Newborn care practices among postnatal mothers in Garissa County, Kenya.
Kumola, Annastacia Mutono
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Every year, four million infants die within their first month of life, representing nearly 40 per-cents of all deaths of children under age 5 globally. In Kenya, neonatal mortality is 31 per 1000 live births with neonates contributing 42% of the under-five mortality while in North Eastern province (which hosts Garissa County the area of study) under-five mortality was 33 per 1000 with neonatal mortality contributing to 60% of infant mortality in the region. Delivery by a skilled birth attendant has remained low at 32% in this region with only 17% of births occurring in a health facility. Therefore understanding newborn care practices in the home environment where most newborns are born is essential in order to develop appropriate approaches for reducing neonatal mortality. The aim of this study was therefore to establish the newborn care practices (thermal care, cord care and breastfeeding) in the community among post-natal mothers in Garissa County, Kenya. A cross-sectional study design was used to evaluate newborn care practices in seven community units. Data was collected from 421 respondents from a randomly selected sample of postnatal mothers who had delivered in the past one year preceeding the study period in the community of study. Data was collected through semi-structured questionnaires, key informant interviews and focused group discussions. Data was analyzed using STATA. Chi-square and logistic regression were to test for association between the various explanatory factors and the newborn care practices. A total of 421 respondents were interviewed. The mean age of the respondents was 24 (SD 5) years with majority 70% between 20-29years. Majority of the respondents were married 97% (407). Most of the respondents, 51% (212) had no formal education. Newborn care practices were identified as poor in 14% of the respondents for all three practices, more specifically, 66% of the respondents had poor breastfeeding practices, 57% had poor cord care practices and 45% had poor thermal care practices. The following factors were significantly associated with poor newborn care practices: The logistic regression analysis revealed that, across all three newborn practices timing of the first ANC visit (P value <0.001) and place of delivery (P value < 0.001) had significant influence on newborn care practices. The significant predictors of cord care practice were marital status (P value= 0.025) and timing of first ANC visit P value <0.001. Religion (P value<0.001) and Maternal occupation (P value=0.002) were significantly associated with thermal care practice. Breastfeeding was found to be influenced by religion (P value <0.001), maternal occupation (P value <0.001), attendance of ANC (P value <0.001) and paternal occupation (P value=0.005). Newborn care is still largely poor with health facility delivery, ANC attendance and early timing of ANC visit as the main predictors of good newborn care. Results from FGD and KII revealed that harmful practices such as application of cow dung on the stump, immediate bathing of the newborn and introduction of pre-lacteals meals were still being practiced. This was driven by traditional beliefs. This study recommends need advocacy to mothers to deliver at health facilities and seek antenatal care early as this will promote good newborn care practices. The study recommends further research on assessing newborn care practices at among the health care providers at facility level.