Differences in essential newborn care at birth between private and public health facilities in eastern Uganda

Figures & data

Fig. 1 Map of the UNEST study area.

Fig. 2 Coverage of babies receiving essential newborn care interventions. * χ²prob=0.007

Table 1 Background characteristics of respondents for endline census

	Total (all facility deliveries)	Private facilities	Public facilities
Characteristics	N (%)	N (%)	N (%)	p
Maternal age (yrs)	n=1,358	n=299	n=1,059
<19	96 (7.07)	16 (5.35)	80 (7.55)	0.1797
19–25	564 (41.53)	120 (40.13)	444 (41.93)	0.5770
26–30	357 (26.29)	79 (26.42)	278 (26.25)	0.9530
>30	341 (25.11)	84 (28.09)	257 (24.27)	0.1786
Marital status	n=1,369	n=306	n=1,063
Not married	116 (8.47)	22 (7.19)	94 (8.84)	0.3610
Married	1,253 (91.53)	284 (92.81)	969 (91.16)	0.3610
Education	n=1,369	n=306	n=1,063
No education	127 (9.28)	33 (10.78)	94 (8.84)	0.3026
Primary	783 (57.20)	198 (64.71)	585 (55.03)	0.0026*
Secondary	407 (29.73)	68 (22.22)	339 (31.89)	0.0011*
University	52 (3.80)	7 (2.29)	45 (4.23)	0.1176
Wealth quintile	n=1,036	n=240	n=796
1 (Poorest)	154 (14.86)	46 (19.17)	108 (13.57)	0.0326*
2 (Poor)	219 (21.14)	52 (21.67)	167 (20.98)	0.8185
3 (Average)	258 (24.90)	63 (26.25)	195 (24.50)	0.5827
4 (Rich)	207 (19.98)	48 (20.00)	159 (19.97)	0.9919
5 (Richest)	198 (19.11)	31 (12.92)	167 (20.98)	0.0054*
Parity	n=1,369	n=306	n=1,063
1	262 (19.14)	37 (12.09)	225 (21.17)	<0.001
2–4	585 (42.73)	129 (42.16)	456 (42.90)	0.8176
>4	522 (38.13)	140 (45.75)	382 (35.94)	0.0019*
Number of ANC visits	n=1,351	n=300	n=1,051
1	46 (3.40)	15 (5.00)	31 (2.95)	0.0842
2–3	646 (47.82)	142 (47.33)	504 (47.95)	0.8496
>3	659 (48.78)	143 (47.67)	516 (49.10)	0.6621
Trimester of first ANC visit	n=1,363	n=303	n=1,060
1	322 (23.62)	59 (19.47)	263 (24.81)	0.0536*
2	875 (64.20)	198 (65.35)	677 (63.87)	0.6356
3	166 (12.18)	46 (15.18)	120 (11.32)	0.0700
Mode of delivery	n=1,369	n=306	n=1,063
Spontaneous	1,307 (95.47)	303 (99.02)	1,004 (94.45)	<0.001*
Caesarean	60 (4.38)	3 (0.98)	57 (5.36)	0.001*
Other	2 (0.15)	0 (0.00)	2 (0.19)	0.4454

Table 2 Place of delivery

	Baseline		Endline
	n=395	%	n=1,761	%
Facility delivery	275	69.6	1,369	77.7
Public facility	176	44.6	1,062	60.3
Private facility	99	25.1	306	17.4
Delivered by traditional birth attendant	44	11.1	147	8.3
Delivered at home or elsewhere	110	27.8	245	13.9
Missing	10	2.5	0	0.0

Table 3 Determinants of births in private health facilities

	Univariate unadjusted		Multivariate unadjusted
Variable	OR	95% CI	OR	95% CI
Parity
1	1		1
2–4	1.72	1.15–2.56	1.72	1.06–2.81
>4	2.22	1.50–3.32	2.01	1.22–3.31
Wealth quintile
1 (Poorest)	1
2 (Poor)	0.73	0.46–1.16	0.75	0.46–1.21
3 (Average)	0.76	0.49–1.19	0.75	0.48–1.19
4 (Rich)	0.71	0.44–1.14	0.75	0.46–1.22
5 (Richest)	0.44	0.26–0.73	0.52	0.30–0.90
Education level
No education	1
Primary	0.96	0.63–1.48	1.08	0.67–1.76
Secondary or higher	0.56	0.35–0.89	0.93	0.53–1.66
Trimester of first ANC visit
1	1
2	1.30	0.94–1.80	1.31	0.89–1.92
3	1.71	1.10–2.66	1.77	1.07–2.95
Mode of delivery
Normal	1
Caesarean	0.17	0.05–0.56	0.20	0.48–0.84

Table 4 Reported neonatal care practices by place of delivery

	Public health facilities	Private health facilities
Practices	N (%)	N (%)	p
Clean instrument used to cut the cord	n=1,063	n=306
	883 (83.07)	252 (82.35)	0.7681
Clean instrument used to tie or clamp the cord	n=1,063	n=306
	1,014 (95.39)	285 (93.14)	0.1153
Dry cord care	n=1,062	n=304
	631 (59.42)	170 (55.92)	0.2733
Breastfed within first hour	n=1,063	n=306
	734 (69.05)	218 (71.24)	0.4633
Baby fed by breast only (no bottle)	n=1,063	n=306
	1,026 (96.52)	300 (98.04)	0.1791
Exclusive breastfeeding in the first month	n=1,063	n=305
	862 (81.09)	247 (80.98)	0.9655
Baby wrapped after delivery with dry cloth	n=1,063	n=306
	1,060 (99.72)	304 (99.35)	0.3428
Baby placed skin-to-skin	n=1,063	n=306
	821 (77.23)	218 (71.24)	0.0309*
First bath delayed >6 h	n=1,055	n=302
	920 (87.20)	255 (84.44)	0.2146
Hygienic cord care	n=1,063	n=306
Clean instrument used to cut cord; clean instrument used to tie cord; nothing placed on cord	502(47.22)	140(45.75)	0.6498
Thermal protection	n=1,063	n=306
Baby wrapped after delivery with dry cloth; placed skin-to-skin; bath delayed >6 h	724 (68.11)	183 (59.80)	0.0067*
Optimal feeding practices	n=1,063	n=306
Baby breastfed within first hour; no bottle used; exclusive breastfeeding for the first month	128 (12.04)	30 (9.80)	0.2798

Table 5 Number and distribution of essential newborn care interventions by place of delivery (%)

	Number of newborn care interventions received
	9	8	7	6	5	4	3	2	1	0	Mean (SD)
Private facility	8.5	27.4	46.8	68.8	81.0	89.5	95.1	98.2	99.5	100.0	6.16 (1.92)
Public facility	16.4	42.8	67.8	82.9	92.4	96.6	98.4	99.5	99.8	100.0	7.04 (1.59)
p											<0.001*

Interventions include: Wrapping the baby using a dry cloth; early skin-to-skin placement; delayed bath at least 6 h after delivery; clean instrument used to cut the umbilical cord; clean device used to tie or clamp the cord; placing nothing on the cord stump; breastfeeding within the first hour after birth; no use of bottle; not giving any food or drink other than breast milk for the first month.