Essential newborn care practices at health facilities and homes in Ethiopia: a cross-sectional study

Background: WHO recommends essential newborn care practices that every newborn needs for health and survival regardless of birthplace. Previous Ethiopian studies of these actions had long recall periods and most considered either facility or home deliveries. We aimed to assess selected practices, i.e., thermal care, cord care, initiation of breastfeeding, and first immunizations among neonates born at health facilities and homes in Ethiopia.

Methods: We used data from the Performance Monitoring for Action Ethiopia 2019-2020 survey and analyzed 2,493 live births whose mothers completed interviews at seven weeks postpartum in five regions, namely Tigray, Afar, Amhara, Oromia, Southern Nations, Nationalities and Peoples regions, and Addis Ababa. Practices were assessed using an interviewer-administered questionnaire. Essential newborn care indicators were analyzed among neonates born at health facilities and homes and expressed as proportions with a 95% confidence interval. Clustering was accounted for in all analyses.

Results: Practices were assessed among 1532 (61%) facility-born and 961 (39%) home-born neonates. Some of the appropriate actions had higher coverage at health facilities: skin-to-skin care 76% vs. 9%, immediate drying and wrapping with a cloth 80% vs. 79%, delayed bathing until 24 h after birth 73% vs. 39%, appropriate instrument to cut the cord 100% vs. 94%, use of new or boiled instrument 90% vs. 79%, nothing or chlorhexidine applied on cord 89% vs. 64%, first-hour initiation of breastfeeding 69% vs. 62%, and BCG and first polio immunization within the first six weeks after birth 54% vs. 20%. Thermal care, cord care, and provision of vaccines at birth were relatively more common in Addis Ababa, while first-hour breastfeeding initiation was higher in the Oromia region.

Conclusion: Neonates born at health facilities had higher, although not optimal, coverage of thermal care, cord care, early breastfeeding initiation, and the first immunizations. Strengthening the health extension program to promote facility delivery, further enhancing the coverage and quality of essential newborn care at health facilities, and increasing the coverage of first vaccinations and other essential services after birth are crucial for improving neonatal health and survival in Ethiopia.