Hypothermia is increasingly recognized as a major cause of neonatal morbidity and mortality in resource poor settings. High prevalence of hypothermia has been reported widely from warmer high mortality regions of Africa and South Asia. The World Health Organization recognizes newborn thermal care as a critical and essential component of essential newborn care; however, hypothermia continues to remain under-documented, under-recognized and under-managed. This review aims to provide a thorough patho-physio-epidemiological discussion of neonatal hypothermia applied to local risk factors within the developing country context with particular emphasis on prevention, recognition and management. All available published literature on neonatal hypothermia relevant to resource poor settings were reviewed. Studies from the developing country settings were primarily reviewed for epidemiology, domiciliary risk factors as well as potential interventions for thermal care. Functional integrity and efficiency of biological systems is critically dependent on an optimal and very narrow range of core body temperature. Risk factors for neonatal hypothermia differ markedly within low resource settings. A combination of physiological, behavioral and environmental factors universally put all newborns, irrespective of birth weight, at risk of hypothermia. The knowledge deficit along the continuum from health providers to primary care givers has sustained the silent epidemic of hypothermia. The challenges of recognition, understanding of local risk factors and communication have meant a lack of informed thermal care for newborns. Simple, feasible interventions exist, but need to be applied, based on local risk factors that disrupt the warm chain. Further research is needed to document local risk factors, develop better techniques for recognition, evaluation of thermal care within essential newborn care and communication strategies for program effectiveness.

Neonatal hypothermia in low resource settings: a review

Four million neonatal deaths are estimated to occur each year and almost all in low income countries, especially among the poorest. There is a paucity of data on newborn health from sub-Saharan Africa and few studies have assessed inequity in uptake of newborn care practices. We assessed socioeconomic differences in use of newborn care practices in order to inform policy and programming in Uganda. All mothers with infants aged 1-4 months (n = 414) in a Demographic Surveillance Site were interviewed. Households were stratified into quintiles of socioeconomic status (SES). Three composite outcomes (good neonatal feeding, good cord care, and optimal thermal care) were created by combining related individual practices from a list of twelve antenatal/essential newborn care practices. Multiple logistic regression analysis was used to identify determinants of each dichotomised composite outcome. There were low levels of coverage of newborn care practices among both the poorest and the least poor. SES and place of birth were not associated with any of the composite newborn care practices. Of newborns, 46% had a facility delivery and only 38% were judged to have had good cord care, 42% optimal thermal care, and 57% were considered to have had adequate neonatal feeding. Mothers were putting powder on the cord; using a bottle to feed the baby; and mixing/replacing breast milk with various substitutes. Multiparous mothers were less likely to have safe cord practices (OR 0.5, CI 0.3 - 0.9) as were mothers whose labour began at night (OR 0.6, CI 0.4 - 0.9). Newborn care practices in this setting are low and do not differ much by socioeconomic group. Despite being established policy, most neonatal interventions are not reaching newborns, suggesting a "policy-to-practice gap". To improve newborn survival, newborn care should be integrated into the current maternal and child interventions, and should be implemented at both community and health facility level as part of a universal coverage strategy.

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Poor newborn care practices - a population based survey in eastern Uganda

BACKGROUND: To evaluate a delivery strategy for newborn interventions in rural Bangladesh. METHODS: A cluster-randomized controlled trial was conducted in Mirzapur Bangladesh. Twelve unions were randomized to intervention or comparison arm. All women of reproductive age were eligible to participate. In the intervention arm community health workers identified pregnant women; made two antenatal home visits to promote birth and newborn care preparedness; made four postnatal home visits to negotiate preventive care practices and to assess newborns for illness; and referred sick neonates to a hospital and facilitated compliance. Primary outcome measures were antenatal and immediate newborn care behaviours knowledge of danger signs care seeking for neonatal complications and neonatal mortality. FINDINGS: A total of 4616 and 5241 live births were recorded from 9987 and 11153 participants in the intervention and comparison arm respectively. High coverage of antenatal (91% visited twice) and postnatal (69% visited on days 0 or 1) home visitations was achieved. Indicators of care practices and knowledge of maternal and neonatal danger signs improved. Adjusted mortality hazard ratio in the intervention arm compared to the comparison arm was 1.02 (95% CI: 0.80-1.30) at baseline and 0.87 (95% CI: 0.68-1.12) at endline. Primary causes of death were birth asphyxia (49%) and prematurity (26%). No adverse events associated with interventions were reported. CONCLUSION: Lack of evidence for mortality impact despite high program coverage and quality assurance of implementation and improvements in targeted newborn care practices suggests the intervention did not adequately address risk factors for mortality. The level and cause-structure of neonatal mortality in the local population must be considered in developing interventions. Programs must ensure skilled care during childbirth including management of birth asphyxia and prematurity and curative postnatal care during the first two days of life in addition to essential newborn care and infection prevention and management. TRIAL REGISTRATION: Clinicaltrials.gov NCT00198627.

Evaluation of a cluster-randomized controlled trial of a package of community-based maternal and newborn interventions in Mirzapur, Bangladesh.

The current study is designed to explore the practices, knowledge and attitude towards breastfeeding among postnatal mothers and factors that determine them. This descriptive study was carried out in the Neonatal Division, Department of Pediatrics at a tertiary care hospital in South India during April – July 2009. The data was collected from 100 postnatal mothers by trained interviewers using a structured proforma. In addition to demographic data, mothers were also asked about their knowledge on and attitude towards breastfeeding and the practices they follow. Scoring of the responses to questions was done and the data was analyzed using Statistical Package for Social Sciences. The knowledge of the mothers was inadequate in areas of time of initiation of breastfeeding (92%), colustrum feeding (56%), duration of exclusive breastfeeding (38%), knowledge on expressed breastmilk (51%) and continuation of breastfeeding while baby is sick. Better scores corre-lated significantly with higher maternal age, better maternal education, higher socioeconomic status and having received antenatal care from tertiary care centers and private practitioners. There is still a need for programmes, which support and encourage breast-feeding particularly at a primary care level, focusing more on younger, less well-educated women and those from lower socioeconomic class.

https://www.alliedacademies.org/articles/knowledge-attitiude-and-practice-of-breastfeeding-among-postnatal-mothers.pdf

Knowledge, attitiude and practice of breastfeeding among postnatal mothers

Informing Resource-Poor Populations and the Delivery of Entitled Health and Social Services in Rural India

Objectives. To describe selected newborn care practices related to cord care, thermal care and breastfeeding in rural Uttar Pradesh and to identify socio-demographic, antenatal and delivery care factors that are associated with these practices. Methods.A cross-sectional survey in rural Uttar Pradesh included 13,167 women who had a livebirth at home during the two years preceding data collection. Logistic regression was used to identify socio-demographic, antenatal and delivery care factors that were associated with the three care practices. Results. Use of antenatal care and skilled attendance at delivery were significantly associated with clean cord care and early breastfeeding, but not with thermal care. Antenatal home visits by a community-based worker were associated only with clean cord care. Women who received counseling from health workers or other sources on each of the newborn care practices during pregnancy were more likely to report the respective care practices, although levels of counseling were low. Conclusion. The association between newborn care practices and antenatal care, counseling and skilled delivery attendance suggest that evidence-based newborn care practices can be promoted through improved coverage with existing health

Newborn care in rural Uttar Pradesh

This paper deals with an experimental investigation of a family of cone-cylinder bodies having circular and equivalent elliptical (a/b = 2.0) cross sections with variation in nose and afterbody fineness ratios at Mach number 2.0. All elliptical bodies are tested at roll orientations of 0 deg (semimajor axis normal to cross flow velocity) and 90 deg (semiminor axis normal to crossflow velocity). The nose fineness ratios for these bodies are 1.0, 2.0, and 3.0, and the afterbody fineness ratios are 5.0 and 7.0. The effect of changing the cross section shape from circular to elliptical, the roll orientation, and the variation in nose and afterbody fineness ratios on aerodynamic characteristics are discussed. (Author)

R. Sharma

Papers

Newborn care in rural Uttar Pradesh

Experimental investigation on cone cylinder bodies of elliptical and circular cross sections at M = 2.0