Factors influencing Newborn-care Practices in a Selected Rural Area - - PDF document

Factors influencing Newborn-care Practices in a Selected Rural Area of Bangladesh Newborn care is important for the development of healthy life of a baby. In this article we investigate the factors affecting newborn-care practices in rural Bangladesh. For this a community-based cross-sectional study was conducted among 360 samples of postnatal mothers who visited the EPI centers, Tangail district. The mean age of the respondents was 24 (±4.4)

• years. Eighty percent of deliveries were conducted at home either by unskilled family members
• r by relatives. Umbilical cord of 40% newborns was cut by skilled persons; 56% of the mothers

gave colostrums and 79% initiated breastfeeding within one hour of birth. The chi-square and multivariate analysis showed that newborn care is a correlates of education, number living children, access to media , accessibility and wealth index, (p<0.001). Since substantial neonates die within one week of birth, new born care will be an important determinant of the reduction of infant mortality in rural Bangladesh..

Background: Despite improvement in the infant and child health status, a high number of neonatal deaths (41 per 1,000 live birth) pose a serious public-health concern in developing countries, including

• Bangladesh. Globally, almost three-quarters of neonatal deaths occur within the first seven days
• f delivery and ninety-nine percent of all newborn deaths occur in low- and middle- income

countries, with two-thirds of those occurring in Asia and Africa. Bangladesh is one of the developing countries with very high neonatal mortality. During 1995-99 Bangladesh had 42 neonatal deaths per thousand live births. Despite slight improvement in the situation over the last decade, the contribution of neonatal mortality in the infant mortality rate has remained almost static during the period. Around 60% of the infant deaths had been among the neonates since late 1980s and this proportion has remained the same in subsequent 10 years. Until the twenty-first century, newborn health was virtually absent from policies, program and research in developing countries. Improvements in neonatal mortality rates are essential if countries are to meet their targets for Millennium Development Goal Four. Most neonatal deaths in developing countries occur at home, unattended by skilled professionals. In Bangladesh, about two-thirds of all births and three quarters of births in rural areas occur at

• home. Therefore, understanding routine newborn care practices in the home is necessary prior to

designing and prioritizing interventions to reduce neonatal morbidity and mortality in rural

• Bangladesh. Little is known about factors that determine behaviors relating to immediate care of
• newborn. Many of the mothers are very young and uneducated. Majority (about 75%) of the

neonatal deaths are taking place within seven days of birth receiving no appropriate care. So initial care and care seeking behaviour at the appropriate place at the appropriate time lies at the hands of the caregivers at home. We know the knowledge and care seeking behaviour varies in

• ur population depending on their location, taboos, education, traditional beliefs etc.

The aim of the study was to find out the knowledge and practices of selected rural community in relation to new born care, socio-demographic status, feeding practices, and pre lacteal feeding and it can be helpful to find out the effective components for develop a programmed to implement interventions for reducing neonatal morbidity and mortality in Bangladesh.

Materials and Methods A community-based cross-sectional study was conducted in Madhupur Upazila (Lower Administrative Unit) in Tangail district of Bangladesh, during January-June 2012, to collect information of newborn care practices of the recent deliveries about post natal mothers. Sampling of all postnatal mothers who visited the Expanded Program on Immunization (EPI) centers was done using the EPI register. All the EPI centers of Madhupur upazila constituted the sampling frame. Postnatal mothers were randomly selected. The sample-size was determined based on the BDHS 2007. The BDHS 2007 shows that about 30% of mothers visited health facilities for postnatal care services. Considering the 10% non-response, the final sample-size for this study was 360. A pre-tested structured questionnaire was used for collecting information on socio-demographic, maternal, infant and birth characteristics of each child. The factors that were considered are as follows: Maternal characteristics included maternal age; education; number of total living children; religion; wealth index; antenatal check-up and place of delivery. Infant characteristics included newborn sex; delivery attendant; and newborn care which covered care of the baby immediately after birth such as cord cutting and early breast-feeding practices that are important for survival and well-being of the newborn. Birth characteristics included delivery care and cord care/cord cutting that refer to hygienic practices. Data were analyzed using the SPSS software for Windows (version 17). The significance of the differences in patterns among values of the associated factors was tested using chi-square test at a 5% level of significance. Odds ratios with 95% confidence interval (CI) were calculated applying logistic regression model to control confounders and identify the factors associated with newborn care practices. Results: Among 360 postnatal respondents the mean age of the mothers was 24 (SD±4.4) years. About three-fourth (75%) of the post natal mothers were literate. Most (96%) of the mothers were

• housewives. Twenty-two percent of the respondents were from the poorest socioeconomic class,

20 percent were from the middle class, and 19 percent were from the richest class. In the case of accessibility to mass media, only 17 percent read newspapers, 10 percent listened to radio, 60 percent watched television (TV), and 45 percent had mobile phones.

Majority of the mothers (80%) delivered at home, 8.3 percent at the government hospital, 7.5 percent at the private clinic, and the rest 4 percent delivered at the District Sadar Hospital, NGO Clinic and other places. Almost two-third (66%) of the children were born with normal weight (≥2.5 kg). Their mean birth weight was 2.6 kg (SD±0.68). About one-third (31 percent) of the children faced some sort of sickness within 40 days of delivery. The umbilical cords of about 31 percent of the children were cut by the untrained Traditional Birth Attendants (TBAs), 28 percent by relatives or neighbors, 20 percent by trained TBAs and remain 22 percent by nurses, doctors, and other personnel. 9 percent developed cord infection. Among those infected children, 65 percent were treated. The three-fourth (75 percent) of the newborn was treated by doctors for their umbilical cord infection, and 15 percent received treatment from pharmacy, 5 percent from Kabiraj (traditional healer) and 5 percent from others. Among the newborn seventy nine percent were breastfed within one hour of birth. More than half (56 percent) of the new born were given colostrums feeding. About one-third (36 percent) of the newborns had started pre lacteal feeding immediately after birth. Of them, 31 percent fed powder milk, 32 percent cow’s milk and 37 percent flour as pre lacteal feeding. We carried out chi-square analysis to investigate the association between the use of services and

• ther related demographic variables. We found a significant association for education (p<0.001),

watching TV (p<0.001), access to transport (p<0.001), and the wealth index (p<0.001).On logistic regression analysis considering the use of service as the dependent variable; primary level education (p<0.05), wealth index (<0.05), access to newspapers (p<0.001), listening to radio (p<0.05), watching TV (p<0.001) and transport facilities were the important correlates of newborn care by the postnatal mothers when other confounding variables were adjusted. Discussion Reducing maternal and neonatal mortality remains a big challenge for a developing country like Bangladesh .A large proportion of births continue to occur at home in many parts of Bangladesh. Unhygienic and unsafe traditional birth-care practices may contribute to high neonatal mortality and morbidity in rural Bangladesh.

In the present study home delivery preponderance (83.3%) were observed and it was very common in the study area. This finding was higher than 81 percent, 56.1 percent & 51.7 percent reported for Ganda Community, New Delhi and Lucknow respectively. Women may experience a number of problems associated with childbirth in the postpartum period, i.e. six weeks following of the delivery. Since the movement of mother and baby is culturally restricted for about 40 days after delivery, complications can be detected and treated through proper follow-up visits by health workers to women in the postpartum period. Less than

• ne in five newborns is checked by a health professional within six weeks of delivery.

Nationally, only 12% of babies receive a postnatal check-up by a trained health provider within the first two days of delivery. In the present study, 31% of the newborn had different health problem within 40 days after delivery and 9% of them develop umbilical cord infection. Breastfeeding practices play an important role in reducing child mortality and morbidity. Results

• f many studies from Bangladesh and other South Asian countries indicate that women

commonly wait several days after birth to begin breast feeding, avoiding giving colostrum, or supplement breast feeding with other foods or liquids. The notion that colostrum is "dirty" is widespread in the region, and often the colostrum is thrown away. It is perceived that sweet water or foods provide protection for the baby against illness and give the baby a sweet personality. Our study reveals that about 56% mothers give colostrums immediately after birth and about 79% mothers initiated breast-feeding within 1 hour, 15% mothers within 24 hours and 7% mothers within 3 days after birth. This positive findings has implications for nutrition, prevention

• f infection and thermal control and should be supported wholeheartedly.

Besides this, we observed 36% newborn were fed powder milk, cow’s milk and flour as prelacteal feeding and giving artificial milk which is a cause of concern. Such practices delay the initiation of breast feeding and may adversely affect establishment of lactation. In light of the above discussion our study has obtained important population-level information about delivery and newborn care practices in rural Bangladesh. The Government, NGOs, professional organizations, and communities need to act together to save newborn babies and their mothers. These may improve newborn survival and help achieve Millennium development Goal four.