Sources for and quality of neonatal care in 45 low- and middle-income countries

Area of Science:

• Public Health
• Neonatal Medicine
• Global Health Equity

Background:

• Neonatal mortality accounts for nearly half of all under-five deaths globally.
• Skilled birth attendance, essential newborn care (ENC), and postnatal care (PNC) are critical for improving neonatal survival.
• Infections require prompt treatment to prevent neonatal mortality.

Purpose of the Study:

• To assess the levels of ENC and PNC received by mothers and newborns in 45 low- and middle-income countries.
• To examine how ENC and PNC adherence varies by place of delivery.
• To evaluate care-seeking behaviors and sources for sick neonates with fever, focusing on socioeconomic disparities.

Main Methods:

• Analysis of Demographic and Health Survey data from 45 low- and middle-income countries.
• Assessment of adherence to ten key ENC and PNC indicators.
• Examination of care-seeking for neonatal fever across different socioeconomic groups.

Main Results:

• Less than two-thirds of mothers and newborns received care aligned with global ENC and PNC standards for five key indicators.
• Adherence to ENC/PNC standards was higher in private than public facilities, except for immediate breastfeeding and skin-to-skin contact.
• Newborns delivered at home with a skilled birth attendant (SBA) showed the lowest adherence to ENC/PNC, except for immediate breastfeeding.
• Significant socioeconomic disparities were observed in access to skilled delivery and adherence to ENC/PNC, particularly for home births with an SBA.
• Approximately half of caregivers sought outside care for neonatal fever, with 45% utilizing the private sector; care-seeking patterns showed socioeconomic consistency despite disparities.

Conclusions:

• There are significant gaps in the consistent application of essential newborn care and postnatal care standards, highlighting inequities in maternal and newborn health services.
• Socioeconomic disparities in both care provision and care-seeking for neonatal illness persist, disproportionately affecting vulnerable populations.
• Ensuring equitable access to high-quality neonatal care for all families, especially the poorest, is paramount to reducing neonatal and child mortality and achieving global health equity.