title: Poor thermal care practices among home births in Nepal: further analysis of Nepal Demographic and Health Survey 2011.
abstract: BACKGROUND
  Hypothermia is a major factor associated with neonatal mortality in low and middle income countries. Thermal care protection of newborn through a series of measures taken at birth and during the initial days of life is recommended to reduce the hypothermia and associated neonatal mortality. This study aimed to identify the prevalence of and the factors associated with receiving 'optimum thermal care' among home born newborns of Nepal.
  
  
  METHODS
  Data from the Nepal Demographic and Health Surveys (NDHS) 2011 were used for this study. Women who reported a home birth for their most recent childbirth was included in the study. Factors associated with optimum thermal care were examined using Chi-square test followed by logistic regression.
  
  
  RESULTS
  A total of 2464 newborns were included in the study. A total of 57.6 % were dried before the placenta was delivered; 60.3% were wrapped; 24.5% had not bathing during the first 24 hours, and 63.9% were breastfed within one hour of birth. Overall, only 248 (10.7%; 95% CI (8.8 %, 12.9%)) newborns received optimum thermal care. Newborns whose mothers had achieved higher education (OR 2.810; 95% CI (1.132, 6.976)), attended four or more antenatal care visits (OR 2.563; 95% CI (1.309, 5.017)), and those whose birth were attended by skilled attendants (OR 2.178; 95% CI (1.428, 3.323)) were likely to receive optimum thermal care.
  
  
  CONCLUSIONS
  The current study showed that only one in ten newborns in Nepal received optimum thermal care. Future newborn survival programs should focus on those mothers who are uneducated; who do not attend the recommended four or more attend antenatal care visits; and those who deliver without the assistance of skilled birth attendants to reduce the risk of neonatal hypothermia in Nepal.
authors.affiliation: School of Public Health, Curtin University, Perth, Australia.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Khanal
authors.affiliation: Centre for International Health, Curtin University, Perth, Australia.
authors.forename: Tania
authors.initials: T
authors.lastname: Gavidia
authors.affiliation: Public Health Worker, Kathmandu, Nepal.
authors.forename: Mandira
authors.initials: M
authors.lastname: Adhikari
authors.affiliation: Institute of Medicine, Kathmandu, Nepal.
authors.forename: Shiva Raj
authors.initials: SR
authors.lastname: Mishra
authors.affiliation: School of Public Health, Curtin University, Perth, Australia ; School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Karkee
mesh_terms: D036861:Delivery, Obstetric; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007035:Hypothermia / Q000517:prevention & control; D007231:Infant, Newborn; D009390:Nepal; D011247:Pregnancy