To preserve body temperature and reduce the risk of hypothermia, newborns should not be bathed until at least 24 hours following delivery [24]. Newborns are frequently faced with health issues such as hypothermia shortly after delivery. As a result, the WHO recommended delaying newborn bathing until 24 hours to reduce infant morbidity and mortality [10]. The key factors that were found to be significantly associated with late neonatal bathing were education, wealth status, employment, religion, place of residence, region, parity, access to mass media, place of delivery, twin status, size of child at birth, delivery by caesarean section. In general, it was discovered in this survey that less than one-third (12%) of women aged 15–49 bathed their children within 24 hours of birth, despite the fact that a majority (88%) did not. This study's findings were lower than those of Saaka and co [25], who found that only about 23% of women bathed their newborns within 24 hours of delivery in rural parts of Northern Ghana. Perhaps, the differences in study population surveyed among Ghana and Nigeria could explain our observation.
In this present study, women with secondary or higher level of education were more likely than those without secondary or higher level of education to practice LNB. This affirms the findings of previous studies. For instance, Tegene et al. [24] found that women with high or higher degree of education were times more likely to practice LNB than women without a high or higher level of education. Another study in Nepal found that women with higher levels of education were significantly more likely to engage in LNB [26]. The mother's education was found to be strongly related with LNB in a study by Kaphle [27]. Similarly, research in Uganda and Ethiopia indicated that mothers with a high degree of education have a significant link with infant care practices such as LNB [28, 29]. Tegene et al. [24] found that maternal education was positively linked with LNB in their research. This could be because educated women were expected to have a high level of understanding regarding the importance of LNB practice.
In terms of wealth status, the study discovered that women who were rich had a larger likelihood of practicing LNB than women who were poor. When compared to impoverished women, rich women were more likely to engage in LNB. This result was in line with a study by Gul et al. [30], which found that a woman's wealth status is directly related to her use of LNB. This was also in line with Chhetri et al. [31], who discovered that wealth status has a role in LNB practice. Similarly, Adegun et al. [32] found that wealth status was positively related with LNB in an Ibadan study. One probable explanation is that women with greater socioeconomic status have a greater educational level.
Regarding maternal employment, women in sales had a lower likelihood of practicing LNB than women in professional/managerial positions. This conclusion supported previous research conducted in North Ethiopia and Tigray by Berhe et al. [33] and Misgna et al. [5], which found that women who worked in professional/managerial level jobs were more likely to practice LNB than those who worked in sales. This could be attributed to the fact that professional/managerial work allows women to advance in their community, allowing them to access education, health care, decision-making, and financial independence. Women are more likely to practice LNB as a result of this.
Relative to women affiliated to Christian religion, the odds to practice LNB increased among women that professed other religion. Perhaps, this could be attributed to varied religious teachings Christians are exposed to. However, the cross-sectional nature of the study design did not permit exploring the reasons to this observation. The recent study discovered that LNB practice is strongly linked to where you live. In comparison to their urban counterparts, women in rural areas were less likely to practice LNB. Possible reasons include a lack of maternal health services in rural areas compared to urban areas, as well as women in rural areas being expected to have lower maternal education than women in urban regions. This finding is also similar with Misgna et al. [5], who found that women who lived in rural areas were less likely to perform LNB than women who lived in urban areas, with those living in urban areas being roughly seven times more likely to perform LNB. Another study in Southern Ethiopia by Chichiabellu et al. [34] found that women in urban areas were more likely to perform LNB than women in rural areas.
LNB practice was also found to be highly associated with region. When compared to women in the North Central region, women in the South South region were most likely to use LNB. Women in the South South region were more likely than those in the North Central region to practice LNB. This could be attributed to regional differences in socio-demographic and economic status. The poor socio-economic condition of the North Central region may be due to poor literacy, which might lead to low unemployment and, as a result, low income, which explains the variation [24]. It is well known that northern women are devoted to their cultural beliefs and customs, as they would wish to bathe their newborns owing to the appearance of vernix and caseosa on their bodies, which they consider dirty.
Furthermore, the current study discovered that a woman's number of births was strongly linked to her use of LNB. When compared to women at parity one, women at parity two were less likely to use LNB. This result is consistent with a previous study by Bhatt et al. [35], which found that women who had more than one birth were less likely to use LNB than those who only had one. Alemu et al. [36] found that parity level was substantially correlated with LNB practice, which corroborated the current conclusion. In contrast to the current findings, Misgna et al. [5] found that women who had multiple babies were more likely to practice LNB than women who had one. Women who had more than one kid were more likely to practice LNB than women who only had one child, according to Welay et al. [10]. These disparities could be due to inequalities in the socioeconomic level of women and study participants.
Those who had access to the media were more likely to use LNB than women who did not. Women who learned about bathing time for their newborns from the media were more likely than their peers to undertake optimal newborn care, including LNB. This is due to the fact that the media informs women about the components and importance of appropriate newborn care, including LNB. As a result, women receive all of the required information to better grasp the benefits of LNB [17, 36].
The study also discovered that women who gave birth in a health institution were more likely to use LNB than women who gave birth at home. The rural nature of the research zone, where negative cultural ideas and practices associated with LNB are ingrained, could be one possible cause. A study conducted in Zambia by Shamba et al. [37] indicated that the main reason for bathing newborns early was to clear away the blood/fluid/vernix that remained on the skin of the newborn baby. Ayiasi et al. [38] found that women who deliver in a health facility are more likely to use LNB than women who birth at home, which is consistent with the findings of the current study. Similarly, Iganus [39] found that birth in a health facility was a significant driver of LNB, with LNB being nearly universal for women who delivered in a health facility but varied greatly among women who gave birth at home. Kumola [40], on the other hand, found no link between the place of birth and LNB. Furthermore, Baqui et al. [41] found that the place of delivery was not a factor of LNB in cross-sectional research done in India.
The current study found that the odds to practice LNB increased with multiple births, small neonate size at birth, and delivered by caesarean section, when compared to single births, large babies and vaginal delivery, respectively. These findings are consistent with a study in Malawi and Bangladesh where women who delivered by caesarean section were more likely to practice LNB when compared to women who delivered through vagina [42]. Similarly, Semanew et al. [17] discovered that women who gave birth via caesarean section were 43.8 percent more likely to use LNB than those who gave birth vaginally. In contrast, Alemayehu and colleagues [43] found a link between mode of birth and appropriate newborn care practices such as LNB, indicating that mothers who had a caesarean section were less likely to practice LNB.
Strength and limitations
The study is unique in that it is the first of its type to look at maternal and child factors linked to late neonatal bathing in Nigeria. The study makes use of cross-sectional survey data that mirrors the opinions of women aged 15 to 49 across the country; thus, the findings and conclusions are based on a nationally representative survey. The study also used a variety of data collection methodologies, with a relatively high response rate during the data collection. Also, in order to account for a variety of factors associated with LNB, the researchers conducted extensive literature searches. However, there are certain limitations to the study. First, the study design prevents causal conclusions from being taken from the findings. Second, the women who were polled are likely to have recollection and social desirability biases. The cross-sectional nature of the study design restricted the effort to unravel reasons behind some of the observations.