Percent of women with a live birth who reported seeking care from a skilled provider for a sick newborn
The percentage of women with live birth during a specified time period who report having sought care from a skilled provider for their sick newborn. A sick newborn is defined as having a reported newborn illness in the first 28 days after birth. Skilled providers can include private doctors, nurses, physician assistants, midwives and trained birth attendants, and pharmacists.
This indicator is calculated as:
(Number of women with live birth who report seeking care from a skilled provider for a sick newborn / Total number of women with live birth during specified time period) x 100
Data can be used to calculate this indicator from surveys with detailed information on mothers’ newborn health care behaviors or from independent and prospective studies on mothers’ health care seeking behaviors. At present, large-scale, population-based surveys, such as the Demographic Health Survey (DHS) and the UNICEF Multiple Indicator Cluster Survey (MICS) do not have the level of detail to calculate this indicator for newborns. The data can be disaggregated by the type of skilled provider and/or type of facility visited (i.e., public, private, non-governmental, community-based), and other factors such as district or urban/rural location.
Specialized surveys with detailed information on mothers’ health care behaviors for their newborns; independent studies on mothers’ newborn health care seeking behaviors.
This indicator measures women’s healthcare seeking behaviors for their newborns when the infants show signs of sickness. The indicator relates directly to the achievement of Millennium Development Goal #4 to reduce infant and child mortality. Many newborn infants are born at home or returned home shortly after delivery, and they can become ill and die before ever reaching medical care. Until recently, newborn health was not a priority in both the international child health and safe motherhood movements, largely due to the general lack of awareness of the sheer numbers of early infant deaths. WHO estimates that each year nearly 3.3 million babies are stillborn, and more than 4 million others die within 28 days of being born. Newborn deaths contribute to about 40% of all deaths in children under five years of age globally, and more than half of infant mortality (WHO, 2005). Nearly all of these deaths occur in developing countries, and although post-neonatal mortality has declined substantially, neonatal deaths have declined only slightly (Gage, et al., 2005).
This indicator can be used with specialized surveys and independent research studies. The Save Newborn Lives/ Save the Children expert working group (Save the Children, 2010) has recommended that this and related newborn health indicators, including recognition of danger signs, care-seeking, and best practices for newborn care, be more widely used in population based surveys, such as DHS and MICS. It is important to develop indicators that help programs understand community knowledge, attitudes, and behaviors in response to newborn illness and to determine which interventions are the most effective (Gage, et al., 2005).
Newborn illness is often difficult to recognize because infants often present with relatively non-specific symptoms, such as poor feeding and lethargy. In many settings, few facilities or skilled providers may be accessible and affordable and, even where mothers can access skilled providers, adequate diagnostic and/or treatment resources may not be available. Given these barriers to accessing adequate newborn care, mothers may choose to not seek skilled providers. Mothers may also report the recommended behavior rather than actual practice, particularly in areas where communication programs have been promoting healthcare-seeking behaviors for mothers and their newborns (Gage et al., 2005). Surveys rely on recall of events and this indicator is subject to recall bias, which is likely to increase with the length of the recall period. Recall bias can be minimized by keeping the reference period short. Another issue is small sample sizes – even in large surveys, few women may report that their newborn suffered from sickness, thus reducing the denominator for this indicator. Results should therefore be interpreted with caution, especially in surveys with small sample sizes.
newborn (NB), behavior
Gage A, Ali D, Suzuki C, 2005, A Guide for Measuring and Evaluating Child Health Programs, Chapel Hill, NC: MEASURE Evaluation. https://www.measureevaluation.org/resources/publications/ms-05-15
Save the Children, 2010, Report of a Technical Working Group Meeting on Newborn Health Indicators, Washington, DC: Save the Children.
WHO, 2005, The World Health Report 2005: Make every mother and child count, Geneva: WHO. http://www.who.int/whr/2005/media_centre/facts_en.pdf