title: Generating Insights from Trends in Newborn Care Practices from Prospective Population-Based Studies: Examples from India, Bangladesh and Nepal.
abstract: BACKGROUND
  Delivery of essential newborn care is key to reducing neonatal mortality rates, yet coverage of protective birth practices remains incomplete and variable, with or without skilled attendance. Evidence of changes over time in newborn care provision, disaggregated by care practice and delivery type, can be used by policymakers to review efforts to reduce mortality. We examine such trends in four areas using control arm trial data.
  
  
  RESULTS
  We analysed data from the control arms of cluster randomised controlled trials in Bangladesh (27 553 births), eastern India (8 939), Dhanusha, Nepal (15 344) and Makwanpur, Nepal (6 765) over the period 2001-2011. For each trial, we calculated the observed proportion of attended births and the coverage of WHO essential newborn care practices by year, adjusted for clustering and stratification. To explore factors contributing to the observed trends, we then analysed expected trends due only to observed shifts in birth attendance, accounted for stratification, delivery type and statistically significant interaction terms, and examined disaggregated trends in care practice coverage by delivery type. Attended births increased over the study periods in all areas from very low rates, reaching a maximum of only 30% of deliveries. Newborn care practice trends showed marked heterogeneity within and between areas. Adjustment for stratification, birth attendance and interaction revealed that care practices could change in opposite directions over time and/or between delivery types - e.g. in Bangladesh hygienic cord-cutting and skin-to-skin contact fell in attended deliveries but not home deliveries, whereas in India birth attendant hand-washing rose for institutional deliveries but fell for home deliveries.
  
  
  CONCLUSIONS
  Coverage of many essential newborn care practices is improving, albeit slowly and unevenly across sites and delivery type. Time trend analyses of birth patterns and essential newborn care practices can inform policy-makers about effective intervention strategies.
authors.affiliation: Clinical Operational Research Unit, University College London, 4 Taviton Street, London, WC1H 0BT, United Kingdom.
authors.forename: Sonya
authors.initials: S
authors.lastname: Crowe
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom.
authors.forename: Audrey
authors.initials: A
authors.lastname: Prost
authors.affiliation: Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh, India.
authors.forename: Munir
authors.initials: M
authors.lastname: Hossen
authors.affiliation: Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh, India.
authors.forename: Kishwar
authors.initials: K
authors.lastname: Azad
authors.affiliation: Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh, India.
authors.forename: Abdul
authors.initials: A
authors.lastname: Kuddus
authors.affiliation: Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India.
authors.forename: Swati
authors.initials: S
authors.lastname: Roy
authors.affiliation: Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Nair
authors.affiliation: Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India.
authors.forename: Prasanta
authors.initials: P
authors.lastname: Tripathy
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom; Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, GPO Box 921, Kathmandu, Nepal.
authors.forename: Naomi
authors.initials: N
authors.lastname: Saville
authors.affiliation: Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, GPO Box 921, Kathmandu, Nepal.
authors.forename: Aman
authors.initials: A
authors.lastname: Sen
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom; Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, GPO Box 921, Kathmandu, Nepal.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sikorski
authors.affiliation: Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, GPO Box 921, Kathmandu, Nepal.
authors.forename: Dharma
authors.initials: D
authors.lastname: Manandhar
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.affiliation: Clinical Operational Research Unit, University College London, 4 Taviton Street, London, WC1H 0BT, United Kingdom.
authors.forename: Christina
authors.initials: C
authors.lastname: Pagel
mesh_terms: D001459:Bangladesh; D003695:Delivery of Health Care / Q000639:trends*; D006801:Humans; D007194:India; D007231:Infant, Newborn; D009390:Nepal; D036801:Parturition; D011446:Prospective Studies; D013997:Time Factors