Assessing the changes in childbirth care practices and neonatal outcomes in Western China: pre-comparison and post-comparison study on early essential newborn care interventions

OBJECTIVE: To explore the changes in childbirth care practices and health outcomes of newborns after the introduction of early essential newborn care (EENC). DESIGN: A pre-comparison and post-comparison study. SETTING: The study was conducted in December 2016 and December 2018 in 18 counties in four western provinces of China. PARTICIPANTS: 46 hospitals that provide delivery services participated in the study. INTERVENTIONS: EENC practices were introduced and implemented in the 46 hospitals. OUTCOME MEASURES: The changes of hospital indicators such as incidence of birth asphyxia and neonatal mortality were compared in 2016 and 2018. EENC coverage indicators, such as skin-to-skin (STS) contact, and time of first breast feeding were also compared before and after the intervention via interview with 524 randomly selected postpartum mothers (320 in 2016 and 204 in 2018). RESULTS: 54 335 newborns were delivered in the pre-EENC period (2016) and 58 057 delivered in the post-EENC period (2018). According to hospital records, the proportion of newborns receiving immediate STS contact increased from 32.6% to 51.2% (Risk Ratio (RR)=1.57,95% CI 1.55 to 1.59) and the percentage of newborns receiving prolonged STS contact for more than 90 min increased from 8.1% to 26.8% (RR=3.31, 95% CI 3.21 to 3.41). No statistically significant changes were found in neonatal mortality, although slight decreases in birth asphyxiate and neonatal intensive care unit admission rates were detected. Among the mothers interviewed, the proportion of newborns receiving immediate STS contact increased from 34.6% to 80.0% (RR=2.31, 95% CI 1.69 to 3.17). The exclusive breastfeeding rate increased from 43% to 73.4% (RR=1.71, 95% CI 1.43 to 2.04). The average length of the first breast feeding increased from 15.8 min to 17.1 min. CONCLUSIONS: The introduction of EENC has yielded significant improvements in newborn care services at the pilot hospitals, including enhanced maternal and newborn care practices, improved STS contact quality and early breastfeeding performance. Further studies are needed to evaluate the long-term impact of EENC on newborn health outcomes.