Presentation at the Global Maternal Newborn Health Conference, October 21, 2015
Background: Sixty one percent of under-5 mortality are newborn deaths and 50% are on day 1. Evidences generated over the last decade underscored the importance of essential newborn care at time of birth. Bangladesh has been focusing on at-scale implementation of ENC through an integrated approach with maternal interventions.
Methods: Almost all Skilled Birth Attendants have been provided with add-on training on ENC in order to deliver an integrated maternal-newborn package. As part of a system evaluation, 1,190 deliveries were observed on-site at 16 sub-district hospitals and at households of selected communities of 8 sub-districts. Physicians, nurses/paramedics and community skilled birth attendants conducted these deliveries during December 2011 to February 2012. Trained observers used structured checklist to record practices and timing of events. Findings on ENC practices of live born newborns of normal vaginal delivery were analyzed and presented here.
Findings: Eighty two percent deliveries were conducted by a single provider. Almost all babies were dried (99.3%) and wrapped (99.8) with dry cloth immediately; mean time were 77 (SD±65) seconds and 198 (SD±152) seconds from birth for drying and wrapping respectively. Only 7.2% newborns were put on skin-to-skin contact with the mother after birth. For 82% of the newborns a new thread or clamp was used to tie the cord however, less than 1% used a new cutting instrument. Only 7% cutting instruments were boiled before use. Only 63 newborns (5%) could be observed till one hour and the mean time for initiation of breastfeeding was 33 (SD±23) minutes.
Conclusion: Despite universal standard training on ENC, differentials of practices between different components indicate the need for improvement of quality of training and post-training system support. While the country is shifting towards facility delivery, the overarching challenge is to deliver the maternal-newborn integrated package at optimum quality, at the primary care level in particular.