Gaps in neonatal thermal care in low-resource settings: A web-based survey of healthcare workers.

Objective To explore the gaps in knowledge and practice in neonatal thermal care among healthcare workers in low-resource settings. Methods We conducted a 2-round, web-based survey of a purposive and snowball sample of healthcare workers in neonatal care in low-resource settings globally. The questionnaire was developed using themes of neonatal thermal care extracted from existing neonatal care guidelines, including WHO’s. The survey asked multiple-choice questions, supplemented by open-ended questions to capture first hand insights and information on neonatal thermal care. Results of the survey were analysed using Microsoft Excel. Data was collated and summarized using descriptive measures. Results Almost all participants acknowledged the importance of all the WHO warm chain elements, however, fewer participants responded positively regarding the practice of this warm chain. Only 56% of the participants acknowledged the usefulness of checking the peripheral temperature by hand-touch. The usefulness of the core temperature was valued higher than that of the peripheral temperature as an indicator of cold stress, with 70% and 58% agreement, respectively. Opinions diverged regarding the peripheral temperatures, including apparent inaccuracy compared to rectal or axillary temperature. Preferences on rewarming strategies widely differed among participants and so did the availability of warming equipment in their institutions. Conclusions We identified the general acknowledgment of the importance of the WHO warm chain but also its limited practice. We also identified that an inadequate understanding of cold stress underestimates the potential benefits of peripheral temperatures and leads to missed opportunities for timely prevention of hypothermia. Furthermore, lack of consistent guidance on equipment for rewarming hypothermic neonates hampers recovery.

Study on outcome of guided newborn care in postnatal ward and common practices of newborn care among mothers followed in outpatient department at Hi-Tech medical college and hospital, Bhubaneswar

Background: Neonatal period is the most vulnerable phase in a child's life. The aim and goal of newborn care is not only to reduce neonatal mortality but more importantly to ensure their survival to the fullest. The neonatal mortality rate of India is 22 per 1000 live births. The neonatal period is only for 28 days yet it accounts for significant deaths under 5 years of age. Newborn morbidity and mortality contribute significantly to the infant mortality and under-five mortality rates in developing countries. About two-thirds of all infant deaths and 38% of all under-five deaths occur during the neonatal period, resulting in about 4 million neonatal deaths globally per year. Infant and under-five mortality ratio in developing countries have declined significantly in the past couple of decades, yet neonatal mortality rates have remained relatively static. The objective of this study was to understand the outcome of guided newborn care along with the patterns and determinants of essential newborn care and practices.Methods: A prospective cohort study was done among newborns in the postnatal ward and the outpatient (OPD) based newborns at HMCH Bhubaneswar from July 2020 to June 2021. The mothers in the postnatal ward were taught cord care, skin care, optimal thermal care and neonatal feeding practices. The regular follow-up was done maximum up to 7 days. Newborn who came to OPD were evaluated on perspective of essential newborn care and practices, followed by their mothers at home. A questionnaire was formulated for the OPD based patients to be answered before and after guidance.Results: 100 early neonates were taken (N=50 from postnatal ward and N=50 from OPD). Out of 50 neonates in the postnatal ward. 4 (8%) had abdominal colic, 10 (20%) had skin rashes, 2 (4%) had fever, 5 (10%) had feeding issues and 9 (18%) had neonatal hyperbilirubinemia respectively. In OPD neonates 3 (6%) were diagnosed with early onset neonatal sepsis (EONS), 7 (14%) had refusal to feed, 12 (24%) had skin rashes, 5 (10%) had abdominal colic, 14 (28%) were applying coconut oil and 7 (14%) developed hyperbilirubinemia. Whereas in OPD 5 (10%) neonates needed admission NICU and rest were managed symptomatically.Conclusions: Newborn care education and guidance helped in reduction of EONS, in gaining appropriate weight, in delivering optimal thermal care, practicing healthy skin care and implementing proper feeding techniques. All mothers need proper counselling and guidance in essential newborn care.

Viscero-somatic integration: new therapeutic proposals through integrated thermal cures (CIT)

Traditional thermal medicine, gold standard for some pathologies, focuses its therapeutic target mainly on a sectorial level, focusing only on the pathological symptom and neglecting man as a whole. The importance of the whole, of the phenomena of systemic, viscero-somatic and somato-visceral interrelation, has led to the creation of a new approach called "CTI" - Integrated Thermal Care, which uses all the thermal therapies, integrated and administered according to the individual needs to enhance their therapeutic effect. 235 subjects have received, on average, 40 treatments within about a year. They were treated with hydropinic treatment, inhalation treatments, hydrokinesitherapy, vascular pathways, mud therapy and manual neuromuscular therapy associated with the previous treatments. The results obtained in all the FIM, VAS, TINETTI, EUROQOL scales are positive and statistically significant, which suggests that a modification of the treatment protocols, which provides for a unique and integrated stimulation, is the new objective of thermal medicine for serious disabilities.

Assessment of Essential Newborn Care Practices in the Squatter Settlements of Islamabad Capital Territory in Pakistan

Background: While Pakistan has shown progress in reducing child mortality, significant challenges exist in reducing neonatal mortality rate. WHO recommends a package of “essential newborn care” practices based on effective coverage to improve newborn survival. Aim: To assess the coverage of Essential Newborn Care (ENC) as defined by WHO guidelines, in the squatter settlements of Islamabad Capital Territory (ICT). Methods: This cross-sectional survey gathered community-based data on newborn care practices from 416 eligible mothers within randomly selected squatter settlements of ICT. Three composite outcomes (safe cord care, optimal thermal care and good neonatal feeding) were generated by combining individual practices from a list of WHO recommended ENC practices. ENC was considered when all practices within each domain of safe cord care, ideal thermal care and good neonatal feeding were fulfilled. Results: Only 2.9% of newborns received all components of WHO recommended ENC. Seventeen percent newborns received safe cord care, 40.4% received optimal thermal care and 28.8% followed WHO recommended neonatal feeding practice. Various cultural and societal misconceptions were reported which translate into harmful practices for newborn care. Conclusion: The study highlighted an extremely low coverage level of effective essential newborn care. Pakistan needs to address issues of quality care for newborns through policy and programs which focus on Maternal, Newborn, and Child Health (MNCH) continuum of care. It needs a concerted effort at the grass root level, especially training front line workers to educate mothers on various cultural and societal misconceptions that translate into harmful practices for newborns.

Neonatal hypothermia and adherence to World Health Organisation thermal care guidelines among newborns at Moi Teaching and Referral Hospital, Kenya

Neonatal hypothermia is a great concern with near epidemic levels globally. In Kenya, its prevalence is as high as 87% with limited local data on the associated factors such as adherence to warm chain guidelines as recommended by the World Health Organisation (WHO) is limited. This study aimed to determine the prevalence of hypothermia and level of adherence to the WHO thermal care guidelines among newborns admitted at Moi Teaching and Referral Hospital (MTRH). It adopted a prospective study design of following up neonates for the first 24 hours of admission to the MTRH newborn unit. Thermometry, interview of mothers and observation of thermal care practices was done. Descriptive and inferential statistical techniques were adopted. Specifically, Pearson’s chi-square test of associations between predictors of neonatal hypothermia and management outcomes was conducted with their corresponding risk estimates at 95% confidence interval. Among the 372 participants, 64.5% (n = 240) were born at MTRH, 47.6% (177) were preterm and 53.2% (198) had birth weights below 2500 grams. Admission hypothermia was noted among 73.7% (274) and 13% (49) died on the first day of admission. Only 7.8% (29) newborns accessed optimal thermal care. Prematurity, day one mortality and adherence to the warm chain were significantly (p<0.001) associated with admission hypothermia. Inappropriate thermal appliance, inadequate clothing and late breastfeeding significantly increased the risk of neonatal hypothermia. Absence of admission hypothermia increased the likelihood of neonatal survival more than twenty-fold (AOR = 20.91, 95% CI: 2.15–153.62). Three out four neonates enrolled had admission hypothermia which was significantly associated with prematurity, lack of adherence to warm chain and increased risk of neonatal mortality on the first day of life. There was low adherence to the WHO thermal care guidelines. This should be optimized among preterm neonates to improve likelihood of survival.

Neonatal Hypothermia and Associated Factors among Newborns Admitted in the Neonatal Intensive Care Unit of Dessie Referral Hospital, Amhara Region, Northeast Ethiopia

Introduction. Neonatal hypothermia is the reduction in the body temperature of the newborn (less than 36.5°C). It is a global problem in neonates born both at hospitals and homes, but it showed a higher prevalence in developing countries (>90%). Although hypothermia is rarely a direct cause of death, it contributes to a substantial proportion of neonatal mortality globally. Objective. To assess neonatal hypothermia and associated factors among newborns admitted in the NICU of Dessie Referral Hospital. Methods and Materials. An institution-based cross-sectional study was conducted from March 15 to May 30, 2018. The data was collected from the mother and the chart of the newborn using a semistructured questionnaire. Data were cleaned, coded, and entered in EPI-info version 7.1.2.0 then exported to Statistical Package for Social Sciences (SPSS) version 20 software for analysis. Descriptive statistics were used to summarize the data. Bivariate and multivariate logistic regression and crude and adjusted odds ratio with their 95% confidence interval were computed. Finally, p value < 0.05 was used to identify variables that had a significant association with neonatal hypothermia. Result. The proportion of neonatal hypothermia in the study area was 66.8%. Preterm delivery (AOR=2.6, 95% CI: 1.1, 6.2), no skin-to-skin contact within 1 hour of delivery (AOR=3.0, 95% CI: 1.3, 7.8), delivered at night time (AOR=2.0, 95% CI: 1.02, 4.0), and neonates who had resuscitation (AOR=2.9, 95% CI: 1.1, 7.2) showed significant association with neonatal hypothermia. Conclusion. In this study, the proportion of hypothermia was high. Preterm delivery, no skin-to-skin contact within 1 hour, night-time delivery, and having resuscitation were significantly associated with neonatal hypothermia. Therefore, special attention is needed for the thermal care of preterm neonates and neonates delivered at night time. Furthermore, there should be strict adherence to cost-effective thermal care recommendations like warm resuscitation and skin-to-skin contact.

Measuring coverage of WHO recommended Essential Newborn Care practices in the squatter settlements of Islamabad Capital Territory in Pakistan.

Background: Pakistan has shown significant progress in reducing child mortality, however, significant challenges exist in reducing neonatal mortality rate. WHO recommends a package of “essential newborn care” practices based on effective coverage to improve newborn survival. This study assessed the level of effective coverage of newborn care in the squatter settlements of Islamabad Capital Territory (ICT) and also determined if the care received is within the parameters of essential newborn care as defined by WHO guidelines.Methods: A cross-sectional survey was conducted to gather community-based data on newborn care practices from 416 mothers who delivered a live baby in the past twelve months within a randomly selected squatter population of ICT. Three composite outcomes (safe cord care, optimal thermal care and good neonatal feeding) were generated by combining individual practices from a list of essential newborn care practices recommended by WHO. All International ethical standards were followed including informed consent and confidentiality of respondents. Ethical clearance was obtained from the ethical review board of Health Services Academy (HSA).Results: Despite a very high number of institutional deliveries, the study showed that only 2.9% of newborns received all components of WHO recommended essential newborn care. Only 17.1% of the newborns received essential elements of safe cord care, 40.4% received recommended optimal thermal care and 28.8% followed WHO guidelines of good neonatal feeding practice. This low uptake of essential practices was due to the application of various substances on the cord, delayed skin to skin contact and feeding of pre-lacteals to the newborn.Conclusion: The study highlighted that the current level of effective essential newborn care is extremely low in the country. We found multiple cultural and societal misconceptions, that translate into harmful practices for newborns. Interventions such as educating mothers through front line workers, updating health care staff on WHO recommended guidelines for newborn care and declaring widespread harmful traditional practices hazardous for the health of newborn, can help improve essential newborn care in Pakistan.