|Evidence from household surveys for measuring coverage of newborn care practices|
||Deborah Sitrin, Jamie Perin, Lara ME Vaz, Liliana Carvajal-Aguirre, Shane M Khan, Joy Fishel, and Agbessi Amouzou
||Journal of Global Health, 7(2): 020503; DOI: 10.7189/jogh.07.020503
Multiple Asian Countries
||Background Aside from breastfeeding, there are little data on use of
essential newborn care practices, such as thermal protection and hygienic
cord care, in high mortality countries. These practices have not
typically been measured in national household surveys, often the main
source for coverage data in these settings. The Every Newborn Action
Plan proposed early breastfeeding as a tracer for essential newborn care
due to data availability and evidence for the benefits of breastfeeding.
In the past decade, a few national surveys have added questions on
other practices, presenting an opportunity to assess the performance
of early breastfeeding initiation as a tracer indicator.
Methods We identified twelve national surveys between 2005–2014
that included at least one indicator for immediate newborn care in addition
to breastfeeding. Because question wording and reference populations
varied, we standardized data to the extent possible to estimate
coverage of newborn care practices, accounting for strata and multistage
survey design. We assessed early breastfeeding as a tracer by: 1)
examining associations with other indicators using Pearson correlations;
and 2) stratifying by early breastfeeding to determine differences
in coverage of other practices for initiators vs non–initiators in each
survey, then pooling across surveys for a meta–analysis, using the inverse
standard error as the weight for each observation.
Findings Associations between pairs of coverage indicators are generally
weak, including those with breastfeeding. The exception is drying
and wrapping, which have the strongest association of any two interventions
in all five surveys where measured; estimated correlations for
this range from 0.47 in Bangladesh’s 2007 DHS to 0.83 in Nepal’s 2006
DHS. The contrast in coverage for other practices by early breastfeeding
is generally small; the greatest absolute difference was 6.7%, between
coverage of immediate drying for newborns breastfed early compared
to those who were not.
Conclusions Early initiation of breastfeeding is not a high performing
tracer indicator for essential newborn care practices measured in previous
national surveys. To have informative data on whether newborns are
getting life–saving services, standardized questions about specific practices,
in addition to breastfeeding initiation, need to be added to surveys.