Essential newborn care in Sidama, Ethiopia: Findings from a community-based cross-sectional household survey.

AbstractO_ST_ABSObjectiveC_ST_ABSTo describe the existing status and associated factors influencing the utilization of four WHO-recommended essential newborn care among mothers of infants aged 45 days to one year in rural Sidama, Ethiopia. DesignA community-based cross-sectional household survey was conducted in June and July 2023. Data were collected through interviewing mothers of infants using pretested questionnaire. Participants were selected through a multi-stage sampling. Data were analyzed using Stata V.15. SettingSelected rural kebeles of Bilate Zuriya, Boricha, Hawassa Zuriya and Shebedino districts of Sidama, Ethiopia. Participants1,821 mothers of infants aged 45 days to one year. Primary outcome measuresthe proportion of babies who received some or all components of the four WHO-recommended essential newborn cares. ResultsOf 1,821 mothers, 53.9% (981/1,821) reported that their newborns had received immediate and thorough drying, 52.7% (959/1,821) indicated immediate skin-to-skin contact, and 46.9% (854/1,821) revealed that babies initiated breastfeeding within one hour after birth. However, only 2.3% (42/1,821) of mothers reported delayed cord clamping. No newborn received all four. Only 15% (273/1,821) reportedly received at least three of the four, 38.8% (706/1,821) received two, 33.2% (605/1,821) received one, and 13% (237/1,821) have not received any of the care. Facility delivery (RRR=5.26; 95% CI: 1.11, 8.89), Proximity to a facility (RRR=1.70; 95% CI: 1.09, 2.67), living in communities with higher wealth (RRR=11.74; 95% CI: 3.09, 44.63), insurance coverage (RRR=6.54; 95% CI: 2.25, 19.06), and education levels (RRR=7.75; 95% CI: 2.57, 23.34) were significantly associated with utilization of three. ConclusionThe utilization rate of essential newborn care in rural Sidama is unacceptably low. Individual and community level factors were significantly associated with the use. A comprehensive strategy must therefore address the identified factors. Strengths and limitations of the studyThis study has methodological strengths including the uses, a strong community-based study design with a large sample size (N=1,821) and complete response rate, rigorous data quality assurance through electronic collection (Kobo tool box). Further we carefully selected and trained data collectors to minimize social desirability bias, and included a number of variables relevant for policy considerations, and used of multilevel modeling to account for hierarchical data structure. However, the researchers acknowledged several limitations and implemented strategies to alleviate them. Reliance on maternal self-report introduces potential recall and social desirability biases, which were addressed through specific interviewer techniques and by focusing on memorable events. Moreover, the lack of direct observational cross-validation for clinical practices such delayed cord clamping remains a constraint.