title: Practice of skin-to-skin contact, exclusive breastfeeding and other newborn care interventions in Ethiopia following promotion by facility and community health workers: results from a prospective outcome evaluation.
abstract: OBJECTIVE
  To assess the effects of a facility and community newborn intervention package on coverage of early skin-to-skin contact (SSC) and exclusive breastfeeding - the therapeutic components of kangaroo mother care.
  
  
  METHODS
  A multilevel community and facility intervention in Ethiopia trained health workers in 10 health centres and the surrounding communities to promote early SSC and exclusive breastfeeding for all babies born at home or in the facility. Changes in SSC and exclusive breastfeeding were assessed by comparing baseline and endline household surveys.
  
  
  RESULTS
  Overall practice of SSC at any time following delivery increased significantly from 13.1 to 44.1% of mothers. Coverage of immediate SSC also increased significantly from 8.4 to 24.1%. Breastfeeding within the first hour increased from 51.4 to 67.9% and exclusive breastfeeding within the first three days increased from 86 to 95.8%. At endline, SSC was significantly higher among facility births than home births and community health workers had limited contact with mothers.
  
  
  CONCLUSIONS
  While targeted behaviours improved overall, the programme did not achieve adequate increases in SSC and exclusive breastfeeding among home deliveries to expect a reduction in mortality for low birthweight babies. Newborn care programs in Ethiopia should continue to encourage facility delivery while strengthening coverage of community programmes.
authors.affiliation: Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, MD, USA.|International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Maternal and Child Health Integrated Program, Washington, DC, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Callaghan-Koru
authors.affiliation: Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Abiy Seifu
authors.initials: AS
authors.lastname: Estifanos
authors.affiliation: Maternal and Child Health Integrated Program, Addis Ababa, Ethiopia.
authors.forename: Ephrem Daniel
authors.initials: ED
authors.lastname: Sheferaw
authors.affiliation: Maternal and Child Health Integrated Program, Washington, DC, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: de Graft-Johnson
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Carina
authors.initials: C
authors.lastname: Rosado
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Patton-Molitors
authors.affiliation: Department of Pediatrics, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Bogale
authors.initials: B
authors.lastname: Worku
authors.affiliation: Maternal and Child Health Integrated Program, Washington, DC, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Rawlins
authors.affiliation: International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Maternal and Child Health Integrated Program, Washington, DC, USA.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Baqui
mesh_terms: D001942:Breast Feeding; D003150:Community Health Workers; D037001:Directive Counseling; D005002:Ethiopia; D005240:Feasibility Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007224:Infant Care; D007231:Infant, Newborn; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies
keywords: Breastfeeding; Community health; Ethiopia; Kangaroo mother care; Newborn care