Essential Newborn Care Service Readiness and Barriers in Northwest Ethiopia: A Descriptive Survey and Qualitative Study

Abstract

Background: Despite the efforts put forth in improving neonatal survival, there is still a high rate of neonatal morbidity and mortality in northwest Ethiopia. Therefore, this study aimed to determine the essential newborn care service readiness scores and explore the health facility-related barriers in North Gondar Zone, Northwest Ethiopia. Methods: A cross-sectional survey of 16 health facilities (14 health centers and two hospitals) and twelve in-depth interviews were included in the study in three randomly selected districts of North Gondar Zone. A pretested health facility inventory questionnaire customized from the World Health Organization (WHO) service readiness assessment tool was used for a facility audit. Basic emergency and essential obstetric and newborn care (BEmONC), and child immunization service readiness scores were determined using unweighted averages according to the WHO guideline. Descriptive statistics were done for the quantitative data, and thematic content analysis was employed using NVivo 12 software for the qualitative data. Results: All the surveyed health facilities had no specialist medical doctors, and 50% (8/16) of them had no inpatient beds. The overall BEmONC service readiness score was 62.7% (10/ 16) (95% CI: 34.8, 83.8) and only one facility had all the tracer items. Trained staff and guidelines had a 27.5% (4/16) readiness score, followed by 71.9% (12/16) readiness score for equipment, and 88.6% (14/16) readiness score for medicine and commodities. The overall child immunization service readiness score was 90.3% (15/16) (95% CI: 51.4, 94.7) and eleven facilities (68.8%) had all the tracer items. The immunization service readiness score was higher; 84.4% (14/16) for trained staff and guidelines, 92.8% (15/16) for equipment, and 93.8% (15/16) for medicines and commodities. Unavailability of equipment, shortage of supplies, and lack of respectful and compassionate healthcare practices were the key facilityrelated barriers compromising essential newborn care service readiness. Conclusions for Practice: The survey revealed that the essential newborn care service readiness score of the health facilities was low, and it calls for improving BEmONC service readiness in particular. Provision of timely training for newly recruited staff, fulfilling essential equipment, and steady supply is imperative.

Women’s multidimensional empowerment index and essential newborn care practice in Bangladesh: The mediating role of skilled antenatal care follow-ups

“…Only 7.6% of mothers followed good ENC practice and independently, 86.3% used clean and boiled instruments to cut the umbilical cord, 47.1% did not apply anything to the cord, 62.8% dried the newborn in 5 minutes, 47.2% bathed the baby 72 hours or later after birth and 69.0% initiated early breastfeeding within 1 hour of birth. Although the prevalence of most of the ENC components are in line or close with other studies conducted in Ethiopia [ 62 – 67 ], the prevalence of overall ENC practice is very low in Bangladesh, and it is far away from the target of 4 th HPNSP (Health, Population and Nutrition Sector Program) to achieve the prevalence of 25% by 2022 [ 4 , 12 , 24 ]. No significant improvement was observed in good ENC practice in Bangladesh over the previous years.…”

Barriers and facilitators in implementing early essential newborn care of well‐born babies in low‐ and middle‐income countries: A mixed‐method systematic review

“…Of the 13 quantitative studies, three (Abdu et al 2019;Berhe et al 2017;Tasew et al 2019) did not report selection criteria clearly and three (Abdu et al 2019;Ayenew et al 2020;Chanie et al 2021) did not consider confounders or apply appropriate methods to control for confounders. Among mixed-methods studies, the reason for choosing the mixed-methods approach was not explained in two studies (Delele et al 2021a;Xu et al 2018) (2/3). One study did not report the reasons for nonresponse on the quantitative component and did not provide sufficient data substantiating the interpretation of the results of the qualitative component (Xu et al 2018).…”

“…Sixteen studies reported the shortage of resources as a challenge in LMICs. Specifically, the obstacles were deficiency of manpower et al 2021a;Rana et al 2019;Tasew et al 2019) or lack access to training (Morseth et al 2020). Some health staff were uncertain about the eligibility of SSC (Alenchery et al 2018).…”

“…18Ashenef, G., et al, 19Fekadu, B., et al, 20 Abdu, H., et al, 22 Delele, T.G., et al, 23 Rana, N., O. 24 Alenchery, A.J, et al, 26 Yosef, T, D. Getachew and F. Weldekidan, 27 Gonfa, D.N., et al, 28 Agampodi, T.C., et al,The construct of network and communications from the inner setting was presented by five studies(Alenchery et al 2018;Delele et al 2021a;Holztrattner et al 2021;Rana et al 2019;Vail et al 2018). Four studies reported that a lack of teamwork(Alenchery et al 2018;Rana et al 2019;Vail et al 2018) and a delegation system for tasks(Delele et al 2021a) were challenging.…”

“…24 Alenchery, A.J, et al, 26 Yosef, T, D. Getachew and F. Weldekidan, 27 Gonfa, D.N., et al, 28 Agampodi, T.C., et al,The construct of network and communications from the inner setting was presented by five studies(Alenchery et al 2018;Delele et al 2021a;Holztrattner et al 2021;Rana et al 2019;Vail et al 2018). Four studies reported that a lack of teamwork(Alenchery et al 2018;Rana et al 2019;Vail et al 2018) and a delegation system for tasks(Delele et al 2021a) were challenging. The cooperation was often between the paediatrician, gynaecologist and labour room workers(Alenchery et al 2018) and the role of nurses was stressed(Holztrattner et al 2021).The construct of structural characteristics, which referred to the structure, age, level and size of an organisation, was reported by five studies(Berhe et al 2017;Birhanu & Mathibe-Neke, 2022;Fekadu et al 2022;Morseth et al 2020;Vail et al 2018).as a special service(Morseth et al 2020).The construct of implementation climate, which referred to the absorptive capacity for change in an organisation, was identified by five studies.…”