Effect of Birth Preparedness on Institutional Delivery in Semiurban Ethiopia: A Cross-Sectional Study.

BACKGROUND: Ethiopia has one of the lowest rates of facility delivery and is promoting birth preparedness among pregnant women through its community health services to increase the rate of institutional delivery and reduce maternal mortality. Observational studies of birth preparedness in Ethiopia have thus far only reported the marginal effect of birth preparedness when controlling for other factors, such as parity and education. OBJECTIVES: In this cross-sectional study, we use propensity score modeling to estimate the average population-level effect of birth preparedness on the likelihood of delivering at a facility. METHODS: We conducted secondary analysis of household survey data collected from 215 women with a recent live birth within the catchment areas of 10 semi-urban health centers. A mother was considered well prepared for birth if she reported completing four of the following six actions: identified a skilled provider, identified an institution, saved money, identified transport, prepared clean delivery materials, and prepared food. We performed unadjusted and multivariate logistic regression analyses, with and without propensity score weighting, to assess the relationship between birth preparedness and institutional delivery. FINDINGS: One hundred respondents (47%) delivered in an institution, and over two-thirds (151, 71%) were considered well prepared for birth. Institutional delivery was more common among women who were considered well prepared (57%) versus those who were considered not well prepared (19%). In the model with propensity score weighting, women who were well prepared for birth had 3.83 times higher odds of delivering at a facility (95% CI: 1.41-10.40, p-value = 0.010). CONCLUSIONS: This study contributes to existing evidence supporting the inclusion of antenatal birth preparedness counseling as a part of an antenatal care package for promoting institutional delivery. Important gaps remain in operationalizing the definition of birth preparedness and understanding the pathway from exposure to outcome.

Newborn care practices in rural Bangladesh: Implications for the adaptation of kangaroo mother care for community-based interventions.

Bangladesh has one of the world's highest rates of low birth weight along with prevalent traditional care practices that leave newborns highly vulnerable to hypothermia, infection, and early death. We conducted formative research to explore existing newborn care practices in rural Bangladesh with an emphasis on thermal protection, and to identify potential facilitators, barriers, and recommendations for the community level delivery of kangaroo mother care (CKMC). Forty in-depth interviews and 14 focus group discussions were conducted between September and December 2012. Participants included pregnant women and mothers, husbands, maternal and paternal grandmothers, traditional birth attendants, village doctors, traditional healers, pharmacy men, religious leaders, community leaders, and formal healthcare providers. Audio recordings were transcribed and translated into English, and the textual data were analyzed using the Framework Approach. We find that harmful newborn care practices, such as delayed wrapping and early initiation of bathing, are changing as more biomedical advice from formal healthcare providers is reaching the community through word-of-mouth and television campaigns. While the goal of CKMC was relatively easily understood and accepted by many of the participants, logistical and to a lesser extent ideological barriers exist that may keep the practice from being adopted easily. Women feel a sense of inevitable responsibility for household duties despite the desire to provide the best care for their new babies. Our findings showed that participants appreciated CKMC as an appropriate treatment method for ill babies, but were less accepting of it as a protective method of caring for seemingly healthy newborns during the first few days of life. Participants highlighted the necessity of receiving help from family members and witnessing other women performing CKMC with positive outcomes if they are to adopt the behavior themselves. Focusing intervention messages on building a supportive environment for CKMC practice will be critical for the intervention's success.

Newborn care practices at home and in health facilities in 4 regions of Ethiopia.

BACKGROUND: Ethiopia is one of the ten countries with the highest number of neonatal deaths globally, and only 1 in 10 women deliver with a skilled attendant. Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can be delivered in communities as well as facilities. This article describes newborn care practices reported by recently-delivered women (RDWs) in four regions of Ethiopia. METHODS: We conducted a household survey with two-stage cluster sampling to assess newborn care practices among women who delivered a live baby in the period 1 to 7 months prior to data collection. RESULTS: The majority of women made one antenatal care (ANC) visit to a health facility, although less than half made four or more visits and women were most likely to deliver their babies at home. About one-fifth of RDWs in this survey had contact with Health Extension Workers (HEWS) during ANC, but nurse/midwives were the most common providers, and few women had postnatal contact with any health provider. Common beneficial newborn care practices included exclusive breastfeeding (87.6%), wrapping the baby before delivery of the placenta (82.3%), and dry cord care (65.2%). Practices contrary to WHO recommendations that were reported in this population of recent mothers include bathing during the first 24 hours of life (74.7%), application of butter and other substances to the cord (19.9%), and discarding of colostrum milk (44.5%). The results suggest that there are not large differences for most essential newborn care indicators between facility and home deliveries, with the exception of delayed bathing and skin-to-skin care. CONCLUSIONS: Improving newborn care and newborn health outcomes in Ethiopia will likely require a multifaceted approach. Given low facility delivery rates, community-based promotion of preventive newborn care practices, which has been effective in other settings, is an important strategy. For this strategy to be successful, the coverage of counseling delivered by HEWs and other community volunteers should be increased.