Socio-demographic characteristics of respondents
Out of the total 423 reproductive age women planned for the study, 388 women were successfully interviewed with the response rate of 91.7%. All of the 388 interviewed women were included in the final analysis. The mean (±SD) age of the respondents was 25.4(±5) years. At the time of data collection, the mean (±SD) age of the infants about which thermal care was assessed is 3.8(±1.6) months. Majority of women were literate (i.e. can read and write), which accounted for 283 (72.9 %) and the rest 105 (27.1 %) were illiterate (i.e. cannot read and write). Protestant Christian was the commonest religion; followed by Islam, Orthodox Christian and Waqefata (i.e traditional belief); each accounted 251(64.7%), 40(10.3%), 36(9.3 %) and 36(9.3%) respectively. Regarding the marital status of women, at the time of interview; 325(83.8%) were married, 25(6.4%) were widowed, 17(4.4%) were separated, and 16(4.1%) were divorced. Table 1 presents socio-demographic characteristics of the respondents.
Table 1. Socio-demographic characteristics of the respondents, West Guji Zone, Oromia; Southern Ethiopia; June 2020
Characteristics of respondents
|
Frequency
|
Percentage (%)
|
Age of women in completed years (n=388)
|
|
|
<18
|
9
|
2.3
|
18-34
|
345
|
88.9
|
35-49
|
34
|
8.8
|
Women’s educational level (n=388)
|
|
|
No education(grade 0)
|
126
|
32.5
|
Primary education(grade 1-8)
|
221
|
56.9
|
Secondary education and above ( grade 9 and above )
|
41
|
10.6
|
Women’s occupation(n=388)
|
|
|
Farmer
|
165
|
42.5
|
House wife
|
75
|
19.4
|
Merchant
|
105
|
27.1
|
Daily laborer
|
23
|
5.9
|
Employed
|
16
|
4.1
|
others
|
4
|
1.0
|
Women’s Religion (n=388)
|
|
|
Waqefata
|
36
|
9.3
|
Protestant Christian
|
251
|
64.7
|
Orthodox Christian
|
36
|
9.3
|
Islam
|
40
|
10.3
|
Catholic Christian
|
23
|
5.9
|
Others
|
2
|
0.5
|
Sex of the youngest infant
|
|
|
Male
|
213
|
54.9
|
Female
|
175
|
45.1
|
Past Obstetrics History of Studied Women
At the time of survey, majority of the respondents, 311(80.1%) were women who gave birth more than once. Significant proportion of women, 250(64.4%) delivered the youngest infant at home and the remaining 138(35.6%) of women delivered in health facilities. Among these deliveries, only 120(30.9%) of them were attended by health workers of variable level of qualification. However, majority of these women, 298(76.8%) attended antenatal care during pregnancy of the last infant. Table 2 presents past obstetric history of study participants.
Table 2. Past obstetrics history of rural women, West Guji Zone, Oromia; southern Ethiopia, June 2020
Past obstetrics history
|
Frequency
|
Percentage (%)
|
Number of all previous births(n=388)
|
|
|
1
|
77
|
19.8
|
2-4
|
187
|
48.2
|
>=5
|
124
|
31.9
|
Did you seek ANC during pregnancy of the most recent birth(n=388)
|
|
|
No
|
90
|
23.2
|
Yes
|
298
|
76.8
|
Place of the birth of the last infant (n=388)
|
|
|
Home
|
250
|
64.4
|
Health post
|
22
|
5.7
|
Health center
|
28
|
7.2
|
Hospital
|
84
|
21.6
|
Others
|
4
|
1.0
|
Attendants of the last birth(n=388)
|
|
|
Traditional birth attendant
|
38
|
9.8
|
Relative
|
162
|
41.7
|
HEW*
|
40
|
10.3
|
Health professional
|
80
|
20.6
|
Nobody
|
65
|
16.7
|
Others
|
3
|
0.8
|
Gestational age of the last infant (n=388)
|
|
|
<9 months
|
6
|
1.5
|
>=9 months
|
382
|
98.5
|
*: HEW- Health Extension Worker.
Women’s Practice of Neonatal Thermal Care
Majority, 350(90.2%) of women had prepared clothes for immediate drying of babies before delivery. However, only 32(8.2%) of women dried-off their babies of birth fluids before delivery of placenta. Significant proportion of women, 131(33.8%) and 135(35.3%) performed drying of their babies immediately and long time after placenta delivery respectively. A qualitative finding shows that drying is usually done after first bath. Focus group discussants said like this “immediately after delivery before drying, newborns are bathed and then wrapped with clean clothes. But if a delivery is at a health facility, newborns are not bathed. They are wrapped with clothes and no bath is done until mothers return their home from the health facility”- 18 years old and mother of 5 months old infant… “Some women do drying and wrapping. But this practice is at its early state of expansion among women who have exposure to health facilities. The common practice is to bath the baby immediately after delivery with warm water and, then wrap with warm clothes” -18 years old and mother of 6 months old infant.
Majority, 336(86.6%) of women have prepared clothes for immediate wrapping of their baby before delivery. However, only 113(8.2%) of women wrapped their babies of within 5 minutes of delivery. Table 3 presents women’s practice of immediate drying and wrapping of newborns.
Table 3. Newborn immediate drying and wrapping practices among rural women in West Guji Zone, Oromia; southern Ethiopia, June 2020
Newborn drying and wrapping practices
|
Frequency
|
Percentage (%)
|
First drying time (n=388)
|
|
|
Immediately before placental delivery
|
32
|
8.2
|
Immediately after placental delivery
|
131
|
33.7
|
Long time after placental delivery
|
137
|
35.3
|
Cannot remember
|
88
|
22.7
|
First drying time in minute(n=388)
|
|
|
In less than 5 minutes
|
92
|
23.7
|
Between 5-15 minutes
|
125
|
32.2
|
Between 16-30 minutes
|
51
|
13.1
|
After 30 minutes
|
57
|
14.7
|
Could not remember
|
63
|
16.2
|
Reason for delayed drying (n=233)
|
|
|
attendant was focusing on mothers until placenta delivery
|
80
|
34.3
|
Waited until umbilical cord is cut
|
17
|
7.3
|
Waited until placental delivery
|
74
|
31.8
|
Drying baby is taboo until placental burial
|
27
|
11.6
|
Nobody was available
|
21
|
9.0
|
Waited until baby get bath
|
14
|
6.00
|
First wrapping time in minute(n=388)
|
|
|
In less than 5 minutes
|
113
|
29.1
|
Between 5-15 minutes
|
68
|
17.5
|
Between 16-30 minutes
|
38
|
9.8
|
After 30 minutes
|
117
|
30.1
|
Could not remember
|
52
|
13.4
|
Reason for delayed wrapping(n=223)
|
|
|
attendant was focusing on mothers until placenta delivery
|
45
|
20.2
|
Waited until umbilical cord is cut
|
28
|
12.5
|
Waited until placental delivery
|
43
|
19.3
|
Wrapping baby is taboo until placental burial
|
6
|
2.7
|
Nobody was available
|
15
|
6.7
|
Waited until baby get bath
|
86
|
38.6
|
Great majority, 328(84.5 %) of women have bathed their baby in less than 6 hours of delivery and 306(78.9%) women used warm water for the first bath. Forty two (70.0%) of women who delayed first newborn bath at least by 6 hours after delivery did so because they were advised by health workers advised them to do so, whereas only 8(11.7% of delayed bath) women delayed the bath because it keeps the newborns warm. Table 4 presents newborn first bath time among rural women in west Guji Zone.
Table 4. Rural women’s practice of first newborn bath in west Guji Zone, Oromia; southern Ethiopia, June 2020
First newborn bath practices
|
Frequency
|
Percentage (%)
|
First bath time after delivery (n=388)
|
|
|
In less than 6 hours
|
328
|
84.5
|
after 6 hours
|
60
|
15.5
|
Type of water used for first bath(=388)
|
|
|
Warm water
|
306
|
78.9
|
Cold water
|
61
|
15.7
|
others
|
21
|
5.4
|
Reason for delayed newborn bath(n=60)
|
|
|
To keep baby warm
|
8
|
13.3
|
Health professional advised me to do so
|
42
|
70.0
|
Others
|
10
|
16.7
|
Reason for Early bathing (n=328)*
|
|
|
To remove different secretions or blood or dirty from body
|
270
|
82.3
|
To remove visible vernix
|
62
|
18.9
|
To improve health and strength of newborn
|
18
|
5.5
|
To make baby refreshed and comfortable
|
26
|
7.9
|
Encouraging sleep and improving health
|
15
|
4.6
|
To prevent different smells
|
33
|
10.1
|
Others
|
4
|
1.2
|
*- the percentage may not add up to 100 as responses are mutual exclusive
Two hundred sixty eight(69.1%) women put head covering to their baby immediately after delivery and almost all of them, 267(68.8%) maintained the practice during neonatal period. Two hundred sixty six (68.6%) women have prepared head covering when nearing term.
Three hundred sixty four (93.8%) women breastfed their baby and 210(57.7%) of them initiated breast feeding within one hour of delivery. Exclusive breast feeding during neonatal period was practiced by 227(62.4%) women. Table 5 presents rural women’s breast feeding practice after delivery in west Guji.
Table 5. Rural women’s practice of breast feeding during neonatal period, West Guji Zone, Oromia; southern Ethiopia, June 2020
breast feeding practices
|
Frequency
|
Percentage (%)
|
Time to initiate breast feeding after delivery (n=364)
|
|
|
Within one hour
|
210
|
57.7
|
after one hour
|
154
|
42.3
|
What did you do with colostrum?(=364)
|
|
|
Provided to baby
|
136
|
37.4
|
Discarded
|
226
|
62.1
|
others
|
2
|
0.6
|
Provided extra foods/fluids during neonatal period (n=388)
|
|
|
Yes
|
137
|
35.3
|
No
|
227
|
58.5
|
Could not remember
|
24
|
6.2
|
Reasons for delayed initiation of breast feeding within 1 hour of delivery (n=154)
|
|
|
Colostrum is dirty/not good for baby
|
28
|
18.2
|
Lack of sufficient breast milk
|
10
|
6.5
|
Baby need sleep/rest after delivery
|
55
|
35.7
|
Baby did not show sign of hunger
|
10
|
6.5
|
Baby needed to be bathed
|
13
|
8.4
|
Mother needed rest
|
18
|
11.7
|
Mother needed bathing
|
10
|
6.5
|
Others
|
10
|
6.5
|
Women’s Beliefs towards Neonatal Thermal Care
In general women believes in importance of wrapping newborns after delivery. However, newborn wrapping is usually done after first bath. The focus group discussant quoted “after having bath newborns are wrapped with hot clothes to prevent cold form hitting them”-18 years old and mother of 3 months old infant. Women also believe that bathing newborns before drying and wrapping is better than having immediate drying and wrapping in preventing cold from newborns. Focus group discussants quoted “early bathing is better than drying and wrapping in preventing cold”-20 years old and mother of 6 months old infant….“Early bathing and then wrapping with clean clothes prevent cold”-18 years old and mother of 6 months old infant. Regarding immediate drying of newborn which is usually done after first bath, women believes that drying with dry clothes damages fragile skin of newborns. A focus group discussant quoted “because newborn’s skin is very fragile, it should not touched by clothes for drying. That is why bath is done to remove body secretions”-36 years old and mother of 6 months old infant.
Early bathing of newborns as soon as possible after delivery of placental is deep rooted practice. Women strongly believe that newborns should be bathed as soon as possible after delivery provided that placental delivery is not delayed. Other recommended newborn thermal cares like immediate drying and wrapping are usually done after the first newborn’s bath opposite to the standard recommendation. However newborn’s bath is rarely done before delivery of placenta. Focus discussants quoted “if placenta is safely delivered, the newborns should be bathed immediately and kept away from cold”-25 years old and mother of 5 months old infant… “If placenta is immediately delivered, then the baby will be bathed immediately. Then there will be no problem of cold”- 22 years old and mother of 6 months old infant.
All women believe in importance of head covering to prevent cold from newborns. Also immediate covering of head of newborns as soon as possible is believed to be important practice. Focus group discussants quoted “Yes it is helpful. It prevents cold from injuring baby”-33 years old and mother of 5 months old infant… “Head covering should be done immediately after delivery”- 28 years old and mother of 6 months old infant.
Initiation of breastfeeding is almost universal and women claim that they initiate breast feeding immediately after placental delivery and the first bath. However they did not mention or believed in thermal care importance of either early or frequent breast feeding. Focus group discussants quoted “I do not think that early initiation of breast feeding benefits in keeping baby warm except that delayed initiation of breastfeeding results in baby’s failure to familiarize with breastfeeding”-20 years old and mother of 6 months old infant… “Early initiation of breastfeeding does not prevent cold from newborns. Delaying up to 2to 3 hours after delivery without initiating breastfeeding does not have any problem. Just we learned early initiation of breastfeeding from our mothers”-25 years old and mother of 5 months old infant.
Skin to skin care of newborn is non-existent and strange thermal care practice in study area. Women perceive skin to skin care of newborn as an odd, frightening and potential dangerous ways of handling newborns. Focus group discussants quoted “such practice (i.e skin to skin care) is not done in this area. Holding baby in such way is frightening. This practice is new to us. We hear/see it today”-20 years old and mother of 6 months old infant… “If skin to skin care is done, babies may get injured especially by inexperienced young mothers”- 30 years old and mother of 4 months old infant… “Because we are strange to it (i.e skin to skin care), it looks somewhat odd to us”- 20 years old and mother of 6 months old infant. Elder women would not advise younger women to do skin to skin care. Furthermore, women do not believe that skin to skin care helps in keeping newborn warm. However they claimed that they can do skin to skin care if taught to do so.