Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
BMC Pregnancy Childbirth. 2021 Mar 26;21(Suppl 1):237. doi: 10.1186/s12884-020-03421-w.
Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. "Every Newborn Birth Indicators Research Tracking in Hospitals" (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF.
The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women's exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording.
Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8-21.0). Survey-reported (53.2, 95% CI 39.4-66.8) and register-recorded results (85.9, 95% CI 58.1-99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5-93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3-73.5%) and drying (7.3-29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5-3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting.
Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.
即刻新生儿护理（INC）实践，尤其是早期启动母乳喂养（EIBF），对新生儿健康至关重要。然而，在许多情况下，目前的覆盖范围跟踪仍依赖于家庭调查数据。“每个新生儿出生指标研究跟踪医院”（EN-BIRTH）是一项验证产妇和新生儿健康指标的观察性研究。本文报告了 EIBF 的结果。
EN-BIRTH 研究于 2017 年 7 月至 2018 年 7 月在孟加拉国、尼泊尔和坦桑尼亚的五家公立医院进行。临床观察员使用平板电脑记录了 EIBF 和 INC 实践（出生后 1 小时内皮肤接触、擦干和延迟脐带结扎）的时间戳数据。为了评估 EIBF 测量的有效性，我们将观察结果作为金标准与登记记录和妇女退出访谈报告进行了比较。使用百分比一致性来评估 EIBF 和 INC 实践之间的一致性。Kaplan Meier 生存曲线显示了时间。进行了定性访谈，以探讨登记记录的障碍/促成因素。
在观察到的 7802 名≥1 小时的新生儿中，EIBF 的覆盖率较低（10.9%，95%置信区间 3.8-21.0）。调查报告（53.2%，95%置信区间 39.4-66.8）和登记记录结果（85.9%，95%置信区间 58.1-99.6）在所有医院均高于观察水平，从而高估了覆盖率。登记册除了母乳喂养外，没有记录其他 INC 做法。在四个地点，EIBF 与其他 INC 做法（皮肤接触 69.5-93.9%）的一致性较高，但与延迟脐带结扎（47.3-73.5%）和干燥（7.3-29.0%）的一致性为中等/较差。EIBF 和皮肤接触的延迟时间最长，剖宫产分娩后很少发生 EIBF（0.5-3.6%）。定性研究结果表明，关注准确性和完整性有助于提高登记报告的质量。
本研究强调了尽管存在测量挑战，但仍需要跟踪 EIBF 的重要性，并发现覆盖率水平较低，特别是在剖宫产分娩后。调查报告和登记记录均高估了覆盖率。EIBF 与皮肤接触有很强的一致性，但不是其他 INC 指标的简单追踪指标。其他 INC 做法难以在调查中测量，未被登记册记录，可能需要专门的研究或审计。持续关注 EIBF 对于改善提供者实践和提高覆盖率至关重要。需要投资和创新来改善测量。
