Poor Universal Coverage of Immediate Essential Newborn Care at Hospitals of Wollega Zones, The Case of Western Ethiopia

Figures & data

Table 1 Categories of Essential Newborn Care and Their Verifying Criteria

Categories of ENC	Verification Criteria Included to Measure Enc During Observations
Keeping the baby warm	1. Provider delivered baby on to mother’s abdomen 2. Dried the baby immediately with a dry clean towel 3. Change the wet towel 4. Cover the baby’s body and head with a clean dry cloth
Helping the baby breathe	1. Check for the breathing 2. Initiating the baby to breathe 3. Suctioning done when it was required
Keeping the delivery procedure and baby clean	1. Umbilical cord was cut with sterile scissors or blade 2. Applying nothing to umbilical cord other than chlorhexidine 3. Washing hands before touching the neonate to give eye care 4. Cleaning the surroundings of an eye before eye care
Early initiation of breastfeeding	1. Delivery attendants initiated breastfeeding in the first one hour
Provision of TTC prophylactic eye care and vitamin K.	1. Providing Vitamin K (phytonadione) one milligram to newborn intramuscularly 2. Giving Tetracycline (1%) eyes ointments in each lower conjunctival sac

Table 2 Sociodemographic and Economic Status of the Mothers’ of the Newborns That Childbirth Attended at Hospitals of Wollega Zones, West Ethiopia, 2017 (n=375)

Variables		Frequency	Percent
Marital status	Married	351	93.60
	Single/Divorced/Widowed	24	6.40
Age (Median Age=25, IQR=7)	18–19	22	5.86
	20–24	142	37.87
	25–29	134	35.73
	30–34	42	11.20
	35 and above	35	9.33
Ethnicity	Oromo	320	85.33
	Amhara	47	12.54
	Others	8	2.13
Religion	Protestant	214	57.10
	Orthodox	93	24.80
	Muslim	61	16.30
	Others	7	1.80
Educational status	No formal education	92	24.54
	Primary cycle	93	24.80
	Secondary school	89	23.73
	College/University	101	26.93
Occupation	Marchant	66	17.60
	Gov’t employee	87	23.20
	house-wife	183	48.80
	Student	23	6.13
	others	16	4.27
Residency	Rural	196	52.27
	Urban	179	47.73
Annual income	Lowest	86	22.94
	Second	71	18.93
	Middle	78	20.80
	Fourth	74	19.73
	Highest	66	17.60

Table 3 Obstetric and Related Factors of the Women Give Childbirth at Hospitals of Wollega Zones, West Ethiopia, 2017 (n=375)

Characteristics	Categories	Frequency	Percent
Parity (Median=1, IQR= 3)	Prime parous	119	31.73
	Two-four	234	62.4
	five or more	22	5.90
Number of previous alive children	No	121	32.27
	One to three	213	56.80
	Four and above	41	10.93
Gestational age (Mean GA= 39.05, SD±1.5)	Preterm	22	5.86
	Term	304	81.07
	Post-term	16	4.27
	Unknown	33	8.80
HIV status	Positive	10	2.67
	Negative	355	94.67
	Unknown	10	2.67
Delivery day	Working day	240	64.00
	Weekends	80	21.33
	Holiday	55	14.67
Delivery time	Day	236	62.93
	Night	139	37.07
Assistant to delivery attendant	Yes	279	74.40
	No	96	25.60

Figure 1 Immediate Essential Newborn Care Service provided to newborns at Hospitals, output of composite observation for each category, West Ethiopia, 2017.

Table 4 Description of Sub-Components of Essential Newborn Care at Hospitals of Wollega Zones, West Ethiopia, 2017 (n=375)

Core Activities Under the Components of ENC		Frequency (%)
Dry and stimulate	Delivered baby on to mother’s abdomen	372(99.20)
	Dry with dry towel	372(99.20)
	Rubbing the back or Slapping or flicking the soles of the feet	103(27.47)
	Change towel	311(82.93)
Evaluate breathing	Check breathing	363(96.80)
	Suctioning necessary and done (N=212)	173(81.6)
	Suctioning not necessary but done(N=163)	46(28.2)
	Baby needs resuscitation and done(N=55)	55(100)
Cord care	Cord clamped/tied	375(100)
	Cord cut with sterile scissor/blade	371(98.93)
Keep the newborn warm	New born Placed skin-to-skin	33(8.80)
	Cover the baby’s body and head with clean cloth	179(47.73)
Initiate breastfeeding in the first one hour		315(84.00)
Administer eye drops/eye ointment	Wash hands with soap and water	23(6.13)
	Cleaned the eye from medial to lateral	30(8.00)
	Give tetracycline eye ointment/drops	111(29.60)
Administer vitamin K		198(52.80)
Place the newborn’s identification bands on the wrist or ankle		17(4.53)
Weigh the newborn		370(98.67)
Record all observations and treatment		353(94.13)

Table 5 Multivariate Logistic Regression Model Analysis of Factors Associated with ENC Service Provision to Newborns Delivered at Hospitals of Wollega Zones, Western Ethiopia, 2017

Factors		Keep New Born Warm	Help Baby Breathe	Help Baby Feed	Disease Prevention
		AOR	AOR	AOR	AOR
Age in years	≤24	1	1	1	#
	25–29	1.24(0.65, 2.38)	1.68(0.96, 2.97)	0.46(0.22, 0.98)^Table Footnote*
	≥30	1.91(0.85, 4.28)	0.92(0.45, 1.90)	0.34(0.13, 0.89)^Table Footnote*
Employment type	Gov’t	1	1	1	1
	Self	1.16(0.53, 2.50)	0.96(0.43, 2.10)	1.88(0.72, 4.91)	1.49(0.66,3.35)
	Unemployed	1.18(0.63, 2.21)	0.96(0.43, 2.10)	1.94(0.85,4.45)	2.14(1.13, 4.05)^Table Footnote*
Annual income	Lowest	1	1	1	#
	Second	0.42(0.17, 1.03)	0.83(0.38, 1.85)	1.08(0.42, 2.77)
	Middle	1.74(0.83, 3.66)	1.21(0.57, 2.57)	0.76(0.28, 2.00)
	Fourth	2.83(1.40, 5.70)^Table Footnote**	1.03(0.47, 2.26)	1.35(0.47,3.88)
	Highest	2.44(1.10,5.42)^Table Footnote*	0.98(0.41, 2.33)	1.19(0.38, 3.73)
Delivery day	Working Day	1	1	1	1
	Weekends	1.95(1.05, 3.63)^Table Footnote*	1.54(0.79, 2.99)	0.32(0.16, 0.64)^Table Footnote***	0.75(0.39,1.42)
	Holy Day	1.10(0.53,2.28)	1.01(0.47, 2.18)	0.92(0.37,2.26)	1.91(0.99, 3.68)
Number of previous child alive	No	1	1	1	1
	One to three	1.32(0.67, 2.60)	#	2.87(1.38, 6.00)^Table Footnote**	1.81(1.04, 3.16)^Table Footnote*
	Four & above	0.67(0.23,1.97)		1.37(0.42, 4.44)	3.19(1.44, 7.08)^Table Footnote**
Presence of Assistant	No	1	1	1	1
	Yes	1.97(1.05, 3.62)^Table Footnote*	3.69(1.74, 7.82)^Table Footnote***	2.48(1.29,4.77)^Table Footnote**	1.06(0.61,1.84)
Baby needed resuscitation	No	1	1	1	1
	Yes	4.15(2.13, 8.10)^Table Footnote***	2.49(1.30, 4.74)^Table Footnote**	0.23(0.11, 0.49)^Table Footnote***	2.91(1.62,5.21)^Table Footnote***

Notes:

* P-value less than 0.05

** P-value less than 0.01

*** P-value less than 0.001

# not included in the model.