Health facility structure and maternal characteristics related to essential newborn care in Brazil: a cross-sectional study.

Abstract

To assess the use of the WHO's Essential Newborn Care (ENC) programme items and to investigate how the non-use of such technologies associates with the mothers' characteristics and hospital structure. A cross-sectional observational health facility assessment. This is a secondary analysis of the 'Birth in Brazil' study, a national population-based survey on postnatal women/newborn babies and of 266 publicly and privately funded health facilities (secondary and tertiary level of care). Data on 23 894 postnatal women and their newborn babies were analysed. The facility structure was assessed by evaluating the availability of medicines and equipment for perinatal care, a paediatrician on call 24/7, a neonatal intensive care unit (NICU) and kangaroo mother care. The use of each ENC item was assessed according to the health facility structure and the mothers' sociodemographic characteristics. The utilisation of ENC items is low in Brazil. The factors associated with failure in pregnant woman reference were: pregnant adolescents (OR_adj 1.17; 95% CI 1.06 to 1.29), ≤7 years of schooling (OR_adj 1.47; 95% CI 1.22 to 1.78), inadequate antenatal care (OR_adj 1.67; 95% CI 1.47 to 1.89). The non-use of corticosteroids was more frequently associated with the absence of an NICU (OR_adj 3.93; 95% CI 2.34 to 6,66), inadequate equipment and medicines (OR_adj 2.16; 95% CI 1.17 to 4.01). In caesarean deliveries, there was a less frequent use of a partograph (OR_adj 4,93; 95% CI 3.77 to 6.46), early skin-to-skin contact (OR_adj 3.07; 95% CI 3.37 to 4.90) and breast feeding in the first hour after birth (OR_adj 2.55; 95% CI 2.21 to 2.96). The coverage of ENC technologies use is low throughout Brazil and shows regional differences. We found a positive effect of adequate structure at health facilities on antenatal corticosteroids use and on partograph use during labour. We found a negative effect of caesarean section on early skin-to-skin contact and early breast feeding.