Although child mortality has decreased considerably in the last several decades, newborn mortality has declined less substantially and its share of all under-5 mortality consequently has grown. While life-saving interventions such as skilled birth attendance and delivery in a health facility have increased, they have only contributed to a limited reduction in neonatal mortality. This calls for further study on specific interventions related to newborn care. This study examines the associations of thermal and cord care practices with newborn mortality.
This study used data from 16 Demographic and Health Surveys to examine changes over time in coverage of recommended newborn care practices—thermal care and hygienic cord care—and differences in coverage of recommended practices by place of delivery. Among home births, we further examined the associations between newborn care practices and newborn mortality over time, and the key predictors of receipt of the recommended practices. Sample size proved to be a limitation to exploring associations between recommended newborn care practices and neonatal mortality among home births within individual surveys. Thus, we pooled data from recent surveys with newborn care questions to test the association between each practice and newborn mortality within a larger sample. We also conducted an in-depth analysis of newborn care practices among home births in larger and pooled samples in India, Bangladesh, and Nepal. We performed multivariable logistic regressions to test the associations between newborn care practices and neonatal mortality, and to explore predictors of newborn care practices in these countries.
Overall, we found an increase in recommended newborn care practices over time, more implementation of practices among births delivered in a health facility than at home, and a relationship between cord care and mortality among home births. In a pooled sample of home births assessed in recent surveys in Bangladesh and Nepal, we found that newborns who had only an antiseptic placed on their umbilical cord stump had significantly lower odds of dying compared with babies who had dry cord care. In recent surveys in South Asia, we found that antenatal care and skilled attendance at birth significantly increased the odds of receiving recommended newborn care practices. However, missing responses were common for mothers whose newborn died, particularly in response to questions about the child’s first bath. These results suggest a potential mediating relationship of newborn care practices between antenatal and delivery care and newborn survival, and we suggest that counseling on these interventions during antenatal care might help to ensure that women understand the recommended practices in the event that they cannot access a health facility to deliver. Findings also suggest that a mother’s recall or report of details surrounding the traumatic event of a loss of a child may be incomplete.