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Geographic equity in essential newborn care practices in Ethiopia: a cross-sectional study
Tadesse Guadu Delele1,2,3, Lars Åke Persson4,5, Joanna Schellenberg4
1Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. tadeguade2@gmail.com.
Insights
Essential newborn care practices in Ethiopia show geographic inequities, particularly in delayed bathing and immunizations. Improving facility births and postnatal counseling is crucial for equitable access to essential newborn care.
Area of Science:
- Public Health
- Neonatal Care
- Health Equity
Background:
- Essential newborn care (ENC) encompasses vital practices for all neonates.
- Geographic equity in ENC access is understudied in Ethiopia.
- Evidence on geographic disparities in ENC practices is scarce.
Purpose of the Study:
- To assess the geographic distribution and equity of selected WHO-recommended ENC practices in Ethiopia.
- To analyze ENC practices for neonates born in health facilities versus at home.
- To identify geographic variations in initial skin-to-skin care, delayed bathing, cord care, breastfeeding initiation, and early immunizations (BCG, polio).
Main Methods:
- Analysis of cross-sectional survey data from 2,493 neonates (2019-2020).
- Utilized Global Moran's I and Local Getis-Ord Gi* statistics for spatial analysis.
- Employed Kriging interpolation to predict national coverage of ENC practices.
Main Results:
- ENC practices were more prevalent in health facilities and in Central, Northern, and Southern regions.
- Geographic inequities identified in delayed bathing (facility/home), proper cord care (facility), and first immunizations (facility/home).
- No significant geographic inequities found for initial skin-to-skin care and timely breastfeeding initiation.
Conclusions:
- Higher ENC coverage observed in health facilities and specific regions (Central, Northern).
- Significant geographic inequities persist in delayed bathing and early immunizations.
- Recommendations include enhancing facility delivery, ensuring vaccine availability, and improving maternal counseling throughout the perinatal period to achieve geographic equity in ENC.
Background:
Essential newborn care is a set of measures every newborn baby needs, regardless of its birthplace. Geographic equity in essential newborn care refers to the fairness of access to newborn care across different regions. These practices vary across different social groups, but evidence on the geographic equity of newborn care in Ethiopia is scarce. We aimed to assess the geographic distribution and equity of selected essential newborn care practices (initial skin-to-skin care, delayed bathing, proper cord care, timely breastfeeding initiation, and immunizations of BCG and first-dose polio vaccines) recommended by the World Health Organization among neonates born at health facilities and homes in Ethiopia.
Methods:
We analyzed cross-sectional survey data from 2,493 neonates in the Performance Monitoring for Action (PMA) Ethiopia 2019-2020 survey in five regions and the Addis Ababa City Administration. The survey employed a cross-sectional study design, and the data were collected from 2019 to 2020. We studied the geographic variation of selected essential newborn care practices using Global Moran's I statistics and hot and cold spot analysis (Local Getis-Ord Gi* statistic), and the coverage of these practices were predicted for the whole country using Kriging interpolation.
Results:
This study showed that selected essential newborn care practices were higher among neonates in health facilities, those born in Central, Northern, Southern, and a few areas in Southwest and Northwest Ethiopia. Geographic inequities were demonstrated in delayed bathing in facility and home births, proper cord care in facility births, and first immunizations in both facility and home births. Geographic inequities were not observed for initial skin-to-skin care and timely breastfeeding initiation.
Conclusion:
Selected essential newborn care practices were higher among neonates born in health facilities, and the recommended essential newborn care practices were higher in Central and Northern Ethiopia. There were geographic inequities in delayed bathing and immunizations of BCG and first-dose polio vaccines among neonates born in health facilities and homes. Enhancing facility delivery, availing first vaccinations in facilities, and improving discharge counseling for mothers during antenatal, delivery, and postnatal care are crucial to ensuring geographic equity in essential newborn care in Ethiopia.
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