Newborn Care Practices At Home In Sri Lanka

Newborn Care Practices at Home: Effect of a Hospital-based Intervention in Sri Lanka
by Upul Senarath,a,* Dulitha N. Fernando,a and Ishani Rodrigob Departments of aCommunity Medicine, and bPaediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

Summary The aim of the present study was to evaluate the effect of an essential newborn care (ENC) training programme formaternity ward staff in improving newborn care practices after hospital discharge. A before-and-after study was conducted in the community involving mothers who had given birth in two hospitals in the Puttalam district in Sri Lanka. The intervention was a 4-day training programme and primarily aimed at increasing knowledge and skills of ENC among health care providers in the maternity units of thesehospitals. Before the intervention, 144 mother–newborn pairs were followed-up and interviewed at their households within 28–35 days of delivery. Three months after the intervention, 150 mother–newborn pairs were interviewed at home. Results revealed that there was a significant improvement in umbilical cord care practices at home following the intervention. Application of ‘surgical spirit’ on umbilicalcord has declined from 71.5% in the pre-intervention to 45.3% in the post-intervention samples (p < 0.001). Pre-intervention breastfeeding rates were high, and there wasn’t any further improvement in the post-intervention. There was a 35% reduction in the proportion of newborns who developed any undesirable health events at home (p < 0.05). Findings suggest that the implementation of acomprehensive 4-day training programme of ENC for maternity ward health professionals can be followed by a significant improvement in mothers’ practices on care of umbilical cord and clinical outcomes of newborns. Key words: essential newborn care, training of health staff, neonatal care, Sri Lanka.

Acknowledgements The National Science Foundation, Sri Lanka has provided funds for this study under GrantNo. RG/2003/M/06. The authors wish to acknowledge the Family Health Bureau Colombo, the health staff of the Puttalam district, Dr Sybil Wijesinghe (Former consultant Family Health Bureau, Colombo) and Professor Graham Vimpani (Discipline of Paediatrics and Child Health, University of Newcastle, Australia) for the information and logistic support in this research activity.
*Upul Senarath wasoffered a visiting fellowship at the School of Medical Practice and Population Health, University of Newcastle, NSW, Australia during the preparation of the manuscript. Correspondence: Dr Upul Senarath, Department of Community Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 08, Sri Lanka. E-mail .

Introduction Four million newborns die each year, 99% of them in low-and middle-income countries [1]. The distribution of direct causes of death indicates that severe infections, prematurity related conditions and birth asphyxia account for most neonatal deaths [1, 2]. Majority of these deaths could be prevented through simple and cost-effective essential newborn care (ENC) interventions [3, 4]. Previous studies have highlighted that field-based health workertraining was associated with a reduction in neonatal mortality and morbidity in the community [5–7]. In countries with high institutional birth rates, training of hospital health care providers is commonly viewed as an important strategy, since the most critical period of newborn care lies during the hospital stay. However, the hospital-based interventions should not only target on improving carepractices within the hospital, but also should play a major role in developing mothers’ skills and confidence for caring newborns while at home. ENC is based on principles of prevention of infection, thermal protection, resuscitation of newborn with asphyxia, early and exclusive
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