Geographic Equity in Essential Newborn Care Practices in Ethiopia: a cross- sectional study

Abstract Background Essential newborn care practices vary across different social groups, but evidence on the geographic equity of newborn care in Ethiopia is scarce. We aimed to assess the geographic distribution and equity of selected essential newborn care practices recommended by the World Health Organization that are initial skin-to-skin care, delayed bathing, proper cord care, timely breastfeeding initiation, and immunizations of BCG and first-dose polio vaccines among neonates born at health facilities and homes in Ethiopia. Methods We analyzed data from 2,493 neonates in the Performance Monitoring for Action Ethiopia 2019–2021 survey in five Regions and Addis Ababa City Administration. We studied the geographic variation of selected essential newborn care practices using Global Moran’s I statistics and hot and cold spot analysis (Local Getis-Ord Gi* statistic), and the coverage of these practices were predicted for the whole Country using Kriging interpolation. Results This study showed that selected essential newborn care practices were higher among neonates in health facilities, those born in Central, Northern, Southern, and a few areas in Southwest and Northwest Ethiopia. Geographic inequities were demonstrated in delayed bathing in facility and home births, proper cord care in facility births, and first immunizations in both facility and home births. Geographic inequities were not observed for initial skin-to-skin care and timely breastfeeding initiation. Conclusion Selected essential newborn care practices were higher among neonates born in health facilities, and the recommended essential newborn care practices were higher in Central and Northern Ethiopia. There were geographic inequities in delayed bathing and immunizations of BCG and first-dose polio vaccines among neonates born in health facilities and homes. Enhancing facility delivery, availing first vaccinations in facilities, and improving discharge counseling for mothers during antenatal, delivery and postnatal care are crucial to ensuring geographic equity in essential newborn care in Ethiopia.