Essential newborn care practice at four primary health facilities in conflict affected areas of Bossaso, Somalia: a cross-sectional study
Open accessAbstract
Newborn mortality is increasingly concentrated in contexts of conflict and political instability. However, there are limited guidelines and data on the availability and quality of newborn care in conflict settings. In 2016, an interagency collaboration developed the Newborn Health in Humanitarian Settings Field Guide- Interim version (Field Guide) . In this study, we sought to understand the baseline availability and quality of essential newborn care in Bossaso, Somalia as part of an investigation to determine the feasibility and effectiveness of the Field Guide in improving newborn care in humanitarian settings. A cross-sectional study was conducted at four purposely selected health facilities serving internally displaced persons affected by conflict in Bossaso. Essential newborn care practice and patient experience with childbirth care received at the facilities were assessed via observation of clinical practice during childbirth and the immediate postnatal period, and through postnatal interviews of mothers. Descriptive statistics and logistic regression were employed to summarize and examine variation by health facility. Of the 332 pregnant women approached, 253 (76.2%) consented and were enrolled. 97.2% (95% CI: 94.4, 98.9) had livebirths and 2.8% (95% CI: 1.1, 5.6) had stillbirths. The early newborn mortality was 1.7% (95% CI: 0.3, 4.8). Nearly all [95.7%, (95% CI: 92.4, 97.8)] births were attended by skilled health worker. Similarly, 98.0% (95% CI: 95.3, 99.3) of newborns received immediate drying, and 99.2% (95% CI: 97.1, 99.9) had delayed bathing. Few [8.6%, (95% CI: 5.4, 12.9)] received immediate skin-to-skin contact and the practice varied significantly by facility ( p < 0.001). One-third of newborns [30.1%, (95% CI: 24.4, 36.2)] received early initiation of breastfeeding and there was significant variation by facility ( p < 0.001). While almost all [99.2%, (95% CI: 97.2, 100)] service providers wore gloves while attending births, handwashing was not as common [20.2%, (95% CI: 15.4, 25.6)] and varied by facility ( p < 0.001). Nearly all [92%, (95% CI: 86.9, 95.5)] mothers were either very happy or happy with the childbirth care received at the facility. Essential newborn care interventions were not universally available. Quality of care varied by health facility and type of intervention. Training and supervision using the Field Guide could improve newborn outcomes.
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Skin-to-skin contact was not generally reported as being practised.
“Skin-to-skin contact was not generally reported as being practised, and when practised, its frequency varied across levels of care.28 31 36 48”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [36]
When skin-to-skin contact was practised, its frequency varied across levels of care.
“Skin-to-skin contact was not generally reported as being practised, and when practised, its frequency varied across levels of care.28 31 36 48”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [36]
Provision of eye care with tetracycline results varied across studies.
“Provision of eye care with tetracycline was assessed at the health facility level in four studies and the results varied.31 36 47 60”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [36]
In Somalia, delaying bathing was observed in 99.2% (95% CI 97.1 to 99.9) of newborns born in the PHCCs.
“This practice varied across settings, for example, in Somalia, it was observed in 99.2% (95% CI 97.1 to 99.9) of newborns born in the PHCCs,36 while in Uganda and Afghanistan it was not a common practice.48 56”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [36]
In two settings, training seemed to improve the practice of dry cord care.
“In two settings, training seemed to improve the practice of dry cord care.36 52”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [36]
Delaying bathing practice varied across settings.
“This practice varied across settings, for example, in Somalia, it was observed in 99.2% (95% CI 97.1 to 99.9) of newborns born in the PHCCs,36 while in Uganda and Afghanistan it was not a common practice.48 56”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [36]
In Somalia, 42.1% (95% CI 35.9 to 48.6) of newborns were observed to receive eye care.
“In Somalia, 42.1% (95% CI 35.9 to 48.6) of newborns were observed to receive eye care36”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [36]
Hand washing level of practice varied across settings.
“Hand washing was reported in five studies and its level of practice varied across settings.36 46 49 52 55”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [36]
In Somalia, a study reported that 71% of women that delivered at the assessed PHCCs were followed up at home 7-9 days after discharge.
“In Somalia, a study reported that 71% of women that delivered at the assessed PHCCs were followed up at home 7–9 days after discharge.36”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [36]
In PHCCs in Somalia, 4.1% (95% CI 2.0 to 7.4) of newborns received vitamin K.
“In PHCCs in Somalia, 4.1% (95% CI 2.0 to 7.4) of newborns received vitamin K36”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [36]
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- Authors
- Amsalu, R., Morris, C. N., Chukwumalu, K., Hynes, M., Janjua, S., Couture, A., Summers, A., Cannon, A., Hulland, E. N., & Baunach, S.
- Affiliations
- Save the Children (US)
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Amsalu, Ribka
- Venue
- Conflict and Health
- Published
- 2019-06-13
- Volume
- 13
- Issue
- 1
- Pages
- 27-27
- ISSN
- 1752-1505 (ISSN-L)
- PMC
- PMC6567601
- OpenAlex
- W2951239960
- Cited by
- 38
- References
- 31
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 13 · 2020: 6 · 2019: 1
- FWCI
- 6.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Conflict and Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
- Keywords
- essential newborn care, conflict-affected settings, humanitarian settings, internally displaced persons, neonatal mortality, skilled birth attendance, skin-to-skin contact, breastfeeding initiation, newborn bathing, hand hygiene, neonatal resuscitation, neonatal infection prevention, primary health centers, maternal and newborn health services, stillbirth, handwashing behavior
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