Chichiabellu et al.

Reproductive Health (2018) 15:162

https://doi.org/10.1186/s12978-018-0609-1

RESEARCH Open Access

Essential newborn care practices and

associated factors among home delivered
mothers in Damot pulasa Woreda, southern
Ethiopia
Tesfaye Yitna Chichiabellu1*, Baze Mekonnen2, Feleke Hailemichael Astawesegn3, Birhanu Wondimeneh Demissie4
and Antehun Alemayehu Anjulo5

Abstract
Background: Globally 3.1 million children die each year in their neonatal period (first 28 days of life) according to
World Health Organization (WHO) 2011 report. Half of these surprisingly occur within the first 24 h of delivery and
75% occur in the early neonatal period.
Methods: A community based cross-sectional study design was carried out from March 2016 to April, 2016 in
Damot Pulasa district, Wolaita zone, Southern Ethiopia to assess selected essential newborn care practices and
associated factors among home delivered mothers in Damot pulasa district. Data were entered into Epi Info version
3.5.1 and exported to SPSS version 20 software for analysis. Multiple logistic analyses were done to control possible
confounding variable. A P-value less than 0.05 was taken as a significant association.
Result: The study showed that the prevalence of essential newborn care practice was 24%. Multivariate logistic
regression analysis revealed that variables like ANC visit (AOR =0.213,P = 0.015,CI = 0.102–0.446),PNC visit (AOR = 0.209,
P = 0.00,CI = 0.110–0.399), advice about essential newborn care practice (AOR =0.114,P = 0.0001, CI = 0.058–0.221),urban
areas women (AOR =2,P = 0.042, CI = 1.024–3.693), planned pregnancy (AOR = 7, P = 0.00, CI =3.732–11.813),
and knowledge about newborn danger signs (AOR = 0.277, P = 0.006, CI = 0.110–0.697) were the independent
predictors of ENBC practices.
Conclusion: Generally, coverage of essential newborn care practices was low. ANC visit, advice about ENBC,
PNC visit, residence, planned pregnancy and knowledge about newborn danger signs were predictors of
essential newborn care practice in the study area. Therefore, Health facilities should enhance linkage with
health posts to increase ANC and PNC service utilization. Health extension workers should also promote and
give health education about pre-lacteal feeding, early bathing, planned pregnancy, newborn danger signs and
application of materials on the newborn stump.
Keywords: Essential newborn care practice, Newborn

* Correspondence: yefaste2005@gmail.com
1
Department of Nursing, College of Health Science and Medicine, Wolaita
Sodo University, P.O.Box: 138, Wolaita Sodo, Ethiopia
Full list of author information is available at the end of the article

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Chichiabellu et al. Reproductive Health (2018) 15:162 Page 2 of 11

Plain English summary socio-economic aspects of poverty; poor health status of

Though many efforts had been made to overcome women; lack of autonomy and decision making author-
newborn mortality in Sub-Saharan Africa, it is continued ity; and illiteracy to health system related factors like
to be great public health problems. Essential newborn poor antenatal and obstetric care; absence of trained
care is a comprehensive strategy designed to improve birth attendant; inadequate referral system; lack of trans-
the health of newborns through interventions before portation facilities; poor linkages between health centers
conception, during pregnancy, at and soon after birth, and communities favored the morbidities and mortalities
and in the postnatal period. Data associated with of pregnant women, perinatal and neonate [5]. In
socio-demographic variables, maternal health services Ethiopia, according to Ethiopia Mini Demographic
utilization, knowledge, counseling from a health worker, Health Survey 2014 report, only 15% of births take place
source of information, and traditional practices were col- at a health institution, 40% of women receive Antenatal
lected. Even though majority of the women used boiled Care (ANC) from a skilled provider, and 12% of women
blade to cut the cord and tied with threads, application receive a postnatal care (PNC) within the first two days
of butter on the umbilical stump practiced by most of of birth [6]. This favors neonatal morbidity and mortality
the women. In addition to low coverage of initiation of rates to be high in Ethiopia; around 122,000 newborns
breast feeding within one hour and giving colostrum, the die every year and the neonatal mortality rate is 37 per
majority, of the women in this study gave pre-lacteals. 1000 live births [7, 8].
Bathing of the newborn after 24 h was practiced by the WHO recommended Essential Newborn Care (ENBC)
majority of the women. The level of coverage of essential practices to reduce the risk of the main causes of neo-
newborn care practices in the district was generally low. natal deaths in both community and facility deliveries
The associated factors of essential newborn care practice [8]. ENBC is a comprehensive strategy designed to
were; ANC visit, advice about ENBC, PNC visit, improve the health of newborns through interventions
residence, planned pregnancy and knowledge about before conception, during pregnancy, at and soon after
newborn danger. birth, and in the postnatal period [9].ENBC practices, as
In conclusions; Health facilities should enhance linkage recommended by WHO, include drying (wiping) and
with health postse to increase antenatal and postnatal care wrapping the newborn immediately after birth, initiating
service utilization. Health extension workers should also skin-to-skin contact, dry cord care (not applying any po-
promote and give health education about pre-lacteal feed- tentially harmful substance to the umbilical cord), im-
ing, early bathing, planned pregnancy, newborn danger mediate initiation of breastfeeding and delayed bathing
signs and application of materials on the newborn stump. (for at least 6 h) [10].
Ethiopia government has been striving to achieve the
Background 3rd Sustainable Development Goal (SDG3) which is to
Globally 3.1 million children die each year in their neo- ensure healthy lives and promote well-being for all, at all
natal period (first 28 days of life) according to World ages [11]. However, the neonatal mortality rates in
Health Organization (WHO) 2011 report. Half of these Damot pulasa is still remained higher than the national
surprisingly occur within the first 24 h of delivery and level; it is 38 per 1, 000 live births [12]. Thus, new in-
75% occur in the early neonatal period (0 to 6 days after novative strategies must be developed for safe home de-
delivery) because of preterm births, severe infections liveries including essential neonatal care in order to
and birth asphyxia [1]. Though many efforts had been change the practice at the household level, besides devis-
made to overcome newborn mortality in Sub-Saharan ing means of proper care of the neonate in domestic set-
Africa, it is continued to be great public health prob- tings and ensuring proper referral of those neonates who
lems. Every year 2.9 million babies die during the neo- cannot be managed at home [13]. A study showed that
natal period [2]; it is also the time of greatest risk for home-based counseling strategy using volunteers and
stillbirths and maternal deaths [3]. designed for scale-up can improve newborn care behav-
One of the targets of the MDG was a two-thirds re- iors in rural communities [14].
duction in infant and child mortality by 2015; it was Traditional Birth Attendants (TBAs), relatives,
intended to achieve by involving skilled birth attendants, neighbors and other aged women from the community
increasing immunization coverage against six vaccine who lack the requisite knowledge of safe delivery and
preventable diseases, improving the status of women newborn care practices; Meanwhile, their intervention to
through education, and enhancing women participation support mothers who give birth at home is inevitable.
in the labor force [4]. This may increase maternal and newborn morbidity and
Globally, around 40 million mothers give birth at mortality among home delivered mothers. Traditional
home per year without any trained health worker. Fac- practice like pre-lacteal feeding, avoiding of first milk
tors like lack of good quality care during labor and birth; and application of material on the newborn stump was
Chichiabellu et al. Reproductive Health (2018) 15:162 Page 3 of 11

practiced by the majority of study participant in the lottery method when more than one eligible respondent
study area. Therefore, improving newborn survival is a present in a house.
major priority in child health today and the government
sets universal sustainable development goals which state Data collection tools and procedures
to end preventable deaths of newborns and under-five Data associated with socio-demographic variables, mater-
children by 2030. Therefore, this study aimed to assess nal health services utilization, knowledge, counseling from
selected essential newborn care practices and associated a health worker, source of information, and traditional
factors among home delivered mothers in Damot pulasa practices were collected using interviewer administered
district. questionnaire adapted from similar studies [8, 14, 18]
(Additional file 1). The data were collected by B.Sc. nurses
Methods and materials who are fluent speakers of the local languages.
Study area
A community based cross-sectional study design was Data processing and analysis
conducted from March 2016 to April 2016 in Damot Data was checked visually for completeness, and then
Pulasa district, Wolaita zone, Southern Ethiopia. Damot coded and entered in to Epi Info version 3.5.1 and
Pulasa located at 365 Km from Addis Ababa, the capital exported in to Statistical Program Social Science (SPSS)
city of Ethiopia. The population of the district was esti- version 20 software for analysis. Binary and multiple lo-
mated to be 130,515 with an estimated number of gistic regressions were run to assess the associations of
women of reproductive age group 30,818 which is 23.6% various factors with essential newborn care practice. The
of the total population. The town has an urban kebele results were presented in the form of tables, figures and
and 22 rural kebeles, in terms of health facilities; there summary statistics. A P-value less than 0.05 was taken as
are 5 governmental health centers, 8 private clinics, 1 a significant association.
private pharmacy, 1 drug vender and 1urban and 22
rural health posts. Results
Socio-demographiccharacterstics
Populations In this study, a total of 450 women have participated
The study population was randomly selected women of and the response rate was 100%. In terms of religion,
reproductive age group who had given birth at home in majority of the respondents were protestant, which
the past one year in Damot Pulasa district which encom- accounts 238 (52.9%) and 434 (96.4%) were Wolaita in
passes 450 women who participated in the study. Those ethnicity. One hundred ninety-five (43.3%) were illiterate
mothers who had given live birth at home within one and 310 (68.9%) were housewife. With regard to marital
year preceding the data collection date included in the status and place of residence, 444 (98.7%) were married
study. The source population was list of households who and 393 (87.3%) were rural dweller (Table 1).
had women’s in the reproductive age and who had given
birth at home in Damot pulasa district. Maternal health services
A total of 364 (80.9%) of respondents belonged to the
Sample size determination age group 19–41 years and the mean age of respondents
The required sample size was determined by using single was 30.8 (± 4.05). Majority of the study subjects con-
population proportion formula by taking 23% of ex- ceived their last baby unintentionally, which accounts
pected prevalence for essential newborn care practice 383 (85.1%). Thirty two (7.1%) received at least one
[8], assuming 5% margin of error and 95% confidence ANC visit. From all mothers, 363 (80.7%) prepared
level, design effect of 1.5 and 10% for non-response rate. themselves for birth. From the total study subjects, 120
The calculated sample size was 450. (26.7%) utilized PNC service and from these mothers, 35
(29%) utilized the service within 7-41 days (Table 2).
Sampling technique and procedures
Cluster multi-stage sampling technique was employed Health service availability
for the Selection of the sampling units. In the district, Concerning health service availability, 318 (70.7%)
there are 22 rural and an urban kebeles. From 22 rural mothers had health facilities (health post)in the nearby
kebeles10 were selected by simple random sampling. site. Home delivered mothers mentioned the following
The total sample size was allocated for each selected reasons why they gave birth at home; Two hundred
kebeles proportionally to the number of households eighty-three (62.9%) “Not seriously ill”, 247 (54.9%) “Had
within each kebele. Then systematic sampling technique TBAs”, 126 (28%) “Unwelcoming of health workers ap-
was used to select a household where participant exist. proach” and 123 (27.3%) “An experience of safe home
The index case was selected and interviewed using delivery before” Moreover, the majority of women
Chichiabellu et al. Reproductive Health (2018) 15:162 Page 4 of 11

Table 1 Socio-demographic characteristics of the respondent in Table 2 Maternal health services of respondents, in Damot
Damot pulasa district, Wolaita Zone, Southern Ethiopia, 2016 pulasa district, Wolaita Zone, Southern, Ethiopia, 2016
Variable Frequency (n = 450) Percentage (%) Variable Frequency (n = 450) Percentage (%)
Religion Receive ANC
Protestant 238 52.9 Yes 32 7.1
Catholic 124 27.6 No 418 92.9
Orthodox 76 16.9 Number of ANC visit
Muslim 12 2.7 Once 13 40.6
Educational status Twice 10 31.25
No education 195 43.3 Three times 6 18.75
Primary level 175 38.9 Four times 3 9.4
Secondary level 67 14.9 Advice about ENBC
Higher education 13 2.9 Yes 32 7.1
Ethnic group No 418 92.9
Wolaita 434 96.4 Preparation for delivery
Gammo 8 1.8 Yes 363 80.7
Amhara 7 1.6 No 87 19.3
Gurage 1 .2 Receive PNC
Occupation Yes 120 26.7
Housewife 310 68.9 No 330 73.3
Farmer 13 2.9 Time for frequency of PNC
Merchant/Trade 100 22.2 Less than 4 h 12 10
Daily labor 27 6.0 4–23 h 20 16.7
Marital status 1–2 days 27 22.5
Married 444 98.7 3–6 days 26 21
Widowed 6 1.3 7–41 days 35 29
Residence
Urban 57 12.7 (92.2%) women who had information about when to
Rural 393 87.3 start breastfeeding, 141 (34%) mothers started breast-
feeding within the first one hour of birth. From all
Age at current pregnancy
mothers, 390 (86.7%) of them had knowledge about
< 20 years 2 0.4
colostrum and 262 (67%) mothers mentioned the im-
20–34 years 364 80.9 portance of colostrum. Four hundred six (90.2%) of
34–49 years 84 18.7 women told that it is possible to expose the neonate for
Planned pregnancy morning sunlight; In addition to this, 432 (96%) of
Yes 67 14.9 women mentioned that, exposing the neonate for vac-
cination has no problem (Table 4) (Figs. 2 and 3).
No 383 85.1
Parity
1 44 12.8 Newborn care practice of the respondent
From all mothers, 408 (90.7%) remembered where they
2–4 194 56.6
positioned the neonate immediately after delivery. Of all
>=5 105 30.6
mothers, 259 (63.5%) put their newborn baby on their
abdomen immediately after delivery (Table 5).
participated in this study, 356 (79.1%) decided to deliver
at home by themselves (Table 3) (Fig. 1). Safe cord cutting
Almost all mothers, 434 (96.4%) used boiled new razor
Knowledge of the respondents blade in order to cut their newborn baby and 288 (64%)
From the total study subjects, 417 (92.7%) of the women study subjects applied butter on the cord after the cord
had information about newborn care. Among 415 was cut.
Chichiabellu et al. Reproductive Health (2018) 15:162 Page 5 of 11

Table 3 Health service utilization of respondents, in Damot the newborn before delivery of the placenta. One hun-
pulasa district, Wolaita Zone, Southern Ethiopia, 2016 dred sixty-six (45.6%) mothers used a pre-prepared towel
Variable Frequency (n = 450) Percentage (%) to dry/wrap up the newborn. About 294 (65.3%) of them
Availability of HF bathed the newborn after 24 h. The majority of study
Yes 450 100 subjects, 249 (55.3%) mothers made skin to skin contact
of mother and newborn.
Type of HF
Health post 318 70.7
The prevalence of essential newborn care practices
Health center 132 29.3 The prevalence of cord cutting, initiation of breastfeed-
HF provide delivery ing and thermal care practices were studied in this study.
Yes 227 50.4 This study revealed that the prevalence of cord cutting,
No 179 39.8 initiation of breastfeeding and thermal care practices
were 434 (96.4%), 206 (45.8%) and 294 (65.3%) respect-
I don’t know 44 9.8
ively (Fig. 4).
Decision for place of birth
Self 356 79.1 Associated factors of essential newborn care practices
Husband 77 17.1 In order to determine the association of independent
Relatives 17 3.8 variables with essential newborn care practices both bi-
variate and multivariate analysis were used. Variables
that showed association with the outcome variables in
Initiation of early exclusive breastfeeding the bivariate analysis were selected for multivariate
From the total study subjects, 206 (45.8%) initiated analysis.
breastfeeding within an hour of birth. From the total of Crude analysis revealed that variables like ANC visit
224 (49.8%) women who gave pre-lacteals, 218 (97.3%) (COR 0.213, 95% CI: 0.102–0.446), advice about ENBC
gave water and 6 (2.7%) gave butter. Two hundred (COR 0.166, 95% CI: 0.078–0.354), PNC visit
twenty three (49.6%) of the respondents gave first milk (COR0.135,95% CI:0.083–0.217), place of residence
to the newborn and 247 (54.9%) mothers fed their breast (COR2.244, 95% CI:1.251–4.025), planned pregnancy
greater than or equal to eight times. (COR 6.863, 95% CI: 3.943–11.943), birth preparedness
(COR 3.511, 95% CI: 1.635–7.541), knowledge about
Thermal care (bathing time) newborn danger signs (COR 5.276, 95% CI: 2.232–12.471),
From all mothers, 362 (80.4%) mothers dried/wrapped and knowledge about newborn care (COR 1.892, 95% CI:
the newborn baby. Of whom 190 (52.2%) dried/wrapped 1.223–2.928) were felt to be the key predictors of essential

Fig. 1 Reasons of women not delivered at health facilities, in Damot pulasa district, Wolaita Zone, Southern Ethiopia, 2016
Chichiabellu et al. Reproductive Health (2018) 15:162 Page 6 of 11

Table 4 Knowledge of the respondents, in Damot pulasa Discussion

district, Wolaita Zone, Southern Ethiopia, 2016 Generally, in this study the coverage of essential new-
Variable Frequency (n = 450) Percentage (%) born care practice was low. Even though majority of the
Information on newborn care women used boiled blade to cut the cord (96.4%) and
Yes 417 92.7 tied with threads (98.2%), application of butter on the
umbilical stump (64%) of the women practiced. I n
No 33 7.3
addition to low coverage of initiation of breast feeding
Information to start breastfeeding
within one hour (45.8%) and giving colostrums
Yes 415 92.2 (49.6%),the majority, (49.8%) of the women in this study
No 35 7.8 gave pre-lacteals. Bathing of the newborn after 24 h was
Time to start breastfeeding practiced by the majority (65.3%) of the women.
First one hour 141 34.0 The prevalence of ENBC practice was 24% which was
higher than the research done in Awebel district East
After one hour 274 66.0
Gojam Zone [8] which was 23.1% but which was much
Knowledge on first milk
lower than the study conducted in Northwest Ethiopia,
Yes 390 86.7 Mandura district [15] which was 41%. Cord cutting was
No 60 13.3 practiced by the majority 96.4% of the women, using
Advantage of first milk new blade, which was much higher than the study con-
Advantageous 262 67.0 ducted in, Nawalparasi district of Nepal (48.31%) [16],
Northern Ghana which revealed 90.8% [17], Sub urban
Disadvantageous 129 33.0
areas of western Nigeria (90.3%) [18], study conducted
Expose neonate for morning sunlight
in Northwest Ethiopia, Mandura district was (59.8%)
Yes 406 90.2 [15],and the study conducted in four regions of Ethiopia
No 44 9.8 which was 88.3% [6], the reason for this might be good
Expose neonate for vaccination awareness and custom followed in the study area but the
Yes 432 96.0 finding was in line with the study conducted at Awebel
district, East Gojam of Ethiopia (97.6%) [8]. Majority of
No 18 4.0
the study participants (98.2%) the cord was tied with
Information when to bath the neonate
thread which was higher than the study conducted in
Yes 436 96.9 the four regions of Ethiopia (48.5%) [6], this might be
No 14 3.1 due to awareness in the study community. Even though
Time of bathing majority of the women used boiled blade to cut the cord
First 24 h 303 69.5 and tied with threads, application of butter on the
umbilical stump (64%) of the women practiced in the
After 24 h 133 30.5
study area which is higher than the study conducted
Knowledge about neonatal problems
in Northern Ghana (14.4%) and the study conducted
Good knowledge 87 19.3 in Northwest Ethiopia Mandura district was (18.18%)
Poor knowledge 363 80.7 [15, 17] but which was lower than the study con-
ducted in the four regions of Ethiopia (88.3%) [6].
newborn care practice and were used to form multivariable Initiation of breastfeeding within one hour in the study
logistic regression analysis (Table 6). area was 45.8% which was higher than the study con-
Multivariate logistic regression was done for variables ducted in rural Bangladesh (40%), East Gojam of
that had statistically significant association with essential Ethiopia (41.6%). This finding was not incongruent with
newborn care practice in crude analysis. Multivariate the study conducted in India (65%), Nepal (51.3%),
logistic regression analysis revealed that variables like Northern Ghana (80%), Eastern Uganda (50%), Western
ANC visit (AOR 0.264, 95% CI:0.090–0.773), advice Nigeria (65.3%), four regions of Ethiopia (52.1%),
about essential newborn care practice (AOR 0.114, 95% Northwest Ethiopia and Southwest Ethiopia (50%) [6,
CI:0.058–0.221), PNC visit (AOR 0.209, 95% CI:0.110– 15–21] respectively. The Majority, 49.8% of the women in
0.399), place of residence (AOR 2, 95% CI:1.024–3.693), this study gave pre-lacteals. The finding was higher as
planned pregnancy (AOR 7, 95% CI:3.732–11.813), and compared to study conducted in the four regions of
knowledge about newborn danger signs (AOR 0.277, Ethiopia (12.4%) gave pre-lacteals [6], but lower than the
95% CI:0.110–0.697) were the independent predictors of study conducted in East Gojam of Ethiopia Awebel dis-
essential newborn care practice after controlling the trict, 11.2% gave pre-lacteals [8]. The reason might be
potential confounders (Table 6). traditional beliefs of the community. Breastfeeding of the
Chichiabellu et al. Reproductive Health (2018) 15:162 Page 7 of 11

Fig. 2 Knowledge of women about ENBC practices in Damot pulasa district, Wolaita Zone, Southern Ethiopia, 2016

first milk (colostrum) was given (49.6%) of the women in supported by the study conducted in Northern Ghana
the study area. This is lower than a case study of tribal which suggested that women who initiated ANC visit
women, Gujarat (63%) [22]. The reason for this was (33%) were two times more likely to practiced essential new-
of the respondent believed that first milk was disadvanta- born care practice as compared to women who initiated
geous and from this (31%) believed that it would cause ANC visit late [17]. This might be due to women who
diarrhea,(60.5%) constipation and (58.9%) believed that it attended ANC have the chance of getting information
would decrease the growth of the newborn. about the components and the importance of newborn
Bathing of the newborn after 24 h was practiced by care practice from health care providers.
the majority (65.3%) of the women in the study area The finding of this study also showed that women who
which was in line with the study conducted in East didn’t get PNC visit early were 79% less likely practiced
Gojam of Ethiopia, Awebel district (65.6%) [8]. But ENBC when compared to women who didn’t get immedi-
this finding was lower than study conducted in ate PNC visit (AOR = 0.209, P = 0.00,CI = 0.110–0.399).
Northern Ghana (93.6%), Rural Nepal (72.2%), South This finding was supported by the study conducted in
Sudan (99%), Easter Uganda (100%), Western Nigeria rural communities of Awebel district, East Gojam of
(98.2%), study conducted in four regions of Ethiopia Ethiopia, which stated that immediate PNC visit was
(74.7%) [6, 16–18, 20, 23]. statistically significant with ENBC practice of women and
In this study women who didn’t get ANC visit were those women who had got immediate PNC visit after de-
73.6% less likely to practiced essential newborn care livery were 3.2 times more likely to practice ENBC when
practice as compared to those who initiated ANC visit compared with those who had not got immediate PNC
(AOR =0.213,P = 0.015,CI = 0.102–0.446), which is after delivery [8]. This could be health extension workers

Fig. 3 Knowledge of women on newborn danger signs in Damot pulasa district, Wolaita Zone, Southern Ethiopia, 2016
Chichiabellu et al. Reproductive Health (2018) 15:162 Page 8 of 11

Table 5 Newborn care practices of respondents, in Damot Table 5 Newborn care practices of respondents, in Damot
pulasa district, Wolaita Zone, Southern Ethiopia, 2016 pulasa district, Wolaita Zone, Southern Ethiopia, 2016
Variable Frequency Percentage (Continued)
(n = 450) (%) Variable Frequency Percentage
Position the neonate (n = 450) (%)

Yes 408 90.7 Water 218 97.3

No 42 9.3 Butter 6 2.7

Place of positioning the neonate Give first milk

On the mother’s abdomen 259 63.5 Yes 223 49.6

Near the delivery surface 86 21.1 No 227 50.4

On another bed separately 52 12.7 Frequency of breastfeeding

Transferred to father/relatives 9 2.2 < 8 times 203 45.1

I don’t remember 2 .5 > = 8 times 247 54.9

Dry/wrapping the neonate Remember time of bathing

Yes 362 80.4 Yes 442 98.2

No 88 19.6 No 8 1.8

Time of dry/wrap the neonate Time of bathing

Before delivery of placenta 190 52.2 First 24 h 156 34.7

Immediately after delivery of placenta 169 46.4 After 24 h 294 65.3

I did not remember 5 1.4 Skin to skin contact

Material used for dry/wrap the neonate Yes 249 55.3

Pre-prepared towel 166 45.6 No 201 44.7

Piece of blanket/Gabi 72 19.8

Available material 126 34.6 and community health workers might gave proper advice
Material used to cut the cord about essential newborn care practice.
Boiled /un-boiled new razor blade 434 96.4
Those mothers who had got ENBC advice during ANC
visit or other meetings were 83.4% more likely practiced
Used razor blade 16 3.6
ENBC practice as compared to women who did not got
Remember material used to tie the cord the advice (AOR =0.114, P = 0.0001, CI = 0.058–0.221). It
Yes 442 98.2 was supported by study done, Awebel district which
No 8 1.8 showed that women who had got advice about ENBC
Material used to tie the cord practices during monthly pregnant mothers’ group
Thread 442 100
meeting were 4.8 times more likely to practice ENBC as
compared with those women who had not got advice
Apply material after cord cutting
about ENBC practices during monthly meeting [8]. The
Yes 288 64.0 reason could be the health care providers could discuss
No 162 36.0 about essential newborn care practice during ANC visit.
Type of material applied on the cord In this study, urban areas women were two times more
Butter 288 100 likely practiced ENBC practice when compared to rural
Initiate exclusive breastfeeding
areas women (AOR =2, P = 0.042, CI = 1.024–3.693).
The finding was supported by a study conducted in
Yes 226 50.2
Mandura district which stated that women in urban
No 224 49.8 areas were three times more likely to have good
Time of initiating exclusive breastfeeding newborn care practices as compared to rural areas [15].
First one hour 206 45.8 This might be due to accessibilities of health service and
After one hour 244 54.2 good knowledge secondary to better educational status
Give pre lacteals
of urban women when compared to rural areas women.
Those women who planned there pregnancy were
Yes 224 49.8
seven times more likely practiced newborn care when
No 226 50.2 compared to women who did not plan their pregnancy
Pre-lacteals given (AOR = 7, P = 0.00, CI =3.732–11.813). The reason for
Chichiabellu et al. Reproductive Health (2018) 15:162 Page 9 of 11

Fig. 4 Distribution of the three essential newborn care practices, in Damot pulasa district, Wolaita Zone, Southern Ethiopia, 2016

this could be women who had planned pregnancy might least four danger signs of the neonates were four times
be more likely to use maternal and child health services. more likely to give good neonatal feeding to their babies
The study showed that those women who were know- [17]. This could be most of the women in the sample
ledge about newborn danger signs practiced ENBC 72% may not have adequate knowledge about newborn care.
more likely when compared to women who had poor This might be due to majority of the women did not get
knowledge about newborn danger signs (AOR = 0.277, P an adequate message about newborn care during ante-
= 0.006, CI = 0.110–0.697). This finding was supported natal care follow up. Findings in this study should be
by the study conducted in rural areas of Northern interpreted in the light of the inherent limitations of the
Ghana which states that women who could mention at study. Recall bias was a possibility since the women were

Table 6 Factors associated with the three essential newborn care practices by bivariate and multiple logistic analyses in Damot
pulasa district, Wolaita Zone, Southern Ethiopia, 2016
Variable ENBCP COR AOR
Yes (%) No (%)
Receive ANC
Yes 18 14 1 1
No 90 328 0.213(0.102–0.446) 0.264(0.090–0.773)*
Advice about ENBC
Yes 19 13 1 1
No 61 252 0.166(0.078–0.354) 0.114(0.058–0.221)*
Receive PNC
Yes 64 56 1 1
No 44 286 0.135(0.083–0.217) 0.209(0.110–0.399)*
Residence
Urban 22 35 2.244(1.251–4.025) 2(1.024–3.693)*
Rural 86 307 1 1
Planned pregnancy
Yes 40 27 6.863(3.943–11.943) 7(3.732–11.813)*
No 68 315 1 1
Birth preparedness
Yes 8 75 3.511(1.635–7.541) 0.467(0.200–1.087)
No 100 267 1 1
Knowledge about newborn danger signs
Good knowledge 6 102 5.276(2.232–12.471) 0.277(0.110–0.697)*
Poor knowledge 81 261 1 1
Knowledge about newborn care
Good knowledge 49 209 1.892(1.223–2.928) 0.760(0.460–1.257)
Poor knowledge 59 133 1 1
Chichiabellu et al. Reproductive Health (2018) 15:162 Page 10 of 11

inquired about events which occurred during a two year Competing interest
period. However, the questioning was focused on the We declared no financial, personal or professional competing interests
influenced this paper.
most recent experiences of essential newborn care
practices in order to minimize this possibility. Authors Information
1
Lecturer in Department of Nursing, College of Health Science and Medicine,
Wolaita Sodo University.
Conclusions 2
Lecturer in Department of Nursing, School of nursing and midwifery, Addis
In this study, the level of coverage of essential newborn Ababa University,
3
Assistant Professor in School of Public Health, College of Medicine and
care practices in the district was generally low. Trad- Health Science, Hawassa University.
itional practice like: pre-lacteal feeding, avoiding of first 4
Lecturer in Department of Nursing, College of Health Science and Medicine,
milk and application of material on the newborn stump Wolaita Sodo University.
5
Lecturer in Department of Medical Laboratory, College of Health Science
were practiced by majority of study participant in the and Medicine, Wolaita Sodo University.
study area. This finding also revealed that most essential
newborn interventions were not reaching the newborns. Ethics approval and consent to participate
Ethical clearance was obtained from Addis Ababa University College of
ANC visit, advice about ENBC, PNC visit, residence, Health Science Department of Nursing and Midwifery Institutional Review
planned pregnancy and knowledge about newborn dan- Board (IRB). Official letter was received from the department of nursing and
ger signs were predictors of essential newborn care prac- midwifery and submitted to Damot Pulasa district Health office and letter of
permission was taken from Damot pulasa district health office for each
tice in the study area. Therefore Damot pulasa district selected kebele to implement the study. Written informed consent was
health office should promote strong community based obtained from each respondent before the interview. The consent forms
behavior change communication on the importance of addressed issues relating to confidentiality and autonomy of the respondent
during data collection.
ENBC practices to change the poor ENBC practices in
the study area. Health facilities should enhance linkage
Publisher’s Note
with health posts to increase ANC and PNC service Springer Nature remains neutral with regard to jurisdictional claims in
utilization. Health extension workers should promote published maps and institutional affiliations.
and give health education about pre-lacteal feeding, early
Author details
bathing, planned pregnancy, newborn dander signs and 1
Department of Nursing, College of Health Science and Medicine, Wolaita
application of materials on the newborn stump. Sodo University, P.O.Box: 138, Wolaita Sodo, Ethiopia. 2Department of
Nursing, School of nursing and midwifery, Addis Ababa University, Addis
Ababa, Ethiopia. 3School of Public Health, College of Medicine and Health
Additional file Science, Hawassa University, Hawassa, Ethiopia. 4Department of Nursing,
College of Health Science and Medicine, Wolaita Sodo University, Sodo,
Ethiopia. 5Department of Medical Laboratory, College of Health Science and
Additional file 1: Annex II: English version questionnaire. (DOCX 29 kb)
Medicine, Wolaita Sodo University, Sodo, Ethiopia.

Abbreviations Received: 1 February 2017 Accepted: 19 September 2018

ANC: Anti Natal Care; EDHS: Ethiopian Demographic and Health Survey;
ENBC: Essential Newborn Care; MDG: Millennium Development Goal;
NMR: Neonatal Mortality Rate; PNC: Post Natal Care; SDG: Sustainable References
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