Essential newborn care in rural settings: The case of Warrap State in South Sudan

Abstract

Essential newborn care is taking a predominant role in addressing under-five healthcare delivery interventions. There are no current well-established guidelines or common methodologies on how to assess the situation of newborn care in countries with weak health information systems, especially when addressing situational needs in rural settings. The main objective of this study was to test the feasibility of collecting information using a community based approach to assess the level of coverage of essential newborn care, especially for rural settings. Six indicators related to promotion and provision of thermal care, early initiation of exclusive breastfeeding, and hygienic cord care, were measured. A two-stage stratified and weighted random sampling was carried out. Standard sample calculations were used to determine a sample of 511 respondents. Descriptive results from the population survey showed that the prevalence of newborns receiving all recommended elements of essential new born care in the surveyed area was 1%. The most common element completed, with nine out of ten respondents, was wrapping the newborn immediately after birth, but only 1% were not bathed within the first six hours after birth. Survey results confirmed low coverage of systematic application of essential newborn care measures in rural areas of Warrap State in South Sudan.This observational study indicates that the collection of information on health care behaviours around essential newborn care indicators (thermal, cord and eye care, and breastfeeding) can be reliably achieved, especially in hard-to-reach areas, at the community level.

The effects of ANC follow up on essential newborn care practices in east Africa: a systematic review and meta-analysis

“…Most newborn deaths occur at home in low- income countries including east African regions due to a lack of access to health care, a limited number of trained health care personnel, and an overall weak health system in the regions 16 .…”

“…In developing countries there is low level of adherence to essential new-born care practice despite this recommendation. Accordingly, reports from east African countries demonstrated the low level of essential newborn care practice 16,[18][19][20][21] . For example in Uganda early bathing and spread over materials on cord stump is a custom [21][22][23] .…”

A systematic review of newborn health interventions in humanitarian settings

“…The databases search identified 5234 results. A total of 181 articles were screened full text; of which a total of 35 articles are included in this review, that is, 33 peer-reviewed28–60 and 2 grey literature publications61 62 (figure 1).…”

“…The 33 peer-reviewed articles and 2 grey literature publications comprise: 1 cluster randomised trial,51 17 cross-sectional studies,30 31 34–37 39–42 46 48–50 52 58 60 2 cohort studies,44 54 5 pre-post studies,32 33 53 55 59 3 controlled pre-post studies,29 47 57 2 case studies43 45 and 5 qualitative studies 28 38 56 61 62. Of these, 10 studies used a mixed methods approach34 35 37 39 41 43 50 53–55 (table 3).…”

“…Overall, 48.6% (n=17) of the studies were considered high-quality, 37.1% (n=13) medium-quality and 14.3% (n=5) low-quality (table 3). Most observational studies were medium-quality30 35 37 39 42 49 60 and high-quality31 36 40 41 44 48 50 58 despite the majority not including statistical methods to control for confounding and potential source of bias, although they do acknowledge these limitations. The controlled pre-post studies were considered medium-quality47 57 and high-quality,29 despite two not accounting for confounders in the design or analysis.…”