Neonatal mortality remains very high in Zimbabwe (29/1,000 live births). Service-related factors have been linked to the care-giver knowledge and newborn care practices. In Manicaland Province, care-seeking behaviors for fever (the main symptom for childhood infections) and knowledge levels of neonatal danger signs remains unacceptably lower than the national averages. A cross-sectional descriptive and analytic design was carried out to determine service-related factors to newborn care practices and their association with neonatal outcomes in Mutare District. Purposive sampling was used to select health facilities and systematic random sampling was used to select participants. A structured interviewer administered questionnaire was used to collect data which was then entered and analyzed using Epi-Info version 7.2. Descriptive and multivariate analysis were performed on data collected from 349 participants. Practice of the five assessed recommended newborn care practices was high. Exclusive breastfeeding (62%), early initiation of breastfeeding (74%), good cord care (73%), care-seeking for neonatal illness within 24hrs of onset of fever (82%) and keeping baby warm was at 58%. Statistically significant independent factors associated with the recommended newborn care practices were post-natal stay for more than 72 hours at the clinic (AOR=0.56; 95%CI: 0.12-0.87, p=0.000), and delivery at the health facility (AOR=0.43; 95%CI: 0.21-0.77; p=0.000). Service delivery had a substantial influence on newborn care practices in Mutare district and influenced neonatal outcomes. Improving newborn care outcomes requires both effective service delivery and community health system strengthening to promote good newborn care.

Neonatal mortality has been increasing in Zimbabwe from 20/1,000 live births between 2000 and 2004 to 29 /1,000 live births between 2010 and 2014.Suboptimal newborn care practices are the predisposing factors to neonatal mortality. In Manicaland Province, care seeking behaviours for fever which is the main symptom of majority of infections in children and knowledge levels of danger signs that should cause the mother to take a child immediately to a health facility remains unacceptably lower than the national averages. A cross sectional descriptive and analytic design was carried out to explore the factors associated with the practice of the recommended newborn care practices by women of child bearing age in Mutare District. Health facilities were purposively sampled and participants were systematically sampled. Structured interviews were used to collect data which was analysed in Epi-Info version 7.2. Descriptive and multivariate analysis was performed on data collected from 349 participants. Practice of the five assessed recommended newborn care practices was high. Exclusive breast feeding (62%), early initiation of Breast feeding (74%), good code care (73%), care seeking for neonatal illness within 24hrs of onset of fever (82%) and keeping baby warm was at 58%. Statistically significant independent factors associated with the recommended newborn care practices were post-natal stay for more than 72 hours at the clinic (AOR=0.56; 95%CI: 0.12-0.87, p=0.000), and delivery at the health facility (AOR=0.43; 95%CI: 0.21-0.77; p=0.000). Cultural practices that impact negatively on neonatal care in Mutare district include; asking for permission to seek treatment for the child when ill, feeding the baby immediately after delivery and applying substances and mixed traditional herbs on the cord stump of the newborn. Improving newborn care outcomes require approaches addressing demand and supply factors to reach communities with correct information on good newborn care.