TY  - JOUR
IS  - 99
EP  - 19
SN  - 1471-2393
TI  - Is essential newborn care provided by institutions and after home births? Analysis of prospective data from community trials in rural South Asia
AV  - public
KW  - Obstetrics & Gynecology
KW  -  RANDOMIZED CONTROLLED-TRIAL
KW  -  MIDDLE-INCOME COUNTRIES
KW  -  LOW-RESOURCE SETTINGS
KW  -  NEONATAL DEATHS
KW  -  HEALTH-CARE
KW  -  FUTURE IMPLICATIONS
KW  -  FORMATIVE RESEARCH
KW  -  WOMENS GROUPS
KW  -  SKILLED CARE
KW  -  BANGLADESH
N1  - © 2014 Pagel et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
N2  - BACKGROUND: Provision of essential newborn care (ENC) can save many newborn lives in poor resource settings but
coverage is far from universal and varies by country and place of delivery. Understanding gaps in current coverage
and where coverage is good, in different contexts and places of delivery, could make a valuable contribution to the
future design of interventions to reduce neonatal mortality. We sought to describe the coverage of essential
newborn care practices for births in institutions, at home with a skilled birth attendant, and at home without a
skilled birth attendant (SBA) in rural areas of Bangladesh, Nepal, and India.
METHODS: We used data from the control arms of four cluster randomised controlled trials in Bangladesh, Eastern
India and from Makwanpur and Dhanusha districts in Nepal, covering periods from 2001 to 2011. We used these
data to identify essential newborn care practices as defined by the World Health Organization. Each birth was
allocated to one of three delivery types: home birth without an SBA, home birth with an SBA, or institutional
delivery. For each study, we calculated the observed proportion of births that received each care practice by
delivery type with 95% confidence intervals, adjusted for clustering and, where appropriate, stratification.
RESULTS: After exclusions, we analysed data for 8939 births from Eastern India, 27 553 births from Bangladesh, 6765
births from Makwanpur and 15 344 births from Dhanusha. Across all study areas, coverage of essential newborn
care practices was highest in institutional deliveries, and lowest in home non-SBA deliveries. However, institutional
deliveries did not provide universal coverage of the recommended practices, with relatively low coverage
(20%-70%) across all study areas for immediate breastfeeding and thermal care. Institutions in Bangladesh had the
highest coverage for almost all care practices except thermal care. Across all areas, fewer than 20% of home
non-SBA deliveries used a clean delivery kit, the use of plastic gloves was very low and coverage of recommended
thermal care was relatively poor. There were large differences between study areas in handwashing, immediate
breastfeeding and delayed bathing.
CONCLUSIONS: There remains substantial scope for health facilities to improve thermal care for the newborn and to
encourage immediate and exclusive breastfeeding. For unattended home deliveries, increased handwashing, use of
clean delivery kits and basic thermal care offer great scope for improvement.
ID  - discovery1425096
UR  - http://dx.doi.org/10.1186/1471-2393-14-99
Y1  - 2014/03/07/
JF  - BMC Pregnancy and Childbirth
A1  - Pagel, C
A1  - Prost, A
A1  - Hossen, M
A1  - Azad, K
A1  - Kuddus, A
A1  - Roy, SS
A1  - Nair, N
A1  - Tripathy, P
A1  - Saville, N
A1  - Sen, A
A1  - Sikorski, C
A1  - Manandhar, DS
A1  - Costello, A
A1  - Crowe, S
PB  - BIOMED CENTRAL LTD
VL  - 14
ER  -