Measuring coverage of WHO recommended Essential Newborn Care practices in the squatter settlements of Islamabad Capital Territory in Pakistan.

Abstract Background: Pakistan has shown significant progress in reducing child mortality, however, significant challenges exist in reducing neonatal mortality rate. WHO recommends a package of “essential newborn care” practices based on effective coverage to improve newborn survival. This study assessed the level of effective coverage of newborn care in the squatter settlements of Islamabad Capital Territory (ICT) and also determined if the care received is within the parameters of essential newborn care as defined by WHO guidelines.Methods: A cross-sectional survey was conducted to gather community-based data on newborn care practices from 416 mothers who delivered a live baby in the past twelve months within a randomly selected squatter population of ICT. Three composite outcomes (safe cord care, optimal thermal care and good neonatal feeding) were generated by combining individual practices from a list of essential newborn care practices recommended by WHO. All International ethical standards were followed including informed consent and confidentiality of respondents. Ethical clearance was obtained from the ethical review board of Health Services Academy (HSA).Results: Despite a very high number of institutional deliveries, the study showed that only 2.9% of newborns received all components of WHO recommended essential newborn care. Only 17.1% of the newborns received essential elements of safe cord care, 40.4% received recommended optimal thermal care and 28.8% followed WHO guidelines of good neonatal feeding practice. This low uptake of essential practices was due to the application of various substances on the cord, delayed skin to skin contact and feeding of pre-lacteals to the newborn.Conclusion: The study highlighted that the current level of effective essential newborn care is extremely low in the country. We found multiple cultural and societal misconceptions, that translate into harmful practices for newborns. Interventions such as educating mothers through front line workers, updating health care staff on WHO recommended guidelines for newborn care and declaring widespread harmful traditional practices hazardous for the health of newborn, can help improve essential newborn care in Pakistan.