skilled healthcare professionals, such as midwives, doctors, and nurses, are available during childbirth to provide safe and effective care. This can be achieved by training and deploying more skilled birth attendants in rural areas, as well as by improving the infrastructure and resources in health facilities.

3. Enhance socio-economic status: Implement interventions to improve the socio-economic status of women, particularly those with low income. This can include providing financial support, vocational training, and income-generating opportunities to empower women and enable them to access better healthcare services.

4. Strengthen health education on newborn care: Develop and implement comprehensive health education programs that focus on promoting beneficial newborn care practices. This can include educating mothers and their families about optimal thermal care, good feeding practices, weighing and immunizing the baby immediately after birth, and good cord care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as the proportion of women attending a certain number of ANC visits, the percentage of births attended by skilled birth attendants, or the adoption of beneficial newborn care practices.

2. Collect baseline data: Conduct a survey or gather existing data to establish the current status of the indicators in the target population. This can involve interviewing a representative sample of women and collecting information on their socio-demographic characteristics, healthcare utilization, and newborn care practices.

3. Introduce the recommendations: Implement the recommended interventions, such as increasing ANC visits, improving skilled delivery attendance, enhancing socio-economic status, and strengthening health education on newborn care.

4. Monitor and evaluate: Continuously monitor the implementation of the interventions and collect data on the indicators of access to maternal health. This can involve conducting follow-up surveys or using existing data sources, such as health facility records or population-based surveys.

5. Analyze the data: Use statistical analysis software, such as STATA, to analyze the collected data and assess the impact of the interventions on the indicators of access to maternal health. This can involve comparing the baseline data with the post-intervention data to determine any changes or improvements.

6. Interpret the findings: Interpret the results of the analysis to understand the effectiveness of the recommendations in improving access to maternal health. Identify any significant changes in the indicators and assess the overall impact of the interventions.

7. Adjust and refine: Based on the findings, make any necessary adjustments or refinements to the interventions to further improve access to maternal health. This can involve scaling up successful interventions, addressing any challenges or barriers identified during the evaluation, and continuously monitoring and evaluating the impact of the interventions over time.

Autores & Coautores

Statistics:

Citations: 15

Authors: 5

Identifiers:

DOI: 10.1186/s12884-016-0874-3

Research Areas:

Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce

Study Countries:

Uganda

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory, Quasi Experimental Study, randomised-control-trial

Study Approach:

Quantitative

Participants Gender:

Female

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