title: Differences in essential newborn care at birth between private and public health facilities in eastern Uganda.
abstract: BACKGROUND
  In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth.
  
  
  OBJECTIVE
  To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda.
  
  
  METHODS
  Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted.
  
  
  RESULTS
  The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p<0.001). Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities.
  
  
  CONCLUSIONS
  In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both private and public sector facilities, and a greater emphasis on tracking access to and quality of care in private sector facilities.
authors.affiliation: Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.|Iganga-Mayuge Health Demographic Surveillance Site, Iganga-Mayuge, Uganda; pwaiswa@musph.ac.ug.
authors.forename: Peter
authors.initials: P
authors.lastname: Waiswa
authors.affiliation: Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Akuze
authors.affiliation: Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.|International Maternal and Child Health Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
authors.affiliation: Saving Newborn Lives, Save the Children, Cape Town, South Africa.
authors.forename: Kate
authors.initials: K
authors.lastname: Kerber
authors.affiliation: Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Moses
authors.initials: M
authors.lastname: Tetui
authors.affiliation: Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Birger C
authors.initials: BC
authors.lastname: Forsberg
authors.affiliation: Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Claudia
authors.initials: C
authors.lastname: Hanson
mesh_terms: D000293:Adolescent; D000328:Adult; D002662:Child Health Services / Q000458:organization & administration; D005260:Female; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods* / Q000458:organization & administration*; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration*; D011181:Postnatal Care / Q000458:organization & administration*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration; D017149:Private Sector / Q000458:organization & administration*; D017150:Public Sector / Q000458:organization & administration*; D012424:Rural Population; D012959:Socioeconomic Factors; D014454:Uganda; D055815:Young Adult
keywords: Uganda; essential newborn care; newborn health; private health care; public health care
references.citation: Int J Qual Health Care. 2009 Apr;21(2):79-86
references.pmid: 19208648
references.citation: BMC Pregnancy Childbirth. 2008;8:10
references.pmid: 18366625
references.citation: Lancet. 2006 Oct 7;368(9543):1284-99
references.pmid: 17027735
references.citation: S Afr Med J. 1990 Aug 4;78(3):136-8
references.pmid: 2377944
references.citation: Trials. 2012;13:213
references.pmid: 23153395
references.citation: Health Policy Plan. 2004 Oct;19 Suppl 1:i5-i21
references.pmid: 15452011
references.citation: BMC Pregnancy Childbirth. 2010;10:9
references.pmid: 20178626
references.citation: Niger J Clin Pract. 2006 Dec;9(2):159-63
references.pmid: 17319350
references.citation: Int J Equity Health. 2011 Aug 19;10:33
references.pmid: 21854584
references.citation: Glob Health Action. 2015 Mar 31;8:24250
references.pmid: 25843494
references.citation: Lancet. 2011 May 7;377(9777):1610-23
references.pmid: 21496910
references.citation: Bull World Health Organ. 2013 Mar 1;91(3):207-16
references.pmid: 23476093
references.citation: Bull World Health Organ. 2003;81(8):616-23
references.pmid: 14576894
references.citation: PLoS One. 2010;5(10):e13243
references.pmid: 20949054
references.citation: Trop Med Int Health. 2009 Apr;14(4):472-9
references.pmid: 19222823
references.citation: J Obstet Gynaecol Res. 2000 Oct;26(5):357-61
references.pmid: 11147723
references.citation: Malar J. 2009;8:131
references.pmid: 19523220
references.citation: Reprod Health Matters. 2011 May;19(37):75-85
references.pmid: 21555088
references.citation: Health Policy Plan. 2012 Jul;27 Suppl 3:iii104-117
references.pmid: 22692413
references.citation: Reprod Health Matters. 2011 May;19(37):4-9
references.pmid: 21555081
references.citation: Malar J. 2009;8:45
references.pmid: 19284673
references.citation: Trop Med Int Health. 2010 Aug;15(8):964-72
references.pmid: 20636527
references.citation: Glob Health Action. 2015 Mar 31;8:24584
references.pmid: 25843498
references.citation: Lancet. 2014 Aug 2;384(9941):455-67
references.pmid: 24853599
references.citation: Popul Health Metr. 2011 Aug 05;9:44
references.pmid: 21819604
references.citation: Soc Sci Med. 2006 Feb;62(4):866-76
references.pmid: 16139936
references.citation: Lancet. 1991 Jul 20;338(8760):167-9
references.pmid: 1677075
references.citation: Stud Fam Plann. 2009 Mar;40(1):39-50
references.pmid: 19397184
references.citation: PLoS Med. 2011 Apr;8(4):e1000433
references.pmid: 21532746
references.citation: BMC Pregnancy Childbirth. 2010;10:65
references.pmid: 20959012
references.citation: PLoS One. 2013;8(3):e60481
references.pmid: 23555980
references.citation: PLoS Med. 2012;9(11):e1001340
references.pmid: 23152724
references.citation: Reprod Health Matters. 2011 May;19(37):62-74
references.pmid: 21555087
references.citation: Malar J. 2013;12:340
references.pmid: 24053172
references.citation: Bull World Health Organ. 2008 May;86(5):332-8
references.pmid: 18545734
references.citation: Matern Child Health J. 2006 Mar;10(2):159-69
references.pmid: 16362233
references.citation: Lancet. 2012 Jan 14;379(9811):e5-6
references.pmid: 21474173
references.citation: Soc Sci Med. 1999 Oct;49(7):849-65
references.pmid: 10468391
references.citation: Bull World Health Organ. 2006 Jan;84(1):21-7
references.pmid: 16501711