Essential newborn care practices in selected public health facilities using observation of 2603 normal deliveries in Uttar Pradesh, India.

Abstract

Introduction: Essential newborn care (ENBC) practices are recommended for all births to improve neonatal survival. This paper aims to understand the facility-level variations and factors associated with the essential newborn care practices by providers in higher-level public health facilities in 25 high priority districts (HPDs) of Uttar Pradesh (UP).

Methods: We used observational cross-sectional quantitative data from 48 selected public health facilities (23 district hospitals (DH) and 25 community health centres (CHC)-first referral units (FRU)) implemented in 25 HPDs of UP from February 2020 to May 2021. We defined ENBC practice as both cord care and initiation of breastfeeding within 1 hour of birth were practiced in normal deliveries by the staff nurse. Descriptive analysis was done based on data from 2603 newborns attended by 318 providers. A stratified analysis was done by DH and CHC-FRU.

Results: Overall, essential newborn care was practiced among 26.1% of the newborns (26.2% in DH and 35.0% in CHC-FRU). The ENBC practice varied across facilities from 3.0% to 64.1% in DH and from 0% to 91.0% in CHC-FRU. The ENBC practice was about 2.3 times higher in facilities with a high level of skill and knowledge of the providers (39.0%) compared with the facilities with a low level of skill and knowledge (16.9%). Similar patterns of association between providers' skills and knowledge of ENBC practices were observed in DH and CHC-FRU.

Conclusion: Skill and knowledge on ENBC components are significantly associated with the clinical practices of providers, with a high level of variability across facilities. This suggests a focused facility-based assessment and enhancement of the clinical competencies of the providers to improve the quality of care in public health facilities in UP.