The Demographic and Health Surveys (DHS) Program, Avenir Health, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
The DHS Program, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
BMC Pediatr. 2019 Jul 22;19(1):248. doi: 10.1186/s12887-019-1616-2.
Although child mortality has decreased over the last several decades, neonatal mortality has declined less substantially. In South Asia, neonatal deaths account for the majority of all under-five deaths, calling for further study on newborn care practices. We assessed five key practices: immediate drying and wrapping, delayed bathing, immediate skin-to-skin contact after birth, cutting the umbilical cord with a clean instrument, and substances placed on the cord.
Using data from Demographic and Health Surveys conducted in Bangladesh, India, and Nepal between 2005 and 2016, we examined trends in coverage of key practices and used multivariable logistic regression to analyze predictors of thermal care and hygienic cord care practices and their associations with neonatal mortality among home births. The analysis excluded deaths on the first day of life to ensure that the exposure to newborn care practices would have preceded the outcome. Given limited neonatal mortality events in Bangladesh and Nepal, we pooled data from these countries.
We found that antenatal care and skilled birth attendance was associated with an increase in the odds of infants' receipt of the recommended practices among home births. Hygienic cord care was significantly associated with newborn survival. After controlling for other known predictors of newborn mortality in Bangladesh and Nepal, antiseptic cord care was associated with an 80% reduction in the odds of dying compared with dry cord care. As expected, skilled care during pregnancy and birth was also associated with newborn survival. Missing responses regarding care practices were common for newborns that died, suggesting that recall or report of details surrounding the traumatic event of a loss of a child may be incomplete.
This study highlights the importance of maternal and newborn care and services for newborn survival in South Asia, particularly antenatal care, skilled birth attendance, and antiseptic cord care.
尽管过去几十年儿童死亡率有所下降，但新生儿死亡率的下降幅度较小。在南亚，新生儿死亡占所有五岁以下儿童死亡的大部分，这就需要进一步研究新生儿护理实践。我们评估了五个关键实践：新生儿出生后立即擦干和包裹、延迟沐浴、立即与皮肤接触、用清洁器械剪断脐带以及在脐带上放置物质。
我们使用 2005 年至 2016 年在孟加拉国、印度和尼泊尔进行的人口与健康调查的数据，检查了关键实践覆盖范围的趋势，并使用多变量逻辑回归分析了热保健和卫生脐带护理实践的预测因素，以及它们与在家中分娩的新生儿死亡率之间的关系。该分析排除了生命第一天的死亡，以确保新生儿护理实践的暴露会先于结果。由于孟加拉国和尼泊尔的新生儿死亡事件有限，我们将这两个国家的数据进行了汇总。
我们发现，产前护理和熟练接生与在家中分娩的婴儿接受推荐实践的几率增加有关。卫生脐带护理与新生儿存活显著相关。在控制了孟加拉国和尼泊尔已知的其他新生儿死亡预测因素后，与干脐带护理相比，使用消毒剂进行脐带护理与死亡几率降低 80%相关。不出所料，怀孕期间和分娩时的熟练护理也与新生儿存活相关。对于死亡的新生儿，关于护理实践的缺失回复很常见，这表明在失去孩子的创伤性事件中，对细节的回忆或报告可能不完整。
这项研究强调了南亚产妇和新生儿护理和服务对新生儿存活的重要性，特别是产前护理、熟练接生和消毒剂脐带护理。
