Pattern of neonatal care practices in urban and rural areas of Ife-Ijesa Zone of Osun State.
The study investigated factors influencing care and treatment preferences for newborns in rural and urban areas of Ife-Ijesha zone of Osun State with a view to providing information that may aid the design of relevant health promotive interventions targeted at reducing newborn deaths in the study area. The study employed a descriptive cross-sectional design. Sample size was determed using the formula for comparing two independent proportions. A multistage sampling method was employed with the local government areas in Ife-Ijesha zone forming the primary sampling units. The first stage involved the use of simple random sampling technique to select two urban and two rural local governments each from the list of LGAs in the zone. At the second stage, simple random sampling was also used to select twenty-five percent of political wards in each LGA. In the third stage, systematic sampling technique was used to select eligible households (households that produced nursing mothers with index children (0-6) months old) in the selected wards. Quantitative and qualitative data collection methods were used to collect information for mothers in the household. Quantitative data were analysed using appropriate descriptive and inferential statistical techniques while qualitative data was analysed using detailed content analysis. Generally, 68% of nursing mothers in the rural area compared with 67.8% in urban area delivered the index child in health facility/Hospital. In spite of easy access to health facilities in the urban area than rural area, some proportion of deliveries took place at home (urban 10.6% and rural 10.1%) and church (urban 19.4% and rural 14.8%). The greater proportion of deliveries that took place at home in urban area (78.9%) were delivered by skilled birth attendants in contrast to 52.9% in the rural area. A higher proportion of nursing mothers in urban area compared with nursing mothers in rural area recognized hypothermia/hyperthermia (urban 88% and rural 62%), refusal to breast feed (urban 75% and rural 61%) and floppy/ weakness (urban 48% and rural 32%) as danger signs during neonatal period. However, danger signs like overly sleepy (urban 11.1% and rural 32.5%), palor (urban 11.7% and rural 24.9%), convulsions (urban 6.1% and rural18.9%), weak cry (urban 40.0% and rural 41.4%), stiff limbs (urban 2.8% and rural 4.7%) and bulging fontanel (rural 3.6% and urban 4.8%) were less likely recognized in urban area compared with rural area. In both areas, practice of newborn care indices of optimal thermal care (rural 14.2% and urban 22.2%) and good cord care (rural 14.2% and urban 10%) are very low. Even though newborn care index of good neonatal feeding (rural 81.7% and urban 82.8%) was very high in both areas, yet equal proportion of nursing mothers in both areas (16.6%) reported that breast-feeding was initiated more than thirty minutes after delivery life against the recommendation of WHO. Socio-demographic factors and knowledge of neonatal health problems did not influence treatment preferences for newborns in both areas (P>0.05). However, age was the only predictor of care practices in urban area (OR 4.358, 1.812-10.481) unlike in rural area where neither socio-demographic factors nor knowledge of neonatal health problems predicted care practices. The study concluded that most mothers had poor knowledge of neonatal danger signs and many unsafe practices such as early bathing, application of harmful substances to umbilical stump and use of home remedies before seeking medical care for sick neonates were prevalent in both areas. Nursing mothers in rural area were less likely to observe optimal thermal care and good cord care practices compared with urban respondents. Age was the only predictor of good care practices in urban area.