title: Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India.
abstract: OBJECTIVE
  Two-thirds of women globally give birth at home, yet little data are available on use of skin-to-skin care (STSC) in the community. We describe the acceptability of STSC in rural Uttar Pradesh, India, and measured maternal, newborn, and ambient temperature in the home in order to inform strategies for introduction of STSC in the community.
  
  
  METHODS
  Community-based workers in intervention clusters implemented a community mobilization and behavior change communication program that promoted birth preparedness and essential newborn care, including adoption of STSC, with pregnant mothers, their families, and key influential community members. Acceptance of STSC was assessed through in-depth interviews and focus groups, and temperature was measured during home visits on day of life 0 or 1.
  
  
  RESULTS
  Incidence of hypothermia (<36.5 degrees C) was high in both low birth weight (LBW) and normal birth weight (NBW) infants (49.2%, (361/733) and 43% (418/971), respectively). Mean body temperature of newborns was lower (P<0.01) in ambient temperatures <20 degrees C (35.9+/-1.4 degrees C, n=225) compared to > or =20 degrees C (36.5+/-0.9 degrees C, n=1450). Among hypothermic newborns, 42% (331/787) of their mothers had a lower temperature (range -6.7 to 0.1 degrees C, mean difference 0.4+/-1.2 degrees C). Acceptance of STSC was nearly universal. No adverse events from STSC were reported. STSC was perceived to prevent newborn hypothermia, enhance mother's capability to protect her baby from evil spirits, and make the baby more content.
  
  
  CONCLUSIONS
  STSC was highly acceptable in rural India when introduced through appropriate cultural paradigms. STSC may be of benefit for all newborns and for many mothers as well. New approaches are needed for introduction of STSC in the community compared to the hospital.
authors.affiliation: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: G L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: V
authors.initials: V
authors.lastname: Kumar
authors.forename: R
authors.initials: R
authors.lastname: Yadav
authors.forename: V
authors.initials: V
authors.lastname: Singh
authors.forename: P
authors.initials: P
authors.lastname: Singh
authors.forename: S
authors.initials: S
authors.lastname: Mohanty
authors.forename: A H
authors.initials: AH
authors.lastname: Baqui
authors.forename: N
authors.initials: N
authors.lastname: Bharti
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.forename: R P
authors.initials: RP
authors.lastname: Misra
authors.forename: S
authors.initials: S
authors.lastname: Awasthi
authors.forename: J V
authors.initials: JV
authors.lastname: Singh
authors.forename: M
authors.initials: M
authors.lastname: Santosham
mesh_terms: D001833:Body Temperature Regulation; D003153:Community Health Services / Q000379:methods*; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000175:diagnosis / Q000628:therapy*; D007194:India; D007224:Infant Care / Q000379:methods*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D017060:Patient Satisfaction; D011247:Pregnancy; D014110:Touch