Cross sectional, community based study of care of newborn infants in Nepal.

OBJECTIVE To determine home based newborn care practices in rural Nepal in order to inform strategies to improve neonatal outcome. DESIGN Cross sectional, retrospective study using structured interviews. SETTING Makwanpur district, Nepal. PARTICIPANTS 5411 married women aged 15 to 49 years who had given birth to a live baby in the past year. MAIN OUTCOMES MEASURES Attendance at delivery, hygiene, thermal care, and early feeding practices. RESULTS 4893 (90%) women gave birth at home. Attendance at delivery by skilled government health workers was low (334, 6%), as was attendance by traditional birth attendants (267, 5%). Only 461 (8%) women had used a clean home delivery kit, and about half of attendants had washed their hands. Only 3482 (64%) newborn infants had been wrapped within half an hour of birth, and 4992 (92%) had been bathed within the first hour. 99% (5362) of babies were breast fed, 91% (4939) within six hours of birth. Practices with respect to colostrum and prelacteals were not a cause for anxiety. CONCLUSIONS Health promotion interventions most likely to improve newborn health in this setting include increasing attendance at delivery by skilled service providers, improving information for families about basic perinatal care, promotion of clean delivery practices, early cord cutting and wrapping of the baby, and avoidance of early bathing.