Prevalence of essential newborn care in home and facility births in the Peruvian Amazon: analysis of census data from programme evaluation in three remote districts of the Loreto region

Stefan Reinders; Magaly M Blas; Melissa Neuman; Luis Huicho; Carine Ronsmans

doi:10.1016/j.lana.2022.100404

Prevalence of essential newborn care in home and facility births in the Peruvian Amazon: analysis of census data from programme evaluation in three remote districts of the Loreto region

Lancet Reg Health Am. 2022 Dec 5:18:100404. doi: 10.1016/j.lana.2022.100404. eCollection 2023 Feb.

Authors

Stefan Reinders¹, Magaly M Blas¹, Melissa Neuman^{2

3}, Luis Huicho⁴, Carine Ronsmans²

Affiliations

¹ Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú.
² Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
³ MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK.
⁴ Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú.

Abstract

Background: Essential newborn care (ENC) covers optimal breastfeeding, thermal care, and hygienic cord care. These practices are fundamental to save newborn lives. Despite neonatal mortality remaining high in some parts of Peru, no comprehensive data on ENC is available. We sought to estimate the prevalence of ENC and assess differences between facility and home births in the remote Peruvian Amazon.

Methods: We used baseline data from a household census of rural communities of three districts in Loreto region, collected as part of the evaluation of a maternal-neonatal health (MNH) programme. Women between 15 and 49 years with a live birth in the last 12 months were invited to complete a questionnaire about MNH-related care and ENC. Prevalence of ENC was calculated for all births and disaggregated by place of birth. Adjusted prevalence differences (PD) were post-estimated from logistic regression models on the effect of place of birth on ENC.

Findings: All 79 rural communities with a population of 14,474 were censused. Among 324 (>99%) women interviewed, 70% gave birth at home, most (93%) without skilled birth assistance. Among all births, prevalence was lowest for immediate skin-to-skin contact (24%), colostrum feeding (47%), and early breastfeeding (64%). ENC was consistently lower in home compared to facility births. After adjusting for confounders, largest PD were found for immediate skin-to-skin contact (50% [95% CI: 38-62]), colostrum feeding (26% [16-36]), and clean cord care (23% [14-32]). ENC prevalence in facilities ranged between 58 and 93%; delayed bathing was lower compared to home births (-19% [-31 to -7]).

Interpretation: Low prevalence of ENC practices among home births in a setting with high neonatal mortality and difficult access to quality care in facilities suggests potential for a community-based intervention to promote ENC practices at home, along with promotion of healthcare seeking and simultaneous strengthening of routine facility care.

Funding: Grand Challenges Canada and Peruvian National Council of Science, Technology, and Technology Innovation.

Keywords: Amazon; Breastfeeding; Cord care; Essential newborn care; Indigenous; Maternal-neonatal health; Peru; Prevalence; Thermal care.