Service-Related Factors Associated With Newborn Care Practices by Mothers in Mutare, Zimbabwe: A Cross-Sectional Study

Neonatal mortality remains very high in Zimbabwe (29/1,000 live births). Service-related factors have been linked to the care-giver knowledge and newborn care practices. In Manicaland Province, care-seeking behaviors for fever (the main symptom for childhood infections) and knowledge levels of neonatal danger signs remains unacceptably lower than the national averages. A cross-sectional descriptive and analytic design was carried out to determine service-related factors to newborn care practices and their association with neonatal outcomes in Mutare District. Purposive sampling was used to select health facilities and systematic random sampling was used to select participants. A structured interviewer administered questionnaire was used to collect data which was then entered and analyzed using Epi-Info version 7.2. Descriptive and multivariate analysis were performed on data collected from 349 participants. Practice of the five assessed recommended newborn care practices was high. Exclusive breastfeeding (62%), early initiation of breastfeeding (74%), good cord care (73%), care-seeking for neonatal illness within 24hrs of onset of fever (82%) and keeping baby warm was at 58%. Statistically significant independent factors associated with the recommended newborn care practices were post-natal stay for more than 72 hours at the clinic (AOR=0.56; 95%CI- 0.12-0.87, p=0.000), and delivery at the health facility (AOR=0.43; 95%CI- 0.21-0.77; p=0.000). Service delivery had a substantial influence on newborn care practices in Mutare district and influenced neonatal outcomes. Improving newborn care outcomes requires both effective service delivery and community health system strengthening to promote good newborn care.