Essential newborn care practices for healthy newborns at a district hospital in Pemba, Tanzania: a cross-sectional observational study utilizing video recordings

Figures & data

Table 1. Definition of essential newborn care indicators and their corresponding actions in video recordings

WHO Essential Newborn Care indicator	Video indicators	Video indicators subcategories
1. Thermal care
The newborn should be wrapped and covered sufficiently	Newborn wrapped and head covered	Not covered when placed on table
		Incompletely covered when placed on table
		Uncovered while on table
		Fully covered while on table
Avoid separating the newborn from its mother and keep skin-to-skin contact	Separation time from mother = total time on resuscitation table
2. Stimulation
Newborns should be stimulated correctly	Number of times newborn is stimulated. Stimulation defined as rubbing the newborn’s back.
3. Routine suctioning
Newborns without need of ventilation should not undergo oral or nasal suction	Newborns without need of ventilation who did not undergo suction
	Total time spent on suction	Total suction time
	Oral vs nasal suction and number of suction events	Oral suction, number of events
		Nasal suction, number of events
	Correct suctioning technique defined as air pushed out of the suction bulb before placement in nose/mouth and then released	Yes
		No
		Uncertain
4. Observation
Newborns should not be left unattended and should be check for breathing and colour.	Number of times the newborn was assessed by health worker	Visually assessed*
		Clinical examination**
		Assessed with stethoscope
5. Umbilical cord care
The cord should be checked for bleeding, kept clean and dry. If bleeding, retied	Number of times abdomen is assessed with unwrapping and the cord retied or clamped if needed.	Cord checked
		Cord clamped
6. Vitamin K
Newborns should be given 1 mg of vitamin K after delivery	Newborns receiving intramuscular administration of vitamin K
7. Antibiotic eye ointment
Newborns should receive antibiotic ointment	Newborns where application of antibiotic ointment was done
8. Breastfeeding
Newborns should be breastfed within the first hour after birth	Separation time from mother = total time on resuscitation table <1 hour the first hour

*Note: Defined as healthcare worker observing the newborn, with no other interactions

**Note: Defined as uncovering of the newborn’s chest for examination of breathing and colour

Figure 1. Flowchart of study population.

Table 2. Socio-demographics, obstetric, and delivery characteristics of women and their healthy newborns

	Participants n (%)*
Maternal age
<20	53 (18%)
20–34	208 (69%)
>35	40 (13%)
Religion
Muslim	296 (98%)
Christian	5 (2%)
Other	0 (0%)
Marital status
Married	292 (97%)
Single	7 (2%)
Divorced	2 (1%)
Highest level of education
No formal education	24 (8%)
Primary	45 (15%)
Secondary	213 (71%)
College	9 (3%)
University	10 (3%)
Occupation
Housewife	248 (82%)
Farmer	5 (2%)
Government employed	20 (7%)
Self-employed	30 (10%)
Unemployed	1 (0%)
Parity on admission
Para 0	74 (25%)
Para 1–4	169 (56%)
Para >5	58 (19%)
Antenatal care (ANC) during this pregnancy
1–3 ANC visits	160 (53%)
>4 ANC visits	136(45%)
None	1(0%)
Missing	4(1%)
Estimated gestational age**
<37 weeks	0 (0%)
>37 weeks	141 (47%)
Missing	160 (53%)
Mode of delivery
Vaginal delivery	283 (94%)
Cesarean section	17 (6%)
Missing	1 (0%)
Presentation of baby
Cephalic	295 (98%)
Breech	5 (2%)
Missing	1 (0%)
Birth weight
<1500 g	0 (0%)
1500–2500 g	32 (11%)
2500–4000 g	251 (83%)
>4000 g	7 (2%)
Missing	11 (4%)
Sex
Male	150 (50%)
Female	151 (50%)
Multiple gestation
Singletons	295 (98%)
Twins	6 (2%)
*23 missing cases ** The women included provided an estimated gestational age in the postnatal questionnaire

Table 3. Essential newborn care intervention compliance by video indicator subcategories

Video indicators	Video indicators subcategories	Number of events	Number of newborns n = 324	Median time hour:min:second (min/max)	IQR hour:min:second
1. Thermal care
Newborn wrapped in kanga and head covered	Not covered when placed on table		76 (23%)	00:02:11 (00:00:17/00:38:49)	00:08:28
	Uncovered while on table		106 (33%)	00:10:29 (00:00:31/01:42:11)	00:14:19
	Fully covered the whole time spent on table		167 (51%)
Separation time = total time on resuscitation table	Separation time		324	00:25:15 (00:00:22/03:35:58)	00:25:10
2. Stimulation
Newborn stimulated correctly			25 (8%)
3. Routine suctioning
Newborns who did not undergo suction			296 (91%)
Suction time	Total suction time		28 (9%)	00:01:09 (00:00:05/00:08:04)	00:01:33
Place	Oral suction	1	2 (1%)
		2–5	8 (3%)
		>5	12 (4%)
	Nasal suction	1	3 (1%)
		2–5	12 (4%)
		>5	4 (1%)
Correct suctioning technique	Yes		11 (39%)
	No		8 (29%)
	Uncertain		9 (32%)
4. Observation
Newborn assessed	Visually assessed	0	99 (31%)
		1	101 (31%)
		>1	124 (38%)
	Clinical examination	1	30 (9%)
		>1	7 (2%)
	Assessed with stethoscope	1	2 (1%)
5. Umbilical cord care
Cord checked	Cord checked	1	59 (18%)
		>1	9 (3%)
Retied if bleeding**	Cord clamp	1	13 (4%)
		>1	2 (1%)
6. Vitamin K
Intramuscular administration of vitamin K			0 (0%)
7. Antibiotic eye ointment
Application of antibiotic eye ointment			1 (0%)
8. Breastfeeding
Separation time from mother<1 hour			293 (90%)
Separation time from mother>1 hour			31 (10%)	01:17:44 (01:00:22/03:35:58)	00:41:34
**Note: there were no observations of bleeding from the cord, every observation was adding of an extra cord clamp and shortening of the umbilical cord.

Figure 2. Essential newborn care compliance to WHO indicators at a Tanzanian referral hospital.

Figure 3. Number of births per week compared with compliance to ENC indicators at a Tanzanian referral hospital.

Table

Quality indicators	Film indicators	Film indicators subdivided	Code
Lie the newborn down on a flat and firm surface, wrap it in a dry towel and cover the head to keep it warm.	Newborn wrapped in kanga and head covered	Not covered start time	1AA
		Not covered end time	1AB
		Not covered total time	1AC
		Fully covered	1B
		Uncovered while on table start time	1CA
		Uncovered while on table end time	1CB
		Uncovered total time	1CC
Stimulate the newborn thoroughly by rubbing its back.	Newborn stimulated		2
Avoid separating mother from newborn whenever possible	Separation time = total time on resuscitation table	Separation time	3
Keep warm by skin to skin contact with the mother	Separation time = total time on resuscitation table	Separation time	3
Check breathing and color every 15 minutes	Newborn assessed	Visually assessed start time	4AA
		Visually assessed end time	4AB
		Visually assessed total time	4AC
		Clinical examination start time	4 BA
		Clinical examination end time	4BB
		Clinical examination total time	4BC
		Assessed with stethoscope start time	4CA
		Assessed with stethoscope end time	4CB
		Assessed with stethoscope total time	4CC
Check the cord for bleeding every 15 min, keep it clean and dry.	Cord checked		5
If bleeding, retie it.	Retied if bleeding		6
If the baby is born with meconium or if secretions are blocking the mouth and nose, and you need to resuscitate first clear the airway;	Suction of newborns	Oral suction	7A
		Nasal suction	7B
	Suction of newborns	Suction time start	8AA
		Suction time end	8AB
		Suction time total	8AC
It is important that you SUCTION meconium OUT of the newborn!	Correct suctioning technique	Yes	9A
		No	9B
		Uncertain	9C
Give 1 mg vitamin K (IM)	Intramuscular administration of vitamin K		10
Start breastfeeding within the first hour after birth and let the newborn feed on demand.	Separation time from mother>1 hour		11
Apply antibiotic eye ointment	Application of antibiotic ointment		12