Knowledge, Practice, and Associated Factors of Essential Newborn Care among Sudanese Women in Eastern Sudan
by
and
Abdullah Al-Nafeesah
1,*, 
Mohammed Ahmed A. Ahmed
2,
Omer Elhory
2,
Hyder M. Mahgoub
2,
Bahaeldin A. Hassan
3,
Osama Al-Wutayd
4 and
Ishag Adam
5 1
Department of Pediatrics, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah 56219, Saudi Arabia
2
Faculty of Medicine, Gadarif University, Gadarif 425, Sudan
3
Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
4
Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah 56219, Saudi Arabia
5
Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah 56219, Saudi Arabia
*
Author to whom correspondence should be addressed.
Children 2022, 9(6), 873; https://doi.org/10.3390/children9060873
Submission received: 21 April 2022
/
Revised: 1 June 2022
/
Accepted: 7 June 2022
/
Published: 12 June 2022
Abstract
:(1) Background: There is a high neonatal mortality rate in countries with low resources, especially sub-Saharan countries. There is no published data in Sudan on mothers’ knowledge and practice of essential newborn care. This study aimed to assess the maternal knowledge and practice of essential newborn care in Gadarif city, eastern Sudan. (2) Methods: A cross-sectional study was conducted in Gadarif city, eastern Sudan. Postnatal mothers (384) were recruited from postnatal and vaccination clinics. A structured questionnaire was used to collect the data. Mothers who responded to essential newborn care knowledge and practice items at a rate equal to 75% or above were classified as having good knowledge and practice. Logistic regression analysis was performed to identify the factors associated with essential newborn care knowledge and practice. (3) Results: In this study, 268 (66.4%) and 245 (63.8%) of the 384 participants had good knowledge and practice of essential newborn care, respectively. None of the investigated factors (age, residence, education, occupation, parity, antenatal care, and mode of delivery) was associated with knowledge and practice of essential newborn care with sociodemographic and obstetric factors. Mothers with poor knowledge were less likely to have good practices (adjusted odds ratios = 0.41; 95% CI (0.26–0.64)). The reported malpractices were giving dietary supplements to the babies (48.2%), mainly water (40.0%) and cow’s milk (43.2%), and putting substances on the umbilical cord (62.8%), with butter (92.1%) accounting for the majority. (4) Conclusion: In the present study, around two-thirds of the participants had good essential newborn care knowledge and practice. Poor knowledge was less likely to be associated with good newborn care practices. More research is needed to build baseline data for neonatal mortality reduction plans.
1. Background
Every year, 2.6 million newborn deaths occur globally, the majority of which are in low-setting countries [1]. The global under-five mortality rate dropped by 43 per 1000 deaths between 1990 to 2010 [2]. However, African countries still report the highest rate of under-five and neonatal mortality [3]. Essential newborn care (ENC) plays a vital role in reducing neonatal mortality [3]. ENC, as recommended by the World Health Organization (WHO), includes the early initiation of exclusive breastfeeding, hygienic cord care, and thermal care [4]. Thermal care components are the immediate wrapping and drying of the baby, delaying bathing for 24 h, and skin-to-skin contact (SSC) [5]. Breastfeeding and SSC have been proven to be effective, low-cost interventions to save newborn lives [6]. Despite this, SSC practice was reported to be suboptimal universally [7]. In Sudan, the last household survey conducted in 2010 reported 189 neonatal deaths out of 6198 live births [8]. Poor household wealth index and delivery complications are the major risk factors associated with neonatal mortality in Sudan [8]. Different malpractices of ENC were reported in African countries, including bathing newborns immediately after delivery and applying traditional substances to the cord [7]. Educated urban residents and good antenatal care attendants were associated with good ENC practice [9,10]. Training in ENC among healthcare workers is needed in African countries. Lower staff members’ knowledge of newborn care and low resources were observed [11]. In 2019, the WHO recommended going back to the basics for newborn care in Sudan [12].
2. Methodology
2.1. Study Design and Settings
A cross-sectional study was conducted in Gadarif city, eastern Sudan, from November 2020 to January 2021. Gadarif has a population of 1,727,401 residents. The city is located 400 km from the capital, Khartoum, on the Ethiopian border. Data were recruited from the postnatal and vaccination clinics distributed all over the city.
2.2. Outcome Measures
The main outcome measures were the knowledge and practice of ENC by the mothers. Secondary outcomes were factors associated with ENC knowledge and practice.
2.3. Sample Size
2.4. Study Population
Inclusion criteria: This study included all healthy mothers in the first 6 weeks of their postnatal period who attended the postnatal and vaccination clinics during the study period. Mothers who delivered live babies and were willing to participate in the study were included.
Exclusion criteria: Severely ill mothers and mothers who had stillbirths or babies with congenital malformations at the time of the study were excluded.
2.5. Data Collection
Questionnaires were used to collect the data. Trained medical officers were allocated to fill out the questionnaire throughout the interview. The first part of the questionnaire was composed of sociodemographic and obstetric data. The second part of the questionnaire was an assessment of each participant’s knowledge and practice of ENC. Each ENC practice was assessed with a series of closed questions, scoring one (1) and zero (0) points for appropriate and inappropriate responses, respectively. The scoring system was generated to obtain knowledge about ENC, with categories of poor or good knowledge. Knowledge was assessed using questions that addressed three components of newborn care, per the WHO recommendations. Good breastfeeding includes the first-hour initiation of exclusive breastfeeding. Optimal thermal care was defined as SSC, using the kangaroo method, and the delay of bathing for 24 h. Safe cord care practice was described as cutting and tying the cord with sterilized materials and to refrain from applying substances on it. The score was estimated as “1 = Correct response (following WHO guidelines) and 0 = Incorrect response (not included in WHO guidelines)”. Participants with at least 75% correct responses were considered as having good knowledge, while those with fewer than 75% correct responses were considered mothers with poor knowledge.
Good practice was assessed through the three components of ENC (cord care, optimal thermal care, and exclusive breastfeeding), based on WHO recommendations [4]. Mothers were categorized as good practitioners if they achieved 75% of the appropriate responses to the questionnaire items. These items were consistent with WHO recommendations for good ENC practice. Poor practice was a category of mothers with fewer than 75% appropriate responses. This scoring was guided by similar studies [20,21].
2.6. Statistics
The data were entered into a computer, with SPSS version 22 used for analysis. Continuous data were not normally distributed and were expressed as median (interquartile), while the categorized data were expressed as numbers (%). Multivariable logistic regression was performed using practice and knowledge of ENC as the dependent variable and sociodemographic and obstetric factors as the independent variables. Multivariable analysis using a standard logistic regression technique to evaluate the independent effect of each covariate by controlling for the effect of other variables. The adjusted odds ratio (AOR) and 95% confidence intervals were computed. A p-value of less than 0.05 in the multivariable logistic regression analysis was considered statistically significant.
2.7. Ethical Approval
Ethical approval was obtained from the Ethical Committee of the Faculty of Medicine of Gadarif University, Sudan. Written informed consent was signed by each participant after an explanation of the study’s objectives. The right to withdraw at any stage of the study was ensured.
3. Results
3.1. Sociodemographic Characteristics
Three hundred eighty-four mothers were enrolled in the study. The median (interquartile) age of the participants was 27.0 (22.0–30.0) years. Over half of the mothers, 256 (66.7%), had less than a secondary education. One hundred forty-four participants (37.5%) were employed, and more than half (57.8%) of their residences were urban (Table 1).
3.2. Obstetric Data
Most participants, 326 (84.9%), had antenatal care during the index pregnancy, but the maximum number of antenatal care visits were two in 98.5% of cases. Two hundred and forty-five women (63.8%) were delivered vaginally, with nearly one-third (32.2%) delivered at home (Table 1).
3.3. Knowledge of ENC
Breastfeeding: Two hundred sixty-eight (69.8%) participants knew to initiate breastfeeding immediately after delivery. The women had received information about colostrum (90.1%), and 343 (89.3%) were informed about its advantages. Cord care: Three hundred six participants (79.7%) were informed about the material that should be used to cut the umbilical cord. Thermal care: Most mothers (63.8%) believed that keeping the baby in SSC was essential to protect the baby from hypothermia. Information about drying and wrapping babies was reported by 71.1% of participants. However, only 8.9% attained knowledge about delaying bathing the baby for 24 h (Table 2). Overall, 225 (66.4%) participants had good knowledge about ENC, based on their responses to the questionnaire items (Table 2).
3.4. Factors Associated with Participants’ Knowledge of ENC
Age, residence, education, occupation, parity, antenatal care, and mode of delivery were not significantly associated with ENC knowledge (Table 3).
3.5. ENC Practices among the Study Populations
Breastfeeding: First postnatal hour breastfeeding was practiced by 344 (89.6%) mothers. Half of the mothers (51.8%) adopted exclusive breastfeeding. The majority (93.8%) of participants fed their babies with colostrum. Cord care: The cord was cut with a new razor blade (65.6%) and tied with a clamp or clean thread (79.7%); no materials were applied to it (37.2%). Thermal care: SSC was adopted by 339 (88.3%) postnatal mothers. Nearly half of the mothers (49.0%) wrapped their babies with preprepared towels. Waiting 24 h to bathe the baby was practiced by 66.1% of participants (Table 2). The participants who scored ≥ 75% on the practice items (good practice) were 245 (63.8%) (Table 2).
3.6. Factors Associated with Participants’ Practices of ENC
There were no statistically significant associations between age, residence, education, occupation, parity, antenatal care, and mode of delivery with newborn practice. Poor knowledge (AOR = 0.41; 95% CI (0.26–0.64)) was less likely to report good newborn practices (Table 4).
3.7. Misconceptions and Malpractices
Only two out of 384 mothers (0.5%) were reluctant to give the first milk to their babies. Beliefs that the first milk could cause diarrhea and decreased growth were behind this reluctance. To cut the cord, 191 (57.7%), 66 (19.9%), and 59 (17.8%) reported the usage of a boiled new razor blade, an un-boiled used razor blade, and available sharp material, respectively. Two hundred forty-one (62.8%) participants applied substances to the umbilical cord. Butter accounted for 92.1% of the applied materials. We observed that 185 (48.2%) mothers fed their babies prelacteals. The main two substances used as an additional diet were water (40.0%) and cow milk (43.2%). The rest of the participants used butter (10.8%) and holly water (6.0%) (Table 5).
4. Discussion
The current study indicated that 66.4% of the participants had good ENC knowledge. This finding is comparable to a similar study in Ghana, in which 62% of mothers had good knowledge about ENC [20]. However, the knowledge about ENC in our study was significantly higher than the reported results from Mekelle City, Ethiopia (36.1%) [21].
These variations can be attributed to differences in the study settings and education levels. The demographics in the Ethiopian study showed only 18.2% above secondary education, in comparison with 32.3% in our study population.
Breastfeeding knowledge among the study populations was satisfactory. Most mothers knew about early breastfeeding (69.8%) and colostrum (90.1%) and its advantages (89.3%). Comparable findings were noted in South Sudan [22].
Overall, cord care knowledge was encouraging in the present study. Most mothers (79.7%) knew which was the right instrument used to cut the cord.
Nearly two-thirds of participants had gained good knowledge about thermal care. Similar thermal care knowledge was reported in Ethiopia [21]. Poor knowledge about the newborn’s first bath was reported (8.9%). This compares with common beliefs documented in Nigeria [23].
Information about ENC given to postnatal mothers in our community was mostly delivered by midwives. A previously published study in Sudan reported poor ENC knowledge (50.6%) among midwives [24]. Wrong messages about ENC were expected to be delivered from midwives to postnatal mothers in the present study.
In the present study, good ENC practice was 63.8% overall. This is consistent with findings from a study in Nepal (66.2%) [25]. The prevalence of good ENC practices in our data is higher than in similar studies from Ethiopia, Damot Pulasa (24%) [26], and Aksum Town (26.7%) [16]. These differences could be explained by sociodemographic differences between the study areas, even within the same country.
The current study showed that first postnatal hour breastfeeding was practiced by 344 (89.6%). In agreement with this frequency, previous studies approved the benefit of the early initiation of breastfeeding [6,7,27].
Our data reported that only 51.8% of mothers exclusively breastfed their babies. This is much lower than reported findings from Ghana (87%) [20] and Uganda (93.2%) [28]. Our finding was comparable with results from Egypt (56%) [29] and Ethiopia (50.2%) [26]. The widespread practice of prelacteal feeding in these two neighboring countries was due to wrong beliefs. In Egypt, supplementary feeding was wrongly considered part of exclusive breastfeeding [29].
Colostrum was given by 93.8% in the present study. Similar good practices were observed in Ghana (91.5%) [20] and Uganda (94.7%) [30]. The WHO raised the importance of first milk to the baby [31]. A previous study in Ethiopia revealed that mothers discarded colostrum, as they had negative beliefs about it [26].
Good cord care practices among the study population were documented, including cutting the cord with a new razor blade (65.6%) and tying with a clamp or clean thread (79.7%). Consistent good cord care practices were reported in a Nigerian study [32]. Nearly two-thirds (67.8%) of vaginal deliveries in our study were hospital deliveries. Hospital cord care practice is expected to be better than that of home delivery. A previously published study in Sudan assessed the nurse midwife’s practice of cord care in four major hospitals in Khartoum; good cord care practice was 65.8% [24].
In 2019, the WHO conducted a workshop in Khartoum that recommended the practice of SSC as an effective, non-costly, and highly beneficial form of thermal care [12]. A worldwide study observed the high prevalence of SSC among high- and middle-income countries [33]. The present study reported one of the highest prevalences of SSC practices in Africa (88.3%). The majority, if not all, of studies published in Africa, reported lower prevalences of SSC: Uganda (17.6%) [30], Ethiopia (19%) [34], and Gambia(35.7%) [35]. This relatively high SSC in our data might be related to another finding: early breastfeeding (89.6%). SSC was ensured during early breastfeeding sessions.
The current study indicated that 66.1% of mothers bathe their babies 24 h after birth. Similar practices were demonstrated in Ghana [20] and Ethiopia [10]. However, lower prevalences were observed in Malawi [36] and Nigeria [23]. In countries where the practice of early bathing was adopted, dirty babies and bad odors were the most frequent factors [23].
ENC knowledge was the only association with ENC practice in our study. Poor knowledge (AOR = 0.41; 95% CI (0.26–0.64)) was less likely to report good newborn practice. This finding supports published studies from Ethiopia [10,21] and Nepal [25]. This could be explained by the fact that in the absence of ENC knowledge, malpractices like prelacteal feeding and applying substances to the umbilical cord will dominate. A previously published study in Bossaso, Somalia, noticed the positive effect of maternal ENC knowledge on practice [25].
The malpractice of applying substances to the cord is widely distributed in African communities. Our data reported that 62.8% of participants applied substances to the cord. We found butter (92.1%) at the top of the list of applied substances. The malpractice of applying butter was similarly observed in studies from Ghana [27] and Ethiopia [34]. Other substances, such as powder in South Sudan [22] and Uganda [28], were applied to the umbilical cord. The beliefs behind the application of these substances were enhancing the healing of the cord and accelerating the cord separation process [37].
We observed that 185 (48.2%) of mothers fed their babies prelacteals. Water (40.0%), cow milk (43.2%), butter (10.8%), and holly water (6.0%) were the substances used. These substances varied from one country to another, based on the cultures of the community. A tea and glucose solution was used by mothers in Uganda [28], anise and caraway in Egypt [29], and honey in Ethiopia [10]. The majority of mothers claimed that family and community pressure were the reason behind this malpractice [38].
Interventions to improve the knowledge and practice of ENC in Sudan are needed. An interventional study in Sudan examined the practice of drying and wrapping the baby. Midwives demonstrated a tenfold improvement in the practice, with a subsequent reduction in neonatal mortality [39]. Our study was facility-based, so our results might not reflect community practices. Moreover, the sample size was small, and the single-city design limited generalizability.
5. Conclusions
Approximately two-thirds of participants had good ENC knowledge and practice. Although the prevalence of good SSC practices was higher in comparison with other African countries, our study shows insufficient ENC knowledge and practices among Sudanese women.
Author Contributions
Conceptualization, A.A.-N., O.E., M.A.A.A. and I.A.; methodology, B.A.H., O.E., H.M.M.; validation, O.A.-W., B.A.H. and I.A.; formal analysis, A.A.-N., M.A.A.A.; investigation, data curation, O.A.-W., B.A.H., H.M.M.; writing—original draft preparation, A.A.-N.; writing—review and editing. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethical Committee of the Faculty of Medicine of Gadarif University, Sudan (21.10.2020).
Informed Consent Statement
Informed consent was obtained from all participants in the study.
Data Availability Statement
The data presented in this study are available on request from the corresponding author.
Acknowledgments
The researchers would like to thank the Deanship of Scientific Research, Qassim University, for funding the publication of this project.
Conflicts of Interest
The authors declare that there are no conflict of interest.
References
- Kuruvilla, S.; Bustreo, F.; Kuo, T.; Mishra, C.K.; Taylor, K.; Fogstad, H.; Gupta, G.R.; Gilmore, K.; Temmerman, M.; Thomas, J.; et al. The Global strategy for women’s, children’s and adolescents’ health (2016–2030): A roadmap based on evidence and country experience. Bull. World Health Organ. 2016, 94, 398–400. [Google Scholar] [CrossRef]
- Bishai, D.M.; Cohen, R.; Alfonso, Y.N.; Adam, T.; Kuruvilla, S.; Schweitzer, J. Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010. PLoS ONE 2016, 11, e0144908. [Google Scholar] [CrossRef] [Green Version]
- Golding, N.; Burstein, R.; Longbottom, J.; Browne, A.J.; Fullman, N.; Osgood-Zimmerman, A.; Earl, L.; Bhatt, S.; Cameron, E.; Casey, D.C.; et al. Mapping under-5 and neonatal mortality in Africa, 2000–2015: A baseline analysis for the Sustainable Development Goals. Lancet 2017, 390, 2171–2182. [Google Scholar] [CrossRef] [Green Version]
- WHO. WHO|WHO Recommendations on Postnatal Care of the Mother and Newborn. 2020. Available online: https://apps.who.int/iris/handle/10665/97603 (accessed on 7 May 2022).
- WHO. WHO|WHO Compendium of Innovative Health Technologies for Low-Resource Settings. 2019. Available online: https://reliefweb.int/report/world/who-compendium-innovative-health-technologies-low-resource-settings-2021?gclid=CjwKCAjwjtOTBhAvEiwASG4bCFOFSazlstYdt2tji7JMhJWlVirbF3sGKJZJdC6HL8qRTQ3CfTOooxoCrRUQAvD_BwE (accessed on 7 May 2022).
- Olorunsaiye, C.Z.; Harris, A.-M.; Yusuf, K.K. Characteristics of Early Newborn Care: A Descriptive Analysis of Recent Births in Nigeria. Int. J. Matern. Child Health AIDS 2020, 9, 93–102. [Google Scholar] [CrossRef]
- Bee, M.; Shiroor, A.; Hill, Z. Neonatal care practices in sub-Saharan Africa: A systematic review of quantitative and qualitative data. J. Health Popul. Nutr. 2018, 37, 9. [Google Scholar] [CrossRef] [Green Version]
- Bashir, A.O.; Ibrahim, G.H.; Bashier, I.A.; Adam, I. Neonatal mortality in Sudan: Analysis of the Sudan household survey, 2010. BMC Public Health 2013, 13, 287. [Google Scholar] [CrossRef] [Green Version]
- Asratie, M.H.; Muche, A.A.; Geremew, A.B. Completion of maternity continuum of care among women in the post-partum period: Magnitude and associated factors in the northwest, Ethiopia. PLoS ONE 2020, 15, e0237980. [Google Scholar] [CrossRef]
- Mersha, A.; Assefa, N.; Teji, K.; Shibiru, S.; Darghawth, R.; Bante, A. Essential newborn care practice and its predictors among mother who delivered within the past six months in Chencha District, Southern Ethiopia, 2017. PLoS ONE 2018, 13, e0208984. [Google Scholar] [CrossRef]
- Murphy, G.A.V.; Gathara, D.; Mwaniki, A.; Nabea, G.; Mwachiro, J.; Abuya, N.; English, M. Nursing knowledge of essential maternal and newborn care in a high-mortality urban African setting: A cross-sectional study. J. Clin. Nurs. 2019, 28, 882–893. [Google Scholar] [CrossRef]
- WHO. EMRO|Getting the Basics Right for Newborn Care|Sudan-Events|Sudan. Available online: http://www.emro.who.int/sdn/sudan-events/getting-the-basics-right-for-newborn-care.html (accessed on 7 May 2022).
- Sami, S.; Kerber, K.; Tomczyk, B.; Amsalu, R.; Jackson, D.; Scudder, E.; Dimiti, A.; Meyers, J.; Kenneth, K.; Kenyi, S.; et al. “You have to take action”: Changing knowledge and attitudes towards newborn care practices during crisis in South Sudan. Reprod. Health Matters 2017, 25, 124–139. [Google Scholar] [CrossRef] [Green Version]
- Sami, S.; Kerber, K.; Kenyi, S.; Amsalu, R.; Tomczyk, B.; Jackson, D.; Dimiti, A.; Scudder, E.; Meyers, J.; Umurungi, J.P.D.C.; et al. State of newborn care in South Sudan’s displacement camps: A descriptive study of facility-based deliveries. Reprod. Health 2017, 14, 161. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ayele, B.G.; Woldu, M.A.; Gebrehiwot, H.W.; Gebre-Egziabher, E.G.; Gebretnsae, H.; Hadgu, T.; Abrha, A.A.; Medhanyie, A.A. Magnitude and determinants for place of postnatal care utilization among mothers who delivered at home in Ethiopia: A multinomial analysis from the 2016 Ethiopian demographic health survey. Reprod. Health 2019, 16, 162. [Google Scholar] [CrossRef] [PubMed]
- Berhe, M.; Medhaniye, A.A.; Kahsay, G.; Birhane, E.; Abay, M. Essential neonatal care utilization and associated factors among mothers in public health facilities of Aksum Town, North Ethiopia, 2016. PLoS ONE 2017, 12, e0175902. [Google Scholar] [CrossRef] [PubMed]
- Murphy, G.A.V.; Gathara, D.; Aluvaala, J.; Mwachiro, J.; Abuya, N.; Ouma, P.; Snow, R.W.; English, M. Nairobi Newborn Study: A protocol for an observational study to estimate the gaps in provision and quality of inpatient newborn care in Nairobi City County, Kenya. BMJ Open 2016, 6, e012448. [Google Scholar] [CrossRef]
- Owor, M.O.; Matovu, J.K.B.; Murokora, D.; Wanyenze, R.K.; Waiswa, P. Factors associated with adoption of beneficial newborn care practices in rural Eastern Uganda: A cross-sectional study. BMC Pregnancy Childbirth 2016, 16, 83. [Google Scholar] [CrossRef] [Green Version]
- Kirkwood, B.R.; Sterne, J.A.C. Essential Medical Statistics, 2nd ed.; Wiley: Hoboken, NJ, USA, 2003. [Google Scholar]
- Ayete-Nyampong, J.; Udofia, E.A. Assessment of knowledge and quality of essential newborn care practices in La Dade Kotopon Municipality, Ghana. PLoS ONE 2020, 15, e0237820. [Google Scholar] [CrossRef]
- Berhea, T.A.; Belachew, A.B.; Abreha, G.F. Knowledge and practice of Essential Newborn Care among postnatal mothers in Mekelle City, North Ethiopia: A population-based survey. PLoS ONE 2018, 13, e0202542. [Google Scholar] [CrossRef] [Green Version]
- Meseka, L.A.; Mungai, L.W.; Musoke, R. Mothers’ knowledge on essential newborn care at Juba Teaching Hospital, South Sudan. South Sudan Med. J. 2018, 10, 56–59. [Google Scholar]
- Adejuyigbe, E.A.; Bee, M.H.; Amare, Y.; Omotara, B.A.; Iganus, R.B.; Manzi, F.; Shamba, D.D.; Skordis-Worrall, J.; Odebiyi, A.; Hill, Z.E. “Why not bathe the baby today?”: A qualitative study of thermal care beliefs and practices in four African sites. BMC Pediatr. 2015, 15, 156. [Google Scholar] [CrossRef] [Green Version]
- Ali NasorTaha, F. Assessment of knowledge, attitude and practices of nurse midwives towards immediate care of the newbornin khartoum state teaching hospitals (2011). J. Am. Sci. 2013, 9, 263–270. [Google Scholar]
- Singh, D.R.; Harvey, C.M.; Bohara, P.; Nath, D.; Singh, S.; Szabo, S.; Karki, K. Factors associated with newborn care knowledge and practices in the upper Himalayas. PLoS ONE 2019, 14, e0222582. [Google Scholar] [CrossRef] [PubMed]
- Chichiabellu, T.Y.; Mekonnen, B.; Astawesegn, F.H.; Demissie, B.W.; Anjulo, A.A. Essential newborn care practices and associated factors among home delivered mothers in Damot pulasa Woreda, southern Ethiopia. Reprod. Health 2018, 15, 162. [Google Scholar] [CrossRef] [PubMed]
- Saaka, M.; Ali, F.; Vuu, F. Prevalence and determinants of essential newborn care practices in the Lawra District of Ghana. BMC Pediatr. 2018, 18, 173. [Google Scholar] [CrossRef] [Green Version]
- Kayom, V.O.; Kakuru, A.; Kiguli, S. Newborn Care Practices among Mother-Infant Dyads in Urban Uganda. Int. J. Pediatr. 2015, 2015, 815938. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Darmstadt, G.L.; Hussein, M.H.; Winch, P.J.; Haws, R.A.; Lamia, M.; El-Said, M.A.; Gipson, R.F.; Santosham, M. Neonatal home care practices in rural Egypt during the first week of life. Trop. Med. Int. Health 2007, 12, 783–797. [Google Scholar] [CrossRef] [PubMed]
- Komakech, H.; Lubogo, D.; Nabiwemba, E.; Orach, C.G. Essential newborn care practices and determinants amongst mothers of infants aged 0–6 months in refugee settlements, Adjumani district, west Nile, Uganda. PLoS ONE 2020, 15, e0231970. [Google Scholar] [CrossRef] [Green Version]
- Peven, K.; Bick, D.; Purssell, E.; Rotevatn, T.A.; Nielsen, J.H.; Taylor, C. Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: A systematic review. Health Policy Plan. 2020, 35, ii47–ii65. [Google Scholar] [CrossRef]
- Afolaranmi, T.O.; Hassan, Z.I.; Akinyemi, O.O.; Sule, S.S.; Malete, M.U.; Choji, C.P.; Bello, D.A. Cord Care Practices: A Perspective of Contemporary African Setting. Front. Public Health 2018, 6, 10. [Google Scholar] [CrossRef] [Green Version]
- Abdulghani, N.; Edvardsson, K.; Amir, L.H. Worldwide prevalence of mother-infant skin-to-skin contact after vaginal birth: A systematic review. PLoS ONE 2018, 13, e0205696. [Google Scholar] [CrossRef]
- Callaghan-Koru, J.A.; Seifu, A.; Tholandi, M.; de Graft-Johnson, J.; Daniel, E.; Rawlins, B.; Worku, B.; Baqui, A.H. Newborn care practices at home and in health facilities in 4 regions of Ethiopia. BMC Pediatr. 2013, 13, 198. [Google Scholar] [CrossRef] [Green Version]
- Ekholuenetale, M.; Onikan, A.; Ekholuenetale, C.E. Prevalence and determinants of mother and newborn skin-to-skin contact in The Gambia: A secondary data analysis. J. Egypt. Public Health Assoc. 2020, 95, 18. [Google Scholar] [CrossRef] [PubMed]
- Khan, S.M.; Kim, E.T.; Singh, K.; Amouzou, A.; Carvajal-Aguirre, L. Thermal care of newborns: Drying and bathing practices in Malawi and Bangladesh. J. Glob. Health 2018, 8, 010901. [Google Scholar] [CrossRef] [PubMed]
- Coffey, P.S.; Brown, S.C. Umbilical cord-care practices in low- and middle-income countries: A systematic review. BMC Pregnancy Childbirth 2017, 17, 1. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Balogun, O.O.; Dagvadorj, A.; Anigo, K.M.; Ota, E.; Sasaki, S. Factors influencing breastfeeding exclusivity during the first 6 months of life in developing countries: A quantitative and qualitative systematic review. Matern. Child Nutr. 2015, 11, 433–451. [Google Scholar] [CrossRef] [PubMed]
- Arabi, A.M.E.; Ibrahim, S.A.; Manar, A.R.; Abdalla, M.S.; Ahmed, S.E.; Dempsey, E.P.; Ryan, C.A. Perinatal outcomes following helping babies breathe training and regular peer–peer skills practice among village midwives in Sudan. Arch. Dis. Child. 2018, 103, 24–27. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Table 1.
Sociodemographic characteristics of the study population.
| Variables | Frequency | Percent | |
|---|---|---|---|
| Age group, years * | 27.0 (22.0–30.0) | ||
| Education | |||
| ≥secondary level | 256 | 66.7 | |
| <secondary level | 128 | 33.3 | |
| Occupation | |||
| Housewives | 240 | 62.5 | |
| Employed | 144 | 37.5 | |
| Residence | |||
| Rural | 162 | 42.2 | |
| Urban | 222 | 57.8 | |
| Parity * | 2 (1–4) | ||
| Antenatal care when pregnant | |||
| ≥two visits | 324 | 84.4 | |
| ˂two visits | 60 | 15.6 | |
| Mode of delivery | |||
| Vaginal delivery | 245 | 63.8 | |
| Cesarean delivery | 139 | 36.2 | |
| Place of birth of vaginal delivery | |||
| Home | 79 | 32.2 | |
| Hospital | 166 | 67.8 | |
| Postnatal care | |||
| Yes | 374 | 97.4 | |
| No | 10 | 2.6 | |
| Time of first postnatal care | |||
| Day 1 | 86 | 23.0 | |
| Day 2–3 | 70 | 18.7 | |
| Day 7–14 | 96 | 25.7 | |
| Day 40–42 | 122 | 32.6 | |
* Median (interquartile).
Table 2.
The quality of ENC components of knowledge and practice.
| Components of ENC | Number | Percentage |
|---|---|---|
| Knowledge | ||
| Breastfeeding | ||
| Breastfeeding a newborn immediately after delivery | 268 | 69.8 |
| Informed about feeding the first milk | 346 | 90.1 |
| Informed about advantages of first milk | 343 | 89.3 |
| Cord care | ||
| Informed about cutting the cord with new razor blade | 306 | 79.7 |
| Thermal care | ||
| Deliver baby onto mother’s abdomen or into her arms | 246 | 64.1 |
| Dry and wrap the baby | 273 | 71.1 |
| Place the baby in skin-to-skin contact | 245 | 63.8 |
| Delay bathing the baby for 24 h after delivery | 34 | 8.9 |
| Overall good newborn care | 255 | 66.4 |
| Practice | ||
| Breastfeeding | ||
| Breastfeeding started in the first hour of delivery | 344 | 89.6 |
| Exclusive breastfeeding | 199 | 51.8 |
| Colostrum was given to the baby | 360 | 93.8 |
| Newborn was breastfed > 8 times per day | 213 | 55.5 |
| Cord care | ||
| The cord was cut with new razor blade | 252 | 65.6 |
| The cord was tied with clamp/clean thread | 306 | 79.7 |
| No material has been applied to the cord | 143 | 37.2 |
| Thermal care | ||
| The baby positioned on mother’s abdomen | 83 | 21.6 |
| The baby kept in immediate skin-to-skin contact | 339 | 88.3 |
| The baby was wrapped before the delivery of the placenta | 137 | 35.7 |
| The baby was wrapped with pre-prepared towel | 188 | 49.0 |
| The baby had been bathed after 24 h | 254 | 66.1 |
| Overall good newborn care practice | 245 | 63.8 |
Table 3.
Factors associated with participants’ knowledge of ENC.
| Variables | Poor Knowledge (129) | Good Knowledge (255) | OR (95%CI) | p |
|---|---|---|---|---|
| Age, year * | 27 (21–30) | 27 (23–31) | 1.02 (0.96–1.08) | 0.542 |
| Residence | ||||
| Rural | 61 (47.3) | 101 (39.6) | 0.60 (0.34–1.04) | |
| Urban | 68 (52.7) | 154 (60.4) | Reference | |
| Educational level | ||||
| ≥secondary level | 87 (67.4) | 169 (66.3) | Reference | |
| <secondary level | 42 (32.6) | 86 (33.7) | 1.11 (0.62–2.01) | 0.712 |
| Occupation | ||||
| Housewives | 78 (60.5) | 162 (63.5) | Reference | |
| Employee | 51 (39.5) | 93 (36.5) | 0.75 (0.44–1.27) | 0.296 |
| Parity * | 2.0 (1.0–3.0) | 3.0 (1.0–4.0) | 1.04 (0.86–1.27) | 0.644 |
| Antenatal care | ||||
| ≥two visits | 113 (87.6) | 211 (82.7) | Reference | |
| ˂two visits | 16 (12.4) | 44 (17.3) | 1.58 (0.82–3.06) | 0.168 |
| Mode of delivery | ||||
| Vaginal | 87 (67.4) | 158 (62.0) | Reference | |
| Cesarian | 42 (32.6) | 97 (38.0) | 1.29 (0.81–2.04) | 0.249 |
* Median (interquartile).
Table 4.
Factors associated with participants’ practices of ENC.
| Variables | Poor Practice 139 | Good Practice 245 | OR (95%CI) | p |
|---|---|---|---|---|
| Age, year * | 27 (21–30) | 27 (23–31) | 0.96 (0.91–1.01) | 0.144 |
| Residence | ||||
| Rural | 63 (45.3) | 99 (40.4) | 0.75 (0.43–1.30) | |
| Urban | 76 (54.7) | 146 (59.6) | Reference | |
| Educational level | ||||
| ≥secondary level | 92 (66.2) | 164 (66.9) | Reference | |
| <secondary level | 47 (33.8) | 81 (33.1) | 0.93 (0.51–1.68) | 0.815 |
| Occupation | ||||
| Housewives | 85 (61.2) | 155 (63.3) | Reference | |
| Employee | 54 (38.8) | 90 (36.7) | 0.94 (0.55–1.60) | 0.833 |
| Parity * | 2 (1–3) | 3.0 (1–4) | 1.04 (0.86–1.26) | 0.652 |
| Antenatal care | ||||
| ≥two visits | 116 (83.5) | 208 (84.9) | Reference | |
| ˂two visits | 23 (16.5) | 37 (15.1) | 0.83 (0.45–1.54) | 0.567 |
| Mode of delivery | ||||
| Vaginal | 92 (66.2) | 153 (62.4) | Reference | |
| Cesarian | 47 (33.8) | 92 (37.6) | 1.09 (0.69–1.72) | 0.685 |
| Knowledge | ||||
| Good | 75 (54.0) | 180 (73.5) | Reference | |
| Poor | 64 (46.0) | 65 (26.5) | 0.41 (0.26–0.64) | 0.005 |
* Median (interquartile).
Table 5.
Misconceptions and malpractices of Sudanese women towards ENC.
| Variables | Frequency/Total Events | Percentage |
|---|---|---|
| Reasons for not using first milk | ||
| Causes diarrhea | 1/2 | 50 |
| Causes constipation | - | - |
| Decreases growth | 1/2 | 50 |
| Others | - | - |
| Non-recommended material used to tie the cord | ||
| Cord tie | 21/78 | 26.9 |
| Others | 57/78 | 73.1 |
| Materials applied to the cord after cutting | ||
| Cow dung | 12/241 | 5.0 |
| Dust | 4/241 | 1.7 |
| Butter | 222/241 | 92.1 |
| Others | 3/241 | 1.2 |
| Additional diet (prelacteal) within 28 days | ||
| Water | 74/185 | 40.0% |
| Butter | 20/185 | 10.8% |
| Cow milk/commercial milk formula | 80/185 | 43.2% |
| Holly water | 11/185 | 6.0% |
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Al-Nafeesah, A.; Ahmed, M.A.A.; Elhory, O.; Mahgoub, H.M.; Hassan, B.A.; Al-Wutayd, O.; Adam, I. Knowledge, Practice, and Associated Factors of Essential Newborn Care among Sudanese Women in Eastern Sudan. Children 2022, 9, 873. https://doi.org/10.3390/children9060873
AMA Style
Al-Nafeesah A, Ahmed MAA, Elhory O, Mahgoub HM, Hassan BA, Al-Wutayd O, Adam I. Knowledge, Practice, and Associated Factors of Essential Newborn Care among Sudanese Women in Eastern Sudan. Children. 2022; 9(6):873. https://doi.org/10.3390/children9060873
Chicago/Turabian StyleAl-Nafeesah, Abdullah, Mohammed Ahmed A. Ahmed, Omer Elhory, Hyder M. Mahgoub, Bahaeldin A. Hassan, Osama Al-Wutayd, and Ishag Adam. 2022. "Knowledge, Practice, and Associated Factors of Essential Newborn Care among Sudanese Women in Eastern Sudan" Children 9, no. 6: 873. https://doi.org/10.3390/children9060873
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