Background characteristics of facilities
This study covered clinics, health centres, and hospitals which sum up to 632 facilities. Among the total facilities, 48% were hospitals (primary, general or referral), 26% were health centers and 26% were clinics (lower, medium or higher). Regarding managing authority, 65% of facilities were public. Most of the facilities (78%) found in urban areas (Table 1).
Table 1. Facility background characteristics (n=632)
|
n
|
%
|
Type of facility
|
Hospital
|
303
|
48%
|
Health centre
|
164
|
26%
|
Clinic
|
165
|
26%
|
Managing authority
|
Public
|
410
|
65%
|
Others1
|
222
|
35%
|
Region
|
Tigray
|
65
|
10%
|
Afar
|
37
|
6%
|
Amhara
|
98
|
16%
|
Oromiya
|
109
|
17%
|
Somalia
|
44
|
7%
|
Benshangul Gumuz
|
31
|
5%
|
SNNPR
|
89
|
14%
|
Gambella
|
30
|
5%
|
Harari
|
24
|
4%
|
Addis Ababa
|
77
|
12%
|
Dire Dawa
|
28
|
4%
|
Location
|
Urban
|
494
|
78%
|
Rural
|
138
|
22%
|
|
Total
|
632
|
100%
|
|
|
|
|
|
|
Others1: Facilities managed or owned by private, NGO or religion institute
Essential newborn Signal Functions
The availability of essential newborn service in health facilities was assessed using the four signal functions: neonatal resuscitation, corticosteroids, antibiotics for preterm or prolonged premature rupture of membrane and injectable antibiotics for sepsis. Among the total surveyed facilities, 74%, 48%, 68%, and 62% of facilities provided neonatal resuscitation, parenteral corticosteroid, antibiotic for preterm or prolonged premature rupture of membrane, and injectable antibiotics respectively. The total mean availability of newborn care services was 0.63 (on average 3 out of 4 services). Of the four newborn signal functions, corticosteroid was least (48%) available in facilities, while neonatal resuscitation (74%) was most available. Among assessed facilities, 99% of hospitals and only 7% of clinics provided neonatal resuscitation. Only 24% and 1% of health centres and clinics provided corticosteroids respectively. A higher proportion of facilities managed by the public provided all signal functions compared with facilities managed by others.
Ninety-four percent of hospitals availed all the four signal functions. But on the contrary, almost none of the clinics provided the essential newborn care services. In public facilities, 3 out of 4 services were available (mean availability 0.82) but only 1 out of 4 services were provided in other facilities (mean availability 0.28). Seven percent, 1%, 3%, and 3% of clinics provided neonatal resuscitation, corticosteroids, antibiotics for preterm or prolonged premature rupture of membrane and injectable antibiotics for sepsis respectively. In general, the availability of newborn care services at facilities found in the Tigray region was higher than the facilities found in other regions. The mean availability of selected newborn signal functions was highest in hospitals (0.94) and Tigray (0.77) compared with their counterparts. Similarly, the mean availability of newborn services was higher in urban facilities (0.64) compared with rural facilities (0.57) (Table 2).
Table 2. Essential newborn care services availability by health facility characteristics
|
Neonatal Resuscitation
|
Corticosteroids
|
Antibiotic for preterm PROM
|
Injectable antibiotics
|
Mean availability of selected NB SFs
|
%
|
%
|
%
|
%
|
Mean
|
Type of facility
|
Hospital
|
99
|
86
|
98
|
92
|
0.94
|
Health centre
|
95
|
24
|
80
|
65
|
0.66
|
Clinic
|
7
|
1
|
3
|
3
|
0.03
|
Managing authority
|
Public
|
96
|
61
|
89
|
80
|
0.82
|
Others1
|
33
|
23
|
30
|
27
|
0.28
|
Location
|
Urban
|
73
|
53
|
69
|
62
|
0.64
|
Rural
|
75
|
30
|
64
|
59
|
0.57
|
Region
|
Tigray
|
85
|
63
|
80
|
78
|
0.77
|
Afar
|
54
|
32
|
49
|
51
|
0.47
|
Amhara
|
85
|
61
|
80
|
74
|
0.75
|
Oromiya
|
83
|
62
|
79
|
68
|
0.73
|
Somalia
|
55
|
25
|
59
|
55
|
0.48
|
Benshangul Gumuz
|
58
|
26
|
55
|
29
|
0.42
|
SNNPR
|
83
|
58
|
75
|
73
|
0.72
|
Gambella
|
50
|
17
|
33
|
43
|
0.36
|
Harari
|
54
|
33
|
38
|
42
|
0.42
|
Addis Ababa
|
71
|
42
|
68
|
49
|
0.57
|
Dire Dawa
|
61
|
21
|
61
|
46
|
0.47
|
|
Total
|
74
|
48
|
68
|
62
|
0.63
|
Others1: Facilities managed or owned by private, NGO or religion institute
Tracer Items for selected newborn care services
The facilities were assessed for the readiness of newborn care in terms of neonatal bag & mask, suction apparatus, injectable antibiotic, ampicillin powder for injection, betamethasone injection, gentamicin injection, guideline for childbirth care, checklist/job aid for childbirth care, trained staff in childbirth care and trained staff in newborn resuscitation in the last two years prior to the survey. Eighty-seven percent, 72% and 2% of hospitals, health centres, and clinics had neonatal bags & mask respectively. Only 7%, 13% and 3% of hospital health centres, and clinics had gentamicin injection respectively. Almost all hospitals (99%) and 94% of health centres had injectable antibiotics. In clinics, the availability of tracer items ranged from 1% for a guideline for childcare to 28% betamethasone injection. Guideline for childbirth care was available in 60% and 63% of hospitals and health centres respectively. Checklist/job aid for childbirth care was available in 78%, 67% and 2% of hospitals, health centres, and clinics respectively. The availability of trained staff in newborn resuscitation in the last two years before the survey ranged from the highest 72 % in hospitals to the lowest 2% in clinics. The mean readiness of tracer items to provide the selected newborn care in hospitals and health centres were about 7 out of 10 (mean=0.65) and 6out of 10 (mean= 0.6) respectively. Clinics on average had less than 1 out of 10 tracer items (Table 3).
Table 3. Readiness indicators for selected Newborn care services by type of health facilities
Tracer items
|
|
|
Hospital
|
Health centre
|
Clinic
|
Total
|
n
|
%
|
n
|
%
|
n
|
%
|
n %
|
Neonatal bag and mask
|
263
|
87
|
118
|
72
|
4
|
2
|
385 61
|
Suction apparatus (mucus extractor)
|
289
|
95
|
138
|
84
|
7
|
4
|
434 69
|
Injectable antibiotic
|
301
|
99
|
154
|
94
|
46
|
28
|
501 79
|
Betamethasone injection
|
69
|
23
|
21
|
13
|
4
|
2
|
94 15
|
Ampicillin powder for injection
|
235
|
78
|
115
|
70
|
13
|
8
|
363 57
|
Gentamicin injection
|
21
|
7
|
22
|
13
|
5
|
3
|
48 8
|
Guideline for childbirth care
|
182
|
60
|
104
|
63
|
1
|
1
|
287 45
|
Checklist/job aid for childbirth care
|
236
|
78
|
110
|
67
|
3
|
2
|
349 55
|
Received training in newborn resuscitation in the last two years
|
217
|
72
|
108
|
66
|
3
|
2
|
328 52
|
Trained staff in childbirth care
|
185
|
61
|
81
|
49
|
3
|
2
|
269 43
|
Mean readiness of tracer items for selected newborn care
|
0.65
|
0.60
|
0.05
|
0.49
|
|
|
|
|
|
|
|
|
|
Factors associated with newborn care readiness score
At a 5% level of significance, the simple linear regression model result showed that facility type, managing authority, region, power, water availability, emergency transport, and availability of infant weight scale was associated with newborn care readiness score to provide the services. The adjusted coefficient from multiple linear regression model revealed that, overall newborn readiness score for health centres and clinics were lower than that of hospitals (β = -0.049, C.I: (- 0.085, -0.013)) and (β = -0.361, C.I: (-0.434, -0.288)) respectively.
The expected value of newborn care readiness to provide the services was lower in health facilities found in Afar (β= -0.073, CI :(-0.137, -0.008)), Amhara (β= -0.053, CI :(-0.101, -0.004)), Oromiya (β = -0.122, C.I: (-0.169, -0.074)), Somali (β= -0.095, CI: (-0.156, -0.034)) and Gambella (β= -0.096, CI: (-0.166, -0.026)) than health facilities found in Tigray region. The expected value of newborn care readiness was lower in facilities managed by others (β = -0.072, CI: (-0.113, -0.031)) than facilities managed by the public. The expected value of newborn care readiness to provide the service with the availability of infant weight scale was higher than that of without it (β=0.195, CI: (0.133, 0.257)) (Table 4).
In the multiple linear regression model, 74% of the variability of factors associated with newborn care readiness score around its mean was explained by the model (Adjusted R Square=0.74).
Table 4. Determinants for newborn care services overall readiness score
Health facility characteristics
|
Mean
|
SE
|
Crude Model
|
Adjusted Model
|
Beta
|
95% Confidence Interval
|
Beta
|
95% Confidence Interval
|
Type of health facility
|
|
|
|
|
|
|
Hospitals (Ref.)
|
0.652
|
0.010
|
|
|
|
|
Health centers
|
0.601
|
0.016
|
-0.052
|
(-0.083, -0.021)
|
-0.049
|
(-0.085, -0.013)
|
Clinics
|
0.053
|
0.008
|
-0.599
|
(-0.631, -.568)
|
-0.361
|
(-0.434, -0.288)
|
Managing authority
|
|
|
|
|
|
|
Public (Ref.)
|
0.631
|
0.010
|
|
|
|
|
Others1
|
0.209
|
0.019
|
-0.422
|
(-0.459, -0.385)
|
-0.072
|
(-0.113, -0.031)
|
Region
|
|
|
|
|
|
|
Tigray (Ref.)
|
0.605
|
0.035
|
|
|
|
|
Afar
|
0.362
|
0.049
|
-0.243
|
(-0.361, -0.124)
|
-0.073
|
(-0.137, -0.008)
|
Amhara
|
0.558
|
0.030
|
-0.046
|
(-0.139, 0.046)
|
-0.053
|
(-0.101,-0.004)
|
Oromiya
|
0.485
|
0.025
|
-0.119
|
(-0.209, -0.029)
|
-0.122
|
(-0.169, -0.074)
|
Somali
|
0.352
|
0.035
|
-0.252
|
(-0.365, -0.139)
|
-0.095
|
(-0.156, -0.034)
|
Benshangul Gumuz
|
0.371
|
0.058
|
-0.234
|
(-0.359, -0.108)
|
-0.039
|
(-0.107, 0.029)
|
SNNP
|
0.556
|
0.031
|
-0.048
|
(-0.142, 0.046)
|
-0.049
|
(-0.099, 0.002)
|
Gambella
|
0.297
|
0.056
|
-0.308
|
(-0.435, -0.181)
|
-0.096
|
(-0.166, -0.026)
|
Harari
|
0.367
|
0.072
|
-0.238
|
(-0.376, -0.100)
|
-0.059
|
(-0.134, 0.015)
|
Addis Ababa
|
0.488
|
0.038
|
-0.116
|
(-0.213, -0.019)
|
-0.028
|
(-0.081, 0.026)
|
Dire Dawa
|
0.457
|
0.061
|
-0.147
|
(-0.278, -0.017)
|
-0.018
|
(-0.088, 0.052)
|
Power
|
|
|
|
|
|
|
No power (Ref)
|
0.451
|
0.019
|
|
|
|
|
Yes available
|
0.504
|
0.016
|
0.053
|
(0.005, 0.102)
|
0.008
|
(-0.019, 0.035)
|
Water
|
|
|
|
|
|
|
No water (ref)
|
0.364
|
0.031
|
|
|
|
|
Water available
|
0.503
|
0.013
|
0.139
|
(0.073, 0.205)
|
0.038
|
(-0.001, 0.077)
|
Emergency Transport
|
|
|
|
|
|
|
No (Ref)
|
0.256
|
0.026
|
|
|
|
|
Yes available
|
0.546
|
0.012
|
0.290
|
(0.237, 0.343)
|
-0.008
|
(-0.042, 0.026)
|
Availability of infant weight scale
|
|
|
|
|
|
|
No (Ref.)
|
0.087
|
0.013
|
|
|
|
|
Available
|
0.639
|
0.008
|
0.551
|
(0.521, 0.582)
|
0.195
|
(0.133, 0.257)
|
Others1: Facilities managed or owned by private, NGO or religion institute