Background
Thermal care practices
Hygienic cord care
Methods
Aims
Data
Indicator construction
Intervention | Indicator | WHO Recommendationa | Harmonized Response Categories | Notes |
---|---|---|---|---|
Thermal care | Immediate drying or wrapping | Dried or wrapped immediatelyb | (1) Dried or wrapped within 5 min of birth or before delivery of the placenta (2) Dried or wrapped after 5 min of birth or after delivery of the placenta (3) Not dried, don’t know, or missing | Only surveys in Bangladesh included options for not being dried or wrapped. |
Delayed bathing | Bathed after 24 h; however, after 6 h may be appropriate in certain contexts | (1) Bathed 6 h or more after birth (2) Bathed within the first 6 h of birth (3) Not bathed, don’t know, or missing | Question not included in India survey. Only surveys in Bangladesh included an option for “Not bathed”. | |
Immediate skin-to-skin contact | Skin-to-skin contact between babies and mothers during the first hour after birth | (1) Skin-to-skin contact immediately after birth (2) No skin-to-skin immediately after birth (3) Don’t know, or missing | Question not included in India survey. | |
Full thermal care | Immediate drying, delayed bathing, skin-to-skin | (1) All recommended thermal care interventions (2) None, some, don’t know, or missing | In India, the thermal care composite variable includes only the indicator for drying. | |
Hygienic cord care | Clean instrument used to cut the cord | A new or boiled instrument should be used to cut the cord | (1) A new or boiled instrument was used to cut the umbilical cord, or a clean delivery kit was used (2) A used or non-boiled instrument (3) Don’t know or missing | Clean instruments could include (boiled or new) blade, scissors, or knife. Other instruments included bamboo, sickle, or other. |
Nothing applied to the cord | Dry cord care is recommended; however, in high-mortality settings chlorhexidine is recommended | (1) Nothing was put on the umbilical cord stump (2) Only an antiseptic and no other substance (3) Any other substance applied (4) Don’t know or missing | Question not included in India survey. Antiseptics include chlorhexidine, methylated spirits, gentian violet, unspecified antibiotic. Other substances include mustard oil, ghee, turmeric, chewed rice, ginger juice, boric powder, talcum powder, vermillion, dung, local herbs. | |
Full hygienic cord care | Clean instrument used to cut the cord and dry or antiseptic cord care | (1) Both recommended cord practices (2) Neither, only one, or don’t know or missing | In India, the cord care composite variable includes only the indicator for cord cutting. |
Analysis
Trends in newborn care practices
Determinants of newborn care practices in South Asia
Newborn care practices and newborn mortality
Results
Trends
Background characteristics
India 2015–16 | Bangladesh 2014 | Nepal 2016 | ||||
% | N | % | N | % | N | |
Place of residence | ||||||
Urban | 15.2 | 5230 | 17.7 | 501 | 40.5 | 617 |
Rural | 84.8 | 29095 | 82.3 | 2335 | 59.5 | 905 |
Wealth quintile | ||||||
Lowest and second lowest | 74.4 | 25538 | 53.2 | 1509 | 59.9 | 912 |
Middle | 14.0 | 4812 | 20.2 | 573 | 21.4 | 326 |
Second highest and highest | 11.6 | 3974 | 26.6 | 754 | 18.7 | 284 |
Education | ||||||
None | 53.7 | 18448 | 19.4 | 549 | 49.6 | 754 |
Primary | 17.6 | 6038 | 33.3 | 945 | 23.6 | 359 |
Secondary or higher | 28.7 | 9838 | 47.3 | 1341 | 26.8 | 408 |
Religion | ||||||
Hindu | 71.3 | 24484 | 5.5 | 156 | 84.9 | 1,292 |
Muslim, other | 28.7 | 9841 | 94.5 | 2680 | 15.1 | 230 |
Maternal age at birth | ||||||
< 18 | 2.2 | 772 | 16 | 454 | 5.1 | 78 |
18–34 | 89.2 | 30601 | 79.6 | 2259 | 88.4 | 1,345 |
35 and older | 8.6 | 2952 | 4.3 | 123 | 6.5 | 98 |
Preceding birth interval | ||||||
First birth | 16.0 | 5499 | 33.7 | 955 | 19 | 289 |
Less than 2 years | 22.3 | 7644 | 8.4 | 237 | 17.7 | 269 |
2 years or more | 61.7 | 21182 | 58 | 1644 | 63.3 | 964 |
Previous child under 5 die | ||||||
No | 84.4 | 28978 | 88.1 | 2498 | 86.2 | 1,311 |
Yes | 15.6 | 5347 | 11.9 | 338 | 13.8 | 210 |
Antenatal care | ||||||
Less than 4 visits | 76.2 | 26166 | 79.1 | 2243 | 51.6 | 785 |
4 or more visits | 23.8 | 8159 | 20.9 | 593 | 48.4 | 736 |
Tetanusa | ||||||
Not fully protected | 18.9 | 6476 | n/a | 17.1 | 260 | |
Fully protected | 81.1 | 27849 | 82.9 | 1,261 | ||
Size at birth | ||||||
Normal or Large | 82.3 | 28234 | 78.9 | 2236 | 82.7 | 1,258 |
Small or very small | 17.7 | 6090 | 21.1 | 600 | 17.3 | 264 |
Gender of child | ||||||
Female | 46.5 | 15956 | 48.2 | 1368 | 45.3 | 690 |
Male | 53.5 | 18369 | 51.8 | 1468 | 54.7 | 832 |
Skilled attendant at birth | ||||||
No | 78.3 | 26873 | 91.8 | 2602 | 93.1 | 1,417 |
Yes | 21.7 | 7451 | 8.2 | 233 | 6.9 | 105 |
PNC in 2 days | ||||||
No | 83.3 | 28578 | 61.4 | 1740 | 87.2 | 1,327 |
Yes | 16.7 | 5747 | 38.6 | 1096 | 12.8 | 194 |
Died the first 28 days | ||||||
No | 97.5 | 33453 | 98.1 | 2783 | 98.7 | 1,501 |
Yes | 2.5 | 871 | 1.9 | 53 | 1.3 | 20 |
Total | 100.0 | 34324 | 100.0 | 2836 | 100.0 | 1,521 |
Mortality analysis | ||||||
India 2015–16 | Bangladesh 2014 and Nepal 2016 | |||||
Number of excluded casesb | 592 | 99 | ||||
Number of deaths on days 1–28 | 555 | 34 | ||||
Total for mortality analysis | 33733 | 4115 |
Predictors of newborn care practices in South Asia
India 2015–16 (immediate drying) | Bangladesh 2014 (immediate drying, delayed bathing, and skin-to-skin) | Nepal 2016 (immediate drying, delayed bathing, and skin-to-skin) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
UOR | 95% CI | AOR | 95% CI | UOR | 95% CI | AOR | 95% CI | UOR | 95% CI | AOR | 95% CI | |
Place of residence (ref = rural) | ||||||||||||
Urban |
0.9*
| [0.8,1.0] |
0.9*
| [0.8, 1.0] | 0.7 | [0.5,1.0] |
0.6*
| [0.4, 0.9] | 0.7 | [0.5,1.1] | 0.7 | [0.5, 1.1] |
Wealth quintile (ref = lowest and second) | ||||||||||||
Middle |
0.8**
| [0.7,0.9] |
0.8***
| [0.7, 0.9] | 1.1 | [0.7,1.6] | 1.0 | [0.6, 1.5] |
2.4***
| [1.7,3.4] |
2.2***
| [1.5, 3.1] |
Second highest and highest | 1.1 | [1.0,1.2] | 1.0 | [0.9, 1.2] | 1.4 | [1.0,1.9] | 1.4 | [1.0, 2.0] |
2.4***
| [1.6,3.4] |
2.3***
| [1.6, 3.4] |
Education (ref = none) | ||||||||||||
Primary |
1.2**
| [1.1,1.3] |
1.1*
| [1.0, 1.3] | 1.2 | [0.8,1.8] | 1.3 | [0.8, 1.9] | 0.8 | [0.6,1.2] | 0.8 | [0.6, 1.2] |
Secondary or higher |
1.2***
| [1.1,1.3] |
1.1**
| [1.0, 1.2] |
1.7*
| [1.1,2.7] |
1.6*
| [1.0, 2.5] | 0.8 | [0.6,1.2] | 0.8 | [0.6, 1.2] |
Religion | ||||||||||||
Hindu | ref | 0.7 | [0.4, 1.3] | 0.8 | [0.4, 1.5] | ref | ||||||
Muslim, other |
0.9*
| [0.8,1.0] | 0.9 | [0.8, 1.0] | ref | 1.1 | [0.6,2.2] | 1.0 | [0.6, 1.8] | |||
Maternal age at birth (ref = 18–34) | ||||||||||||
< 18 | 1.0 | [0.7,1.3] | 1.0 | [0.7, 1.3] | 1.0 | [0.7,1.5] | 1.0 | [0.6, 1.6] | 0.8 | [0.5,1.4] | 1.0 | [0.5, 1.8] |
35 and older |
0.9*
| [0.8,1.0] | 0.9 | [0.8, 1.0] | 0.8 | [0.4,1.7] | 0.9 | [0.4, 1.9] | 0.7 | [0.4,1.4] | 0.9 | [0.5, 1.5] |
Preceding birth interval (ref = 2+) | ||||||||||||
First birth | 1.0 | [0.9,1.1] | 1.0 | [0.9, 1.1] | 1.0 | [0.7,1.4] | 0.9 | [0.6, 1.3] | 1.1 | [0.7,1.5] | 1.1 | [0.7, 1.7] |
Less than 2 years | 1.0 | [0.9,1.1] | 1.0 | [0.9, 1.1] | 0.8 | [0.4,1.4] | 0.8 | [0.4, 1.4] |
1.7**
| [1.2,2.5] |
1.6*
| [1.1, 2.4] |
Antenatal care (ref = less than 4) | ||||||||||||
4 or more visits |
1.4***
| [1.3,1.6] |
1.4***
| [1.2, 1.5] | 1.3 | [0.9,1.8] | 1.2 | [0.8, 1.7] | 0.9 | [0.6,1.2] | 0.9 | [0.7, 1.3] |
Size at birth(ref = normal or large) | ||||||||||||
Small or very small | 0.9 | [0.9,1.0] | 0.9 | [0.8, 1.0] |
1.7**
| [1.2,2.3] |
1.8***
| [1.3, 2.5] | 1.2 | [0.8,1.7] | 1.3 | [0.9, 1.8] |
Gender of child (ref = female) | ||||||||||||
Male | 1.0 | [0.9,1.0] | 1.0 | [0.9, 1.0] | 1.0 | [0.8,1.3] | 1.0 | [0.8, 1.3] | 0.9 | [0.7,1.1] | 0.8 | [0.7, 1.1] |
Skilled attendant at birth (ref = no) | ||||||||||||
Yes |
1.5***
| [1.4,1.7] |
1.4***
| [1.3, 1.6] | 1.5 | [1.0,2.5] | 1.4 | [0.9, 2.4] |
2.8***
| [1.7,4.6] |
2.4**
| [1.4, 4.2] |
ROC | 0.57 | 0.59 | 0.64 | |||||||||
Pseudo R2 | 0.01 | 0.01 | 0.04 |
India 2015–16 (clean instrument to cut the cord) | Bangladesh 2014 (clean instrument, dry or antiseptic cord care) | Nepal 2016 (clean instrument, dry or antiseptic cord care) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
UOR | 95% CI | AOR | 95% CI | UOR | 95% CI | AOR | 95% CI | UOR | 95% CI | AOR | 95% CI | |
Place of residence (ref = rural) | ||||||||||||
Urban | 1.2 | [0.9,1.6] | 1.1 | [0.8, 1.5] | 1.0 | [0.7,1.3] | 1.0 | [0.8, 1.4] | 1.1 | [0.8,1.5] | 1.1 | [0.8, 1.4] |
Wealth quintile (ref = lowest and second) | ||||||||||||
Middle | 1.0 | [0.8,1.3] | 0.9 | [0.7, 1.1] | 1.1 | [0.7,1.6] | 1.0 | [0.7, 1.4] |
0.7*
| [0.5,1.0] | 0.8 | [0.6, 1.0] |
Second highest and highest |
1.4*
| [1.0,1.9] | 1.2 | [0.8, 1.6] | 1.0 | [0.7,1.3] | 0.8 | [0.6, 1.2] | 0.8 | [0.6,1.1] | 0.8 | [0.6, 1.1] |
Education (ref = none) | ||||||||||||
Primary | 1.1 | [0.9,1.3] | 1.1 | [0.9, 1.3] | 0.9 | [0.7,1.2] | 1.0 | [0.8, 1.3] | 1.1 | [0.8,1.4] | 1.1 | [0.8, 1.4] |
Secondary or higher |
1.3**
| [1.1,1.6] |
1.3**
| [1.1, 1.6] | 1.2 | [0.9,1.7] | 1.3 | [1.0, 1.7] |
1.6**
| [1.2,2.1] |
1.5*
| [1.1, 2.1] |
Religion | ||||||||||||
Hindu | (ref) | 1.3 | [0.8, 1.9] | 1.2 | [0.8, 1.9] | (ref) | ||||||
Muslim, other | 0.9 | [0.8,1.1] | 0.9 | [0.8, 1.1] | (ref) | 0.9 | [0.6,1.3] | 1.0 | [0.6, 1.5] | |||
Maternal age at birth (ref = 18–34) | ||||||||||||
< 18 | 0.7 | [0.5,1.0] | 0.8 | [0.5, 1.2] | 0.8 | [0.6,1.0] | 1.0 | [0.7, 1.4] | 1.0 | [0.6,1.6] | 0.8 | [0.5, 1.4] |
35 and older |
0.7***
| [0.6,0.8] |
0.7**
| [0.6, 0.9] | 1.0 | [0.6,1.5] | 1.1 | [0.7, 1.8] | 0.8 | [0.5,1.3] | 0.9 | [0.6, 1.4] |
Preceding birth interval (ref = 2+) | ||||||||||||
First birth | 0.8 | [0.7,1.0] |
0.7**
| [0.6, 0.9] | 0.7 | [0.5,1.1] | 0.7 | [0.4, 1.1] | 1.1 | [0.8,1.5] | 1.0 | [0.7, 1.4] |
Less than 2 years | 0.9 | [0.8,1.1] | 0.9 | [0.8, 1.1] |
1.5*
| [1.0,2.2] | 1.4 | [1.0, 2.1] | 0.9 | [0.7,1.2] | 0.9 | [0.7, 1.2] |
Antenatal care (ref = less than 4) | ||||||||||||
4 or more visits |
1.3**
| [1.1,1.6] |
1.3*
| [1.0, 1.5] |
1.5*
| [1.1,2.2] |
1.5**
| [1.1, 2.0] | 1.2 | [0.9,1.5] | 1.1 | [0.8, 1.3] |
Size at birth (ref = normal or large) | ||||||||||||
Small or very small | 1.1 | [0.9,1.3] | 1.0 | [0.9, 1.2] | 0.8 | [0.6,1.1] | 0.9 | [0.7, 1.1] | 1.0 | [0.8,1.4] | 1.0 | [0.8, 1.4] |
Gender of child (ref = female) | ||||||||||||
Male | 1.0 | [0.9,1.1] | 1.0 | [0.8, 1.1] | 0.8 | [0.7,1.0] | 0.8 | [0.7, 1.0] | 0.8 | [0.7,1.0] | 0.8 | [0.7, 1.0] |
Skilled attendant at birth (ref = no) | ||||||||||||
Yes | 1.1 | [0.9,1.3] | 1.0 | [0.8, 1.2] |
1.7**
| [1.2,2.5] |
1.7*
| [1.1, 2.4] | 1.0 | [0.7,1.6] | 1.0 | [0.7, 1.6] |
ROC | 0.65 | 0.58 | 0.57 | |||||||||
Pseudo R2 | 0.04 | 0.02 | 0.01 |
Associations between newborn care practices and mortality
India 2015–16 | Bangladesh 2014 and Nepal 2016 | |||||||
---|---|---|---|---|---|---|---|---|
UOR | 95% CI | AOR | 95% CI | UOR | 95% CI | AOR | 95% CI | |
Country (ref = Nepal) | ||||||||
Bangladesh | n/a | n/a | 1.8 | 0.8, 4.1 | 2.3 | 1.0, 5.2 | ||
Place of residence (ref = rural) | ||||||||
Urban | 1.1 | 0.7, 1.5 | 1.3 | 0.9, 1.8 | 0.6 | 0.2, 1.4 | 0.7 | 0.3, 1.7 |
Wealth quintile (ref = lowest and second) | ||||||||
Middle | 1.2 | 0.9, 1.7 | 1.3 | 1.0, 1.8 |
0.1**
| 0.0, 0.4 |
0.1**
| 0.0, 0.5 |
Second highest and highest | 0.7 | 0.4, 1.0 | 0.8 | 0.5, 1.3 | 0.9 | 0.4, 2.4 | 1.3 | 0.4, 4.1 |
Education (ref = none) | ||||||||
Primary | 1.2 | 0.9, 1.6 |
1.4*
| 1.1, 1.8 | 1.5 | 0.5, 4.1 | 1.4 | 0.5, 4.0 |
Secondary or higher | 0.9 | 0.7, 1.2 | 1.0 | 0.7, 1.4 | 1.4 | 0.5, 3.7 | 1.9 | 0.6, 5.6 |
Religion (ref = Hindu) | ||||||||
Muslim, other |
0.7*
| 0.6, 0.9 |
0.7**
| 0.5, 0.9 | 1.3 | 0.6, 2.8 | 0.4 | 0.2, 1.0 |
Maternal age at birth (ref = 18–34) | ||||||||
< 18 | 1.5 | 0.8, 2.6 | 1.0 | 0.5, 1.8 | 2.1 | 0.9, 5.2 | 2.6 | 1.0, 7.0 |
35 and older |
1.9***
| 1.4, 2.4 |
1.8***
| 1.4, 2.5 | 1.7 | 0.3, 8.5 | 1.6 | 0.4, 6.7 |
Preceding birth interval (ref = 2+) | ||||||||
First birth |
1.8***
| 1.4, 2.4 |
2.6***
| 1.9, 3.5 | 1.0 | 0.5, 2.2 | 0.6 | 0.3, 1.3 |
Less than 2 years |
1.4**
| 1.1, 1.9 |
1.4*
| 1.1, 1.9 | 0.5 | 0.1, 2.3 | 0.5 | 0.1, 2.3 |
Previous child under 5 die (ref = no) | ||||||||
Yes |
2.3***
| 1.8, 2.8 |
2.4***
| 1.9, 3.1 | 1.1 | 0.4, 3.2 | 1.1 | 0.4, 2.9 |
Antenatal care (ref = less than 4) | ||||||||
4 or more visits | 0.9 | 0.6, 1.2 | 1.0 | 0.8, 1.4 |
0.2*
| 0.0, 0.9 |
0.2*
| 0.1, 0.9 |
Tetanus (ref = fully protected) | ||||||||
Not fully protected |
1.5**
| 1.2, 1.9 |
1.3*
| 1.0, 1.7 | n/a | |||
Size at birth (ref = normal or large) | ||||||||
Small or very small |
1.9***
| 1.5, 2.5 |
1.9***
| 1.4, 2.5 | 1.7 | 0.7, 3.8 | 1.3 | 0.5, 3.1 |
Gender of child (ref = female) | ||||||||
Male | 1.1 | 0.9, 1.3 | 1.1 | 0.9, 1.4 | 0.6 | 0.3, 1.4 | 0.7 | 0.3, 1.5 |
Skilled attendant at birth (ref = no) | ||||||||
Yes |
0.7*
| 0.5, 1.0 | 0.8 | 0.6, 1.1 |
0.1*
| 0.0, 0.9 |
0.1*
| 0.0, 0.9 |
PNC in 2 days (ref = yes) | ||||||||
No |
2.2***
| 1.5, 3.2 |
2.1***
| 1.5, 3.1 | 1.5 | 0.6, 3.9 | 1.4 | 0.5, 3.8 |
Dry or wrapping (ref = immediately) | ||||||||
Delayed | 1.2 | 0.9, 1.6 | 1.1 | 0.8, 1.5 | 0.7 | 0.3, 2.0 | 0.6 | 0.2, 1.8 |
Not dried, don’t know, missing | n/a | n/a | 1.3 | 0.3, 6.0 | 0.9 | 0.2, 4.3 | ||
Bathing (ref = delayed) | ||||||||
Immediately | n/a | n/a | 1.4 | 0.6, 3.3 | ||||
Not bathed, don’t know, missing |
52.4***
| 18.2,150.6 | ||||||
Skin to skin (ref = yes) | ||||||||
No* | n/a | 1.0 | 0.4, 2.2 | 0.7 | 0.3, 1.7 | |||
Instrument used to cut the cord (ref = sterile) | ||||||||
Unclean |
1.6*
| 1.0, 2.7 | 1.4 | 0.8, 2.4 |
2.4*
| 1.1, 5.4 | 2.0 | 0.9, 4.3 |
Don’t know | n/a | 1.4 | 0.2, 10.5 | 1.7 | 0.2, 17.7 | |||
Substance put on the stump (ref = nothing) | ||||||||
Antiseptic only | n/a |
0.1**
| 0.0, 0.4 |
0.2**
| 0.0, 0.6 | |||
Other | n/a | 0.6 | 0.3, 1.5 | 0.7 | 0.3, 1.6 | |||
Don’t know or missing | n/a | 1.7 | 0.5, 5.3 | 1.8 | 0.5, 6.5 | |||
ROC | 0.68 | 0.77 | ||||||
Pseudo R2 | 0.04 | 0.09 |