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Is antenatal care preparing mothers to care for their newborns? : a community-based cross-sectional study among lactating women in Masindi, Uganda

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Abstract
Background: Neonatal mortality has remained resistant to change in the wake of declining child mortality. Suboptimal newborn care practices are predisposing factors to neonatal mortality. Adherence to four ANC consultations is associated with improved newborn care practices. There is limited documentation of this evidence in sub-Saharan Africa where suboptimal newborn care practices has been widely reported. Methods: Structured interviews were held with 928 women having children under-five months old at their homes in Masindi, Uganda, from October-December 2011. Four/more ANC consultations (sufficient ANC) was considered the exposure variable. Three composite variables (complete cord care, complete thermal care and complete newborn vaccination status) were derived by combining related practices from a list of recommended newborn care practices. Logistic regression models were used to assess for associations. Results: One in five women 220(23.7%) were assessed to practice complete cord care. Less than ten percent 57(6.1%) were considered to practice complete thermal care and 611(65.8%) were assessed to have complete newborn vaccination status. Application of substance on the cord 744 (71.6%) and early bathing 816 (87.9%) were main drivers of sub-optimal newborn care practices. Multivariable logistic models did not demonstrate significant association between four/more ANC consultations and complete cord care, complete thermal care or complete newborn vaccination status. Secondary or higher education was associated with complete cord care [adjusted Odds Ratio (aOR): 2.72; 95% CI: 1.63-4.54] and complete newborn vaccination [aOR: 1.37; 95% CI: 1.04-1.82]. Women who reported health facility delivery were more likely to report complete thermal care [aOR: 3.63; 95% CI: 2.21-5.95] and newborn vaccination [aOR: 1.84; 95% CI: 1.23-2.75], but not complete cord care. Having the first baby was associated with complete thermal care [aOR: 2.00; 95% CI: 1.24-3.23]. Conclusion: Results confirm suboptimal newborn care practices in Masindi. Despite being established policy, adherence to four or more ANC consultations was not associated with complete cord care, complete thermal care or complete newborn vaccination. This finding has important implications for the implementation of focused ANC to improve newborn care practices. Future ANC interventions should focus on addressing application of substance on the cord and early bathing of the baby during the immediate neonatal period.
Keywords
NEONATAL SURVIVAL, EASTERN UGANDA, RURAL UGANDA, BANGLADESH, HEALTH, VACCINATION, HYPOTHERMIA, INFORMATION, PREVALENCE, SERVICES

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Chicago
Ayiasi, Richard Mangwi, Simon Kasasa, Bart Criel, Christopher Garimoi Orach, and Patrick Kolsteren. 2014. “Is Antenatal Care Preparing Mothers to Care for Their Newborns? : a Community-based Cross-sectional Study Among Lactating Women in Masindi, Uganda.” Bmc Pregnancy and Childbirth 14.
APA
Ayiasi, R. M., Kasasa, S., Criel, B., Orach, C. G., & Kolsteren, P. (2014). Is antenatal care preparing mothers to care for their newborns? : a community-based cross-sectional study among lactating women in Masindi, Uganda. BMC PREGNANCY AND CHILDBIRTH, 14.
Vancouver
1.
Ayiasi RM, Kasasa S, Criel B, Orach CG, Kolsteren P. Is antenatal care preparing mothers to care for their newborns? : a community-based cross-sectional study among lactating women in Masindi, Uganda. BMC PREGNANCY AND CHILDBIRTH. 2014;14.
MLA
Ayiasi, Richard Mangwi, Simon Kasasa, Bart Criel, et al. “Is Antenatal Care Preparing Mothers to Care for Their Newborns? : a Community-based Cross-sectional Study Among Lactating Women in Masindi, Uganda.” BMC PREGNANCY AND CHILDBIRTH 14 (2014): n. pag. Print.
@article{8521520,
  abstract     = {Background: Neonatal mortality has remained resistant to change in the wake of declining child mortality. Suboptimal newborn care practices are predisposing factors to neonatal mortality. Adherence to four ANC consultations is associated with improved newborn care practices. There is limited documentation of this evidence in sub-Saharan Africa where suboptimal newborn care practices has been widely reported. 
Methods: Structured interviews were held with 928 women having children under-five months old at their homes in Masindi, Uganda, from October-December 2011. Four/more ANC consultations (sufficient ANC) was considered the exposure variable. Three composite variables (complete cord care, complete thermal care and complete newborn vaccination status) were derived by combining related practices from a list of recommended newborn care practices. Logistic regression models were used to assess for associations. 
Results: One in five women 220(23.7\%) were assessed to practice complete cord care. Less than ten percent 57(6.1\%) were considered to practice complete thermal care and 611(65.8\%) were assessed to have complete newborn vaccination status. Application of substance on the cord 744 (71.6\%) and early bathing 816 (87.9\%) were main drivers of sub-optimal newborn care practices. Multivariable logistic models did not demonstrate significant association between four/more ANC consultations and complete cord care, complete thermal care or complete newborn vaccination status. Secondary or higher education was associated with complete cord care [adjusted Odds Ratio (aOR): 2.72; 95\% CI: 1.63-4.54] and complete newborn vaccination [aOR: 1.37; 95\% CI: 1.04-1.82]. Women who reported health facility delivery were more likely to report complete thermal care [aOR: 3.63; 95\% CI: 2.21-5.95] and newborn vaccination [aOR: 1.84; 95\% CI: 1.23-2.75], but not complete cord care. Having the first baby was associated with complete thermal care [aOR: 2.00; 95\% CI: 1.24-3.23]. 
Conclusion: Results confirm suboptimal newborn care practices in Masindi. Despite being established policy, adherence to four or more ANC consultations was not associated with complete cord care, complete thermal care or complete newborn vaccination. This finding has important implications for the implementation of focused ANC to improve newborn care practices. Future ANC interventions should focus on addressing application of substance on the cord and early bathing of the baby during the immediate neonatal period.},
  articleno    = {114},
  author       = {Ayiasi, Richard Mangwi and Kasasa, Simon and Criel, Bart and Orach, Christopher Garimoi and Kolsteren, Patrick},
  issn         = {1471-2393},
  journal      = {BMC PREGNANCY AND CHILDBIRTH},
  language     = {eng},
  pages        = {11},
  title        = {Is antenatal care preparing mothers to care for their newborns? : a community-based cross-sectional study among lactating women in Masindi, Uganda},
  url          = {http://dx.doi.org/10.1186/1471-2393-14-114},
  volume       = {14},
  year         = {2014},
}

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