Prevalence and determinants of essential newborn care practices in the Lawra District of Ghana

BMC Pediatrics, Volume 18, No. 1, Year 2018

Interpretação

Background: There was less than satisfactory progress, especially in sub-Saharan Africa, towards child and maternal mortality targets of Millennium Development Goals (MDGs) 4 and 5. The main aim of this study was to describe the prevalence and determinants of essential new newborn care practices in the Lawra District of Ghana. Methods: A cross-sectional study was carried out in June 2014 on a sample of 422 lactating mothers and their children aged between 1 and 12 months. A systematic random sampling technique was used to select the study participants who attended post-natal clinic in the Lawra district hospital. Results: Of the 418 newborns, only 36.8% (154) was judged to have had safe cord care, 34.9% (146) optimal thermal care, and 73.7% (308) were considered to have had adequate neonatal feeding. The overall prevalence of adequate new born care comprising good cord care, optimal thermal care and good neonatal feeding practices was only 15.8%. Mothers who attained at least Senior High Secondary School were 20.5 times more likely to provide optimal thermal care [AOR 22.54; 95% CI (2.60-162.12)], compared to women had no formal education at all. Women who received adequate ANC services were 4.0 times (AOR = 4.04 [CI: 1.53, 10.66]) and 1.9 times (AOR = 1.90 [CI: 1.01, 3.61]) more likely to provide safe cord care and good neonatal feeding as compared to their counterparts who did not get adequate ANC. However, adequate ANC services was unrelated to optimal thermal care. Compared to women who delivered at home, women who delivered their index baby in a health facility were 5.6 times more likely of having safe cord care for their babies (AOR = 5.60, Cl: 1.19-23.30), p = 0.03. Conclusions: The coverage of essential newborn care practices was generally low. Essential newborn care practices were positively associated with high maternal educational attainment, adequate utilization of antenatal care services and high maternal knowledge of newborn danger signs. Therefore, greater improvement in essential newborn care practices could be attained through proven low-cost interventions such as effective ANC services, health and nutrition education that should span from community to health facility levels. The study was carried out in the Lawra District hospital. The Lawra District lies in the North-West corner of the upper West Region of Ghana. The total area of the District is 1051.2 km2. The District has two hospitals located in Lawra and Nandom. They provide clinical and public health services as well as serve as a referral centres for the sub-districts. There are 10 sub-districts which provide primary health care services. Apart from agriculture, which engages about 80% of the population, there are small scale enterprises such as petty trading, artisanal works, small-scale industry enterprises, hotel/restaurants/chop bar and transport services. There are also those employed as public servants, although wages are low. The dominant economic activity is agriculture which does not yield the required returns necessary for meaningful standards of living. The result is wide spread poverty among the people with severe impact on women and children. A cross-sectional study was carried out in June 2014 on a sample of 422 lactating mothers and their children. The primary study population comprised women of reproductive age (15 to 49 years) who have delivered a live baby within the past 12 months prior to the conduct of this study. The 12-month limit was set with the intention of mitigating recall bias by the mother. A systematic random sampling technique was used to select the study participants who attended post-natal clinic in the Lawra District Hospital. The list of mothers contained in the attendance register for mothers who sought post-natal care served as the sampling frame. A sampling interval was calculated by dividing the total number of mothers (800) by the required sample size of 422. A random number between 1 and the sampling interval was selected to be the starting point of the sample extraction. Subsequently, the study participants were selected by adding the sampling interval to the number corresponding to the previous mother chosen on the list. This process was continued until the required number was obtained. A sample size of 384 was required to ensure that the estimated prevalence of the main outcome variable (coverage of essential new born care practices) was within plus or minus 5% of the true prevalence at 95% confidence level. An additional 10% to adjust for unexpected events (e.g. damaged/incomplete questionnaire) was factored in the sample size determination and so the sample size was 422. A structured questionnaire was administered through face to face interview to obtain information from respondents. The questionnaire comprised different sections including socioeconomic and demographic information, birth preparedness, knowledge of women about newborn danger signs, care during pregnancy and delivery (Additional file 1). The women were asked questions on essential newborn care practices including a) type of instrument used to cut the umbilical cord b) whether the newborn was dried and wrapped soon after delivery, c) the number hours or days after birth the newborn was first bathed d) the temperature of the water used in bathing e) whether any pre-lacteal food or drink was given, and f) the number of hours or days after birth breastfeeding was initiated g) whether colostrum was fed to the baby h) whether exclusive breast feeding was practiced. Three composite indices of essential newborn care practices (safe cord care, optimal thermal care and good neonatal feeding practices) were the main outcome measures used in the study. Safe cord care was defined as use of a clean cutting instrument to cut the umbilical cord plus clean thread to tie the cord plus no substance applied to the cord. Optimal thermal care was defined as baby wrapped within 10 min of birth plus first bath after 6 or more hours plus using warm water to bath the baby. A child was considered to have received good neonatal feeding, he/she should be breast feeding at the time of the study, initiated breastfeeding within the first 1 hour after birth, not being fed with prelacteals, fed with colostrum and avoidance of bottle-feeding. If one or more of the conditions were not met, then the feeding practice was described as inadequate or bad. The independent variables included socio-demographic factors, maternal age, educational attainment, ethnicity, religion etc. Socio-economic status (SES) was measured as household wealth index. Principal components analysis (PCA) was used to quantify a proxy measure of SES based on ownership of specified durable goods (television, radio, car, mobile telephone, etc.) and housing characteristics (access to electricity, source of drinking water, type of toilet facilities, type of flooring material and type of cooking fuel) [12]. Utilization of antenatal care services and maternal knowledge on newborn danger signs were also assessed as explanatory variables. Descriptive and inferential statistics were done using the predictive analytic software (PASW) for Windows version 18.0 and statistical significance was taken when p < 0.05. Chi-square statistics were performed to compare the levels of each of the dependent variables with the explanatory variables. A multiple logistic regression was used to identify socio-demographic, mothers’ knowledge of specific newborn danger signs, attendance at delivery by skilled birth attendant, antenatal and delivery care factors that were associated with the three newborn care practices (that is, safe cord care, optimal thermal care and good neonatal breastfeeding). Explanatory variables which were significant at bivariate analysis at a p-value of 0.05 or less were fed into the regression model after confirming the absence of multi-collinearity between these independent variables. The study protocol was approved by the Scientific Review and Ethics Committee of the School of Allied Health Sciences, University for Development Studies, Ghana. Informed consent was also obtained after needed information and explanation. In situations, where the respondent could not write or read, verbal informed consent was sought from all the study participants before the commencement of any interview. Data were analyzed and presented anonymously.

AI Digest

Study Justification:

– The study aimed to address the lack of progress in child and maternal mortality targets in sub-Saharan Africa, specifically in the Lawra District of Ghana.
– By examining the prevalence and determinants of essential newborn care practices, the study aimed to identify areas for improvement and develop interventions to reduce child and maternal mortality rates.

Study Highlights:

– The study found that the coverage of essential newborn care practices in the Lawra District was generally low.
– Only 36.8% of newborns had safe cord care, 34.9% had optimal thermal care, and 73.7% had adequate neonatal feeding.
– The overall prevalence of adequate newborn care practices was only 15.8%.
– Maternal educational attainment, utilization of antenatal care services, and maternal knowledge of newborn danger signs were positively associated with essential newborn care practices.

Study Recommendations:

– The study recommends the implementation of proven low-cost interventions such as effective antenatal care services and health and nutrition education.
– These interventions should be targeted at both the community and health facility levels to improve essential newborn care practices.
– Greater emphasis should be placed on providing adequate antenatal care services and promoting maternal education to improve newborn care practices.

Key Role Players:

– Health practitioners and professionals: Doctors, nurses, midwives, and community health workers who can provide antenatal care services and health education.
– Educators: Teachers and trainers who can provide education on maternal and newborn care.
– Community leaders: Local leaders who can promote and support essential newborn care practices within the community.
– Policy makers: Government officials and policymakers who can develop and implement policies to improve newborn care practices.

Cost Items for Planning Recommendations:

– Training and capacity building: Budget for training health practitioners and professionals on essential newborn care practices and health education.
– Health facility improvements: Budget for improving health facilities to provide adequate antenatal care services.
– Educational materials: Budget for developing and distributing educational materials on maternal and newborn care.
– Community outreach programs: Budget for organizing community outreach programs to promote essential newborn care practices.
– Monitoring and evaluation: Budget for monitoring and evaluating the effectiveness of interventions and making necessary adjustments.

Força da prova

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study provides specific data on the prevalence and determinants of essential newborn care practices in the Lawra District of Ghana. The sample size is adequate, and a systematic random sampling technique was used to select the study participants. The study also includes statistical analysis and identifies significant associations between various factors and newborn care practices. However, the abstract could be improved by providing more details on the methodology, such as the specific data collection methods and the statistical tests used. Additionally, it would be helpful to include information on any limitations of the study and suggestions for future research. Overall, the evidence in the abstract is informative, but it could be strengthened by addressing these areas.

Resumo

The study was carried out in the Lawra District hospital. The Lawra District lies in the North-West corner of the upper West Region of Ghana. The total area of the District is 1051.2 km2. The District has two hospitals located in Lawra and Nandom. They provide clinical and public health services as well as serve as a referral centres for the sub-districts. There are 10 sub-districts which provide primary health care services. Apart from agriculture, which engages about 80% of the population, there are small scale enterprises such as petty trading, artisanal works, small-scale industry enterprises, hotel/restaurants/chop bar and transport services. There are also those employed as public servants, although wages are low. The dominant economic activity is agriculture which does not yield the required returns necessary for meaningful standards of living. The result is wide spread poverty among the people with severe impact on women and children. A cross-sectional study was carried out in June 2014 on a sample of 422 lactating mothers and their children. The primary study population comprised women of reproductive age (15 to 49 years) who have delivered a live baby within the past 12 months prior to the conduct of this study. The 12-month limit was set with the intention of mitigating recall bias by the mother. A systematic random sampling technique was used to select the study participants who attended post-natal clinic in the Lawra District Hospital. The list of mothers contained in the attendance register for mothers who sought post-natal care served as the sampling frame. A sampling interval was calculated by dividing the total number of mothers (800) by the required sample size of 422. A random number between 1 and the sampling interval was selected to be the starting point of the sample extraction. Subsequently, the study participants were selected by adding the sampling interval to the number corresponding to the previous mother chosen on the list. This process was continued until the required number was obtained. A sample size of 384 was required to ensure that the estimated prevalence of the main outcome variable (coverage of essential new born care practices) was within plus or minus 5% of the true prevalence at 95% confidence level. An additional 10% to adjust for unexpected events (e.g. damaged/incomplete questionnaire) was factored in the sample size determination and so the sample size was 422. A structured questionnaire was administered through face to face interview to obtain information from respondents. The questionnaire comprised different sections including socioeconomic and demographic information, birth preparedness, knowledge of women about newborn danger signs, care during pregnancy and delivery (Additional file 1). The women were asked questions on essential newborn care practices including a) type of instrument used to cut the umbilical cord b) whether the newborn was dried and wrapped soon after delivery, c) the number hours or days after birth the newborn was first bathed d) the temperature of the water used in bathing e) whether any pre-lacteal food or drink was given, and f) the number of hours or days after birth breastfeeding was initiated g) whether colostrum was fed to the baby h) whether exclusive breast feeding was practiced. Three composite indices of essential newborn care practices (safe cord care, optimal thermal care and good neonatal feeding practices) were the main outcome measures used in the study. Safe cord care was defined as use of a clean cutting instrument to cut the umbilical cord plus clean thread to tie the cord plus no substance applied to the cord. Optimal thermal care was defined as baby wrapped within 10 min of birth plus first bath after 6 or more hours plus using warm water to bath the baby. A child was considered to have received good neonatal feeding, he/she should be breast feeding at the time of the study, initiated breastfeeding within the first 1 hour after birth, not being fed with prelacteals, fed with colostrum and avoidance of bottle-feeding. If one or more of the conditions were not met, then the feeding practice was described as inadequate or bad. The independent variables included socio-demographic factors, maternal age, educational attainment, ethnicity, religion etc. Socio-economic status (SES) was measured as household wealth index. Principal components analysis (PCA) was used to quantify a proxy measure of SES based on ownership of specified durable goods (television, radio, car, mobile telephone, etc.) and housing characteristics (access to electricity, source of drinking water, type of toilet facilities, type of flooring material and type of cooking fuel) [12]. Utilization of antenatal care services and maternal knowledge on newborn danger signs were also assessed as explanatory variables. Descriptive and inferential statistics were done using the predictive analytic software (PASW) for Windows version 18.0 and statistical significance was taken when p < 0.05. Chi-square statistics were performed to compare the levels of each of the dependent variables with the explanatory variables. A multiple logistic regression was used to identify socio-demographic, mothers’ knowledge of specific newborn danger signs, attendance at delivery by skilled birth attendant, antenatal and delivery care factors that were associated with the three newborn care practices (that is, safe cord care, optimal thermal care and good neonatal breastfeeding). Explanatory variables which were significant at bivariate analysis at a p-value of 0.05 or less were fed into the regression model after confirming the absence of multi-collinearity between these independent variables. The study protocol was approved by the Scientific Review and Ethics Committee of the School of Allied Health Sciences, University for Development Studies, Ghana. Informed consent was also obtained after needed information and explanation. In situations, where the respondent could not write or read, verbal informed consent was sought from all the study participants before the commencement of any interview. Data were analyzed and presented anonymously.

Materiais

https://efashare.b-cdn.net/materials/1848b9fc0446cb4ef5b2c4890af1b9e774dbdfc0ed1597e87e9083b9a5fbc11b/12887_2018_1145_MOESM1_ESM.pdf

Inovações

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

1. Mobile health (mHealth) interventions: Develop and implement mobile phone-based applications or text messaging services to provide pregnant women with important health information, reminders for antenatal care visits, and guidance on essential newborn care practices.

2. Community health worker training: Train and empower community health workers to provide education and support to pregnant women and new mothers in remote or underserved areas. These workers can provide information on safe cord care, optimal thermal care, and good neonatal feeding practices.

3. Telemedicine services: Establish telemedicine services to connect pregnant women and new mothers in rural areas with healthcare professionals who can provide remote consultations, advice, and support. This can help address the lack of access to specialized maternal health services in remote areas.

4. Maternal health clinics in rural areas: Establish maternal health clinics in rural areas, staffed by trained healthcare professionals, to provide antenatal care, delivery services, and postnatal care. This can help reduce the need for pregnant women to travel long distances to access healthcare.

5. Maternal health education programs: Develop and implement comprehensive maternal health education programs that target women of reproductive age, their families, and the community. These programs can raise awareness about the importance of essential newborn care practices and provide information on how to access and utilize maternal health services.

6. Financial incentives for facility-based deliveries: Introduce financial incentives, such as cash transfers or vouchers, to encourage pregnant women to deliver their babies in health facilities rather than at home. This can help improve access to skilled birth attendants and essential newborn care services.

7. Strengthening referral systems: Improve the coordination and effectiveness of referral systems between primary healthcare facilities and higher-level healthcare facilities. This can ensure that pregnant women with complications are promptly referred to appropriate facilities for specialized care.

8. Quality improvement initiatives: Implement quality improvement initiatives in healthcare facilities to ensure that essential newborn care practices are consistently provided. This can include training healthcare providers, improving infrastructure and equipment, and implementing standardized protocols and guidelines.

These are just a few potential innovations that could be considered to improve access to maternal health based on the information provided. It is important to note that the feasibility and effectiveness of these innovations would need to be assessed in the specific context of the Lawra District in Ghana.

AI Innovations Description

Based on the study conducted in the Lawra District of Ghana, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthen Antenatal Care (ANC) Services: The study found that women who received adequate ANC services were more likely to provide safe cord care and good neonatal feeding practices. Therefore, it is recommended to enhance ANC services by providing comprehensive education on essential newborn care practices, including safe cord care, optimal thermal care, and good neonatal feeding. This can be achieved through training healthcare providers, implementing standardized protocols, and ensuring regular ANC visits for pregnant women.

2. Improve Maternal Education: The study revealed that mothers who attained at least Senior High Secondary School were more likely to provide optimal thermal care for their newborns. Therefore, promoting education among women can contribute to better maternal health outcomes. Innovative approaches such as community-based education programs, mobile learning platforms, and partnerships with educational institutions can be utilized to improve maternal education and awareness about essential newborn care practices.

3. Enhance Health Facility Delivery: The study found that women who delivered their babies in a health facility were more likely to practice safe cord care. Encouraging women to deliver in health facilities can ensure access to skilled birth attendants and essential newborn care services. Innovations such as mobile clinics, transportation support, and community awareness campaigns can be implemented to promote health facility deliveries and reduce home births.

4. Community-Based Health and Nutrition Education: The study emphasized the importance of health and nutrition education that spans from the community to health facility levels. Implementing community-based health and nutrition education programs can empower women and families with knowledge and skills to provide optimal care for newborns. This can be achieved through partnerships with community leaders, local organizations, and the use of innovative communication channels such as radio, mobile apps, and social media.

5. Low-Cost Interventions: The study highlighted the need for proven low-cost interventions to improve essential newborn care practices. Implementing cost-effective strategies such as training traditional birth attendants, promoting breastfeeding support groups, and providing affordable and accessible supplies for safe cord care and thermal care can significantly improve maternal and newborn health outcomes.

Overall, the development and implementation of these recommendations as innovative solutions can contribute to improving access to maternal health and enhancing essential newborn care practices in the Lawra District of Ghana.

AI Innovations Methodology

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

1. Strengthen antenatal care services: The study found that women who received adequate antenatal care (ANC) services were more likely to provide safe cord care and good neonatal feeding practices. Therefore, improving the quality and accessibility of ANC services can contribute to better maternal and newborn care.

2. Enhance maternal education: The study showed that mothers who attained at least Senior High Secondary School were more likely to provide optimal thermal care for their newborns. Promoting education for women can empower them with knowledge and skills to provide better care for themselves and their babies.

3. Promote institutional deliveries: Women who delivered their babies in a health facility were more likely to have safe cord care. Encouraging women to give birth in healthcare facilities can ensure access to skilled birth attendants and essential newborn care practices.

4. Increase health and nutrition education: The study highlighted the importance of health and nutrition education in improving essential newborn care practices. Implementing community-based education programs can help raise awareness and knowledge among women and their families.

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

1. Define indicators: Identify specific indicators that reflect access to maternal health, such as the percentage of women receiving adequate ANC services, the percentage of institutional deliveries, or the prevalence of essential newborn care practices.

2. Collect baseline data: Gather data on the current status of the selected indicators in the target population. This can be done through surveys, interviews, or existing data sources.

3. Introduce interventions: Implement the recommended interventions, such as strengthening ANC services, promoting institutional deliveries, and providing health and nutrition education. Ensure that these interventions are well-designed and tailored to the local context.

4. Monitor and evaluate: Continuously monitor the implementation of the interventions and collect data on the selected indicators. This can involve regular data collection, surveys, or interviews with the target population.

5. Analyze data: Analyze the collected data to assess the impact of the interventions on the selected indicators. Compare the post-intervention data with the baseline data to determine any improvements or changes.

6. Draw conclusions: Based on the analysis, draw conclusions about the effectiveness of the interventions in improving access to maternal health. Identify any gaps or areas for further improvement.

7. Adjust and refine: Use the findings to adjust and refine the interventions as needed. Continuously iterate and improve the interventions based on the feedback and data collected.

By following this methodology, it is possible to simulate the impact of the recommended interventions on improving access to maternal health and make informed decisions for future implementation.

Autores & Coautores

Statistics:

Citations: 19

Authors: 3

Identifiers:

DOI: 10.1186/s12887-018-1145-4

Research Areas:

Community Interventions, Environmental, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Ghana

Study Design:

Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Female

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