Background
Methods
Study design and setting
Population, sample size and sampling methods
Instruments and measurements
Variables | Descriptions | Measurements |
---|---|---|
Cluster (‘Kebele’) | The smallest administrative unit having about 5000 population on the average. | 73 ‘Kebeles’ (clusters) identified by multistage sampling method were included in the study |
Dependent variable | ||
Neonatal care practice | The minimum neonatal care package adapted from WHO having 12 items were used to create composite index (score) by using PCA. | The 12 items were measured in “Yes” or ‘No’ responses. Yes was given a value of ‘1’ and No was given ‘0’ to covert the categorical variables in to dummy variables. PCA was done to create composite index (score) which was a continuous variable. |
The 12 items used to create neonatal care score (index) | ||
1. Tetanus toxoid (TT) during Pregnancy | Vaccination given for mothers during ANC visit to prevent the mother and her child against Tetanus | Those who received at least 1 dose of TT were coded as ‘Yes =1’ and otherwise ‘No = 0’ |
2. Birth preparedness and complication readiness (BPCR) | A package of interventions composed of 5 variables (Planed to save money, planed to arrange transport, identified place of delivery, identified skilled attendant and identified blood donor) | Composite variable was computed by adding the five responses. Women who scored 3 or more ‘Yes’ responses were categorized as ‘prepared = 1’ and otherwise ‘not prepared = 0’ |
3. Antenatal care (ANC) | Having health facility visit for pregnancy check up by skilled attendants during pregnancy | Those who had at least one ANC visit were labeled as "Yes = 1" and otherwise ‘No = 0’ |
4. Information on neonatal care | Included 4questions: Information on self care, breast feeding, neonatal feeding and vaccination. | Mothers who received the 4 information were labeled as ‘Received adequate information = 1’ and otherwise ‘No adequate information = 0’ |
5. Skilled care at birth | The place where the neonate was born and the person who assisted the mother during delivery | Deliveries conducted in health facility (hospital or health centre) attended by skilled attendant (Those who have trained to the level of Diploma and above) were categorized as “skilled care = 1”, and deliveries conduced at home or anywhere outside a health facility attended by un skilled attendant (family members, TBAs/TTBAs and HEWs) were categorized as ‘Unskilled care = 0’ |
6. Social support during labor | Having accompanying person during labor | Those who had someone (family member/relative) with them during the time of labor and delivery were labeled as ‘have social support = 1’ and otherwise ‘No social support = 0’ |
7. Immediate thermal care | Protecting the newborn from hypothermia by covering with clean cloth and placing in skin-to-skin contact with the mother | Neonates wrapped with clean cloth and placed in skin-to-skin contact with the mother were labeled as ‘appropriate thermal care = 1’ and otherwise ‘Not appropriate thermal care = 0’. |
8. Breast-feeding initiation | The time the newborn first feed breast milk | Those started within 1 hour of birth were labeled as ‘timely initiated = 1 ’ and otherwise ‘delayed initiation = 0’ |
9. Clean and safe cord care | Using clean instrument to cut and tie the cord and putting nothing on the umbilical stump. | If cut by clean material, tied by clean thread and nothing is put on the stamp, it was labeled as “clean/safe cord care = 1’ if any one of these was missing, it was labeled as ‘Non-clean cord care = 0.’ |
10. Exclusive breast feeding of neonate | Giving only breast milk in the first 28 days | Thos who were on breast milk only were labeled as ‘on exclusive breast milk = 1’ and who started anything, including plain water were labeled as ‘Not on exclusive breast milk = 0’. |
11. Newborn bathing | Washing the newborn for the first time | Those who were washed after the first 6 hours of birth were labeled as “appropriate bathing = 1’ & otherwise ‘not = 0’. |
12. Vaccine on date of birth | Includes BCG and polio-0 on the date of birth | Neonates who received the 2 vaccines were labeled as ‘received the vaccines on date of birth = 1’ if one of them was missing, it was labeled as ‘no appropriate immunization on date of birth = 0’ |
Level-2 predictor variables | Communal (kebele) characteristics | |
---|---|---|
Place of residence | The usual place of residence where the woman lives | Rural kebele was coded as ‘1’ and Urban kebele was coded as ‘2’. |
Average distance from health centre | Approximate distance of respondent’s home from the nearest health centre on foot in munities as reported by respondent. | Average distance was computed for each kebele and dichotomized as ‘≤2hours = 1’ and ‘>2hours = 2’ |
Average distance from Hospital | Approximate distance of respondent’s home from the nearest hospital on foot in munities as reported by the respondent. | Average distance was computed for each kebele and categorized as ‘≤2 hours = 1’, ‘>2 hours =2’ |
Level-1 predictor variables | Individual and household characteristics | |
Age | Age of women at interview in completed years | Categorized in to 7 groups by five-years interval, which later recoded in to three categories: ‘<20 = 1’, ‘20-29 = 2’ or ‘>29 = 3’ |
Ethnicity | The ethnic background of the respondent | Each ethnicity was entered and later recoded as ‘Oromo = 1’ and ‘Others = 2’. Others were merged because they were very few for logistic regressions. |
Religion | The religious background of the respondent | Each religion was entered and later recoded as ‘Muslim = 1’ or ‘Others = 2’. Others were merged because they were very few for logistic regressions. |
Educational status | Highest level of education attained by the respondent and her husband | Categorized in to 4 groups as ‘No Formal Education = 1’, ‘primary (1-8) = 2’, ‘Secondary or above (9+ = 3) |
Occupational status | Current employment status and specific occupation of respondent and her husband | Categorized as ‘housewife’ (‘farmer’ for husbands) = 1, ‘employed = 2’, and ‘merchant = 3’ |
Wealth quintiles | Using EDHS questionnaire, house hold assets ownership were assessed and wealth index was computed by using principal component analysis | The wealth status was categorized in to five groups and ranked from poorest to wealthiest quintiles. ’First quintile =1’, ‘Second quintile = 2’, ‘Third quintile = 3, ‘Fourth quintile = 4’ and ‘Fifth quintile = 5’. |
Birth order | Number of births a woman ever had including current birth | The responses was categorized in to three categories as: ‘1st birth order =1’, ‘2nd – 4th = 2’ and ‘≥5th birth order = 3’ |
Preceding birth interval | The duration between the current birth and the preceding birth in months. | The responses were categorized in to three as: ‘<24 months = 1’, ‘24-48 months = 2” and “>48 months = 3’. |
Data management and analysis
Ethical consideration
Results
Socio-demographic characteristics
Variables | No. | Percent |
---|---|---|
Residence | ||
Urban | 861 | 24.9 |
Rural | 2602 | 75.1 |
Age (Years) | ||
<20 | 174 | 5.0 |
20-29 | 2209 | 63.8 |
≥30 | 1080 | 31.2 |
Ethnicity | ||
Oromo | 3033 | 87.6 |
Amhara | 169 | 4.9 |
Dawuro | 96 | 2.8 |
Others* | 165 | 4.7 |
Religion | ||
Musilim | 3019 | 87.2 |
Orthodox | 345 | 10.0 |
Protestant | 99 | 2.9 |
Educational status | ||
No formal education | 1871 | 54.0 |
Primary (1-8) | 1270 | 36.7 |
Secondary (9-12) | 256 | 7.4 |
>12 | 66 | 1.9 |
Occupation | ||
Housewife | 3280 | 94.7 |
Employed (GO, NGO & Private) | 78 | 2.2 |
Others‡ | 105 | 3.1 |
Husband’s Occupation | ||
Farmer | 2459 | 71.0 |
Employed (GO, NGO & Private) | 376 | 10.8 |
Merchant | 413 | 11.9 |
Daily laborer | 190 | 5.5 |
Others‡ | 25 | 0.8 |
Sex of neonates | ||
Male | 1779 | 51.4 |
Female | 1684 | 48.6 |
Types of birth | ||
Singleton | 3387 | 97.8 |
Twins | 76 | 2.2 |
Neonatal care practices
Variables | No. | Unweighted % | Weighted % |
---|---|---|---|
Received TT during pregnancy (at least 1 dose) | 1962 | 56.7 | 53.8 |
Planed for birth and its complications | 1202 | 34.7 | 23.8 |
Received skilled ANC Care at least once | 1840 | 53.1 | 41.9 |
Adequate information on neonatal care | 1501 | 43.3 | 43.0 |
Skilled care at birth | 1064 | 30.7 | 17.5 |
Social support during labor and delivery | 3268 | 94.4 | 95.0 |
Appropriate immediate thermal care | 3359 | 97.0 | 96.5 |
Clean cord care | 3042 | 87.8 | 86.5 |
Timely initiation of breast feeding (within 1 hour) | 2307 | 66.6 | 64.1 |
Exclusive breast feeding (within 28 days) | 3176 | 91.7 | 91.5 |
Appropriate bathing time (>6 hrs) | 2160 | 62.4 | 56.5 |
Vaccines on date of birth (BCG & Polio 0) | 425 | 12.3 | 8.1 |
Over all neonatal care practice | |||
Good Practice (≥Mean score) | 2240 | 64.7 | 59.5 |
Poor Practice (<Mean score) | 1223 | 35.3 | 40.5 |
Factors affecting neonatal care practice
Models | Fixed intercept -cons (95 % CI) | Random effect as Level-2 variance | Intra-class Correlation Coefficient: ICC(ρ) | Log likelihood (LR) (deviance) | Significance of LR test Vs linear regression (P-value) | |
---|---|---|---|---|---|---|
var (-cons (95 % CI)) | var (Residual (95 % CI)) | |||||
Empty model | 0.25 (0.01, 0.49) | 1.02 (0.72, 1.44) | 2.05 (1.96, 2.15) | 0.332 = 33.2% | −6269.60 | <0.0001 |
Full model | −0.30 (-0.69, 0.09) | 0.36 (0.25, 0.51) | 1.94 (1.85, 2.04) | 0.157 = 15.7% | −6143.08 | <0.0001 |
Variables | Crude estimate β (95 % CI) | Adjusted estimate β (95 % CI) |
---|---|---|
Level-2 (higher level)-communal variables | ||
Place of residence | ||
Urban | 1.63 (1.51, 1.75) | 0.86 (0.45, 1.23) |
Distance from health centre (on foot) | ||
>2hours | −0.58 (-0.70, -0.45) | −0.09 (-0.45, 0.27) |
Distance from Hospital (on foot) | ||
>2hours | −1.38 (-1.54, -1.23) | −0.33 (-0.77, 0.11) |
Level-1-lower level (individual) variables | ||
Age (Years) | ||
20-29 | −0.55 (-0.82, -0.2) | −0.21 (-0.44, 0.03) |
>29 | −0.88 (-1.14, -0.59) | −0.25 (-0.52, 0.11) |
Educational status | ||
Primary education (Grades 1-8) | 0.52 (0.41, 0.64) | 0.21 (0.10, 0.32) |
Secondary or above (Grades ≥9) | 1.95 (1.75, 2.14) | 0.76 (0.55, 0.98) |
Occupation | ||
Employed | 1.20 (0.94, 1.45) | 0.18 (-0.06, 0.41) |
Husband’s occupation | ||
Employed | 1.88 (1.71, 2,05) | 0.54 (0.30, 0.77) |
Merchant | 1.28 (1.14, 1.42) | 0.28 (0.09, 0.47) |
Wealth index | ||
Second quintile | 0.45 (0.27, 0.63) | 0.18 (0.03, 0.31) |
Third quintile | 0.57 (0.38, 0.75) | 0.30 (0.15, 0.46) |
Fourth quintile | 0.70 (0.52, 0.88) | 0.41 (0.25, 0.56) |
Fifth quintile | 0.72 (0.54, 0.90) | 0.30 (0.14, 0.46) |
Birth order | ||
2nd -4th | −0.58 (-0.73, -0.44) | −0.30 (-0.52, -0.09) |
≥5th | −1.07 (-1.24, -0.91) | −0.43 (-0.68, -0.19) |
Birth interval | ||
24-48 Months | 0.34 (0.12, 0.56) | 0.20 (0.01, 0.39) |
>48 Months | 0.93 (0.65, 1.21) | 0.34 (0.10, 0.58) |