A Mediation Analysis of Determinants of New-born Care Practices in Four Regions of Ethiopia
Background: Despite a substantial decline in under-five mortality in Ethiopia, neonatal mortality declined steadily and the contribution of the insignificant decline of neonatal mortality to under-five mortality grew from 29.5% in 2000 to 43.3% in 2016. The slow fall of neonatal mortality implies the need for an approach that addresses the main causes of new-born deaths. The World Health Organization recommends essential new-born care practices to save new-borns from morbidity and mortality. The aim of this study was to assess determinants of new-born care practice in the four regions of Ethiopia.
Method: The study is part of an intervention project that attempts to investigate the impact of Optimising Health Extension Project on health service utilisation of mothers and children below the age of five years. Data for 590 births that occurred in the twelve months preceding the survey was extracted from the main study data and utilized for the present study. The outcome variable of our study is the number of new-born care practices performed by women that delivered recently. Thus, Poisson regression analysis was used, and a goodness of fit test showed that the model fits the data well. Maternal healthcare utilisation is considered as a mediating variable and a difference approach was used to test whether the effects of socio-economic and demographic variables were mediated. STATA 14 was used for data management and analysis and 5% level of significance was used to declare statistical significance.
Results: Clothing (88.1%) and drying (75.2%) are the most frequently accomplished thermal care practices. Cutting the cord with a clean and sharp material was practiced for 83.0% of the births. For more than two third of the births (68.5%), timely initiation of breastfeeding was performed as a new-born care practice. Immunization of the new-born for polio 0 was the least performed new-born care practice for 25.8% of the births. Maternal healthcare utilisation beyond ANC was observed to be beneficial to new-born care practice. The total effect of birth preparedness and complication readiness (0.15 (0.08, 0.22)) was split to direct and indirect effect. Both the direct (0.08 (95% CI (0.01, 0.15))) and indirect (0.07 (95% CI (0.02, 0.12))) effects were statistically significant. The predictive power of birth preparedness and complication readiness through its influence on maternal healthcare utilization accounted for 45.3% (95% CI (15.6, 75.0)) of its total effect.
Conclusion: New-born care practice is inadequate in general. However, birth preparedness and complication readiness have dual benefit of enhancing both maternal healthcare utilization and new-born care practices. Therefore, women shall be provided with information on benefits of facility delivery and getting professional assistance during delivery to improve new-born care practices. [Ethiop. J. Health Dev. 2021; 35(2):116-124]
Keywords: New-born care practice, mediation analysis, birth preparedness and complication readiness