The study was conducted in Debre Markos Town, North West Ethiopia from March 28 to May 27, 2020. Debre Markos is located 300 km far from the capital city of Ethiopia, Addis Ababa in South-Eastern direction. According to the Town finance and economic office 2017/18 report, the total population of the Town is 101,582 (Male = 49,775, Female 52,806). Regarding with public health institution, there are 1 public hospital and 4 health centers providing immediate newborn care services in the Town. The average annual delivery in all public health facilities of the Town is 3780.
A facility-based cross-sectional study design with a quantitative method supplemented by a qualitative method was used.
All newborn neonates at public health facilities of Debre Markos Town were included in the study as source population. For quantitative study selected immediate postnatal women and their newborn neonates at public health facilities of Debre Markos Town during the study period who fulfill the inclusion criteria were the study population. For qualitative study purposively selected facility heads, delivery ward team leaders, and skilled birth attendants in the delivery room at public health facilities of Debre Markos Town were included as the study population.
All newborn and all immediate postnatal mothers were included in the study and Newborn with congenital anomalies, newborns with dead mothers, mothers with dead newborns, and critically and mentally ill mothers, were excluded from the study.
For the quantitative, study the sample size was determined by a single population proportion formula by assuming the 76% as a proportion of newborn who get the good practice of immediate newborn care from the previous study, 95% confidence level (CI), 5% margin of error, and the sample size was 280.
From preliminary assessment the source population (annual number of delivery in all public health facilities in the Town was 3780) therefore it was less than 10,000 and n/N was greater than 5% correction formula was used to adjust the sample size. n =n/ (1+n/N) =280/ (1+280/3780) =260.By adding a 10% non-response rate the final sample size was 286.
For the qualitative, study ten in-depth interviews were conducted with purposively selected key informants (two from each health facility). They were head of health facilities, the delivery ward team leaders, and skill birth attendants in delivery room. Since there was information saturation and repetition of ideas only 10 in-depth interviews were conducted
The study was included all public health facilities in the Town purposely. (1 public hospital and 4 health centers) the sample size was distributed to each facility by using population proportional allocation. After the sample size was proportionally allocated to each facility based on their annual delivery then by consecutive sampling method all mothers with their newborn who gave birth in selected facilities during the study period were included in the study until the sample size was achieved.
For qualitative study, Purposive sampling technique was used to select key informants.
In this study, the outcome variable, immediate newborn care practice is defined as care given for newborn babies from birth up to 1 hour of birth. The level of immediate newborn care practice is assessed by using 13 indicators and then the composite score was computed. Independent variables were socio-demographic characteristics of the mother (age, education, residence, marital status, income, knowledge on components of immediate newborn care), obstetric history of the mother(Parity, history of ANC, birth preparedness, and mode of delivery), health system-related variables(Availability of drugs and materials, Health professional related variables(Competency of health professional on their work, Training of health professional on immediate newborn care and challenges of health professionals to give appropriate immediate newborn care)
Data were collected using an interviewer-administered, pre-tested semi-structured questionnaire which was adapted from different literature. Besides, a medical record review was made using observational checklists. All deliveries during day and night time were observed by data collectors.
Five trained public health officers from the nearby district health facilities were collected the data, two supervisors who are holders of degree in Public Health (PH), and the research teams including the principal investigator were supervised the overall process of data collection. The tool was first in English and then translated to Amharic, the local language of the study area. Then it. Then it is back-translated to English to keep the consistency of the tool. A pre-test was conducted in 5% of the sample population in nearby Town health facilities prior to the actual data collection.
For qualitative data collection interview guide was developed after reviewing different literatures and data were collected using in-depth interviews (IDI) with facility heads, the delivery ward team leaders, and skilled birth attendants in delivery room. In-depth interview was made by three experienced data collectors in qualitative research (MPH in health education) from Debre Markos University. The interview was done with one modulator, one note taker and one recorder.
Collected data were coded, entered, and cleaned by Epi-data version 3.1, and then it was exported to SPSS version 22 for analysis. Descriptive, binary, and multivariable analysis was done. All variables that show significant association during the Bivariable analyses at p-value <0.25 were entered to multivariable logistic regression-value < 0.05 was used as a cutoff point to declare statistical significance. The backward logistic regression method was used in multiple regression to identify independent predictors of the outcome variable. Adjusted OR with its corresponding 95% CI was used to know the strength and direction of the association. Multicollinearity is checked for independent variables by using variance inflation factor (VIF). Model fitness was assessed by Hosmer and Lemeshow model fitness test (p-value 0.849).
On the other hand, qualitative data were transcribed, checked, and re-checked by data collectors. Then, line by line coding system was conducted manually by PI. Finally, thematic analysis was used to analyze the data.
Ethical clearance was obtained from Jimma University ethical review board. The permission letter was written from Debre Markos Town health department. Written informed consent was obtained from each key informant and verbal consent from each mother to follow the care provided to their baby and to interview them. The confidentiality of the study participants was maintained at each level of the response. A Personal identifier was not used in the questionnaire to assure privacy. Termination of participation from the study at any time during the study was possible.