Wealth-based equity in essential newborn care practices in Ethiopia: a cross-sectional study 

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Reports from low-income countries, including Ethiopia, show inequities in practices but need more comprehensiveness. We aimed to analyze wealth-based equity of selected essential newborn care practices, i.e., skin-to-skin care, delayed bathing, proper cord care, and timely breastfeeding initiation among neonates born at health facilities and homes in Ethiopia. Methods The Performance Monitoring for Action Ethiopia 2019–2020 survey was conducted in five Ethiopian regions, representing 90% of the total population. We used data on 2,493 newborns. Wealth quintiles were based on principal component analysis of household assets. Wealth-based equity of selected essential newborn care practices was analyzed separately for facility and home deliveries using equiplot, equity gaps, equity ratios, and concentration indices. Results Overall, the equiplots for skin-to-skin care and delayed bathing practices showed minimal inequities for babies born in health facilities. When comparing the extreme groups, socio-economic differences were seen in delayed bathing and timely breastfeeding initiation. Using wealth as a continuous variable across all respondents, delayed bathing and proper cord care were more frequent in the better-off households. In home births, the equiplots showed that all selected essential newborn care practices were more common in the least poor groups. While comparing the extreme groups, socio-economic inequities were present in skin-to-skin care and delayed bathing practices. Using wealth as a continuous variable, skin-to-skin care and delayed bathing were more common in better-off households. Conclusion The coverage of selected essential newborn care practices was higher in facility deliveries. There were minimal socio-economic differences in newborn care of facility births, while inequities in skin-to-skin care and delayed bathing were prominent in home births. Initiatives should focus on increasing facility delivery and improving newborn care practices at home to ensure newborn care equity in Ethiopia. Essential newborn care equity household wealth Ethiopia Figures Figure 1 Figure 2 Figure 3 Background The 2030 Sustainable Development Goal (SDG) 3.2 targeted to reduce neonatal mortality to 12/1000 live births or less [ 1 ]. This target demands narrowing the existing gaps in coverage and quality of newborn care within and between countries [ 2 ]. Meeting the SDG targets in sub-Saharan Africa depends on addressing newborn care inequities [ 3 ]. Evidence from low and middle-income countries highlighted important within-country inequities in newborn care for both home and facility births [ 2 ]. Promotion of essential newborn care practices at health facilities and homes is one strategy for improving newborn health outcomes [ 4 ]. The World Health Organization (WHO) has recommended essential components in the care of all newborns, including thermal care with skin-to-skin contact and delayed bathing for 24 hours, clean cord care with chlorhexidine application after cutting the cord, and initiation of breastfeeding during the first hour [ 5 ]. Ethiopia has implemented a number of health programs to increase facility delivery and improve newborn care practices at home. These include the Health Extension Programme, the volunteer Women’s Development Groups, the Community Based Newborn Care (CBNC) programme, and a community-based health insurance scheme. These efforts have led to some improvements in facility delivery and newborn care practices [ 6 – 8 ]. Based on a nationally representative survey 2019–2020, we have shown that neonates born at health facilities had a higher coverage of essential care practices than home-delivered neonates: skin-to-skin care 76% vs. 9%, delayed bathing until 24 hours after birth 73% vs. 39%, proper cord care 89% vs. 65%, and first-hour initiation of breastfeeding 69% vs. 62% [ 9 ]. Evidence from the 2016 and 2019 EDHS and community-based surveys indicated that initial skin-to-skin care and delayed bathing practices favored the better-off, proper cord care practices were equitable, while timely breastfeeding initiation showed no evidence of inequity. Thus, newborn care inequities in Ethiopia favor the better-off subgroups [ 10 , 11 , 12 ]. Equitable care is a priority for the Ethiopian Ministry of Health [ 13 ]. However, equity analyses based on the nationally representative DHS are based on relatively long periods. The performance Monitoring for Action (PMA) survey 2019–2020 had a short recall period with interviews performed seven weeks after birth [ 9 ]. Therefore, we aimed to investigate the wealth-based inequities in selected essential newborn care practices of Ethiopian infants born at health facilities and homes using absolute and relative equity measures [ 14 ]. Methods Setting The study was performed in five Ethiopian regions; Tigray, Afar, Amhara, Oromia, Southern Nations, Nationalities, and Peoples’ (SNNP) regions, and Addis Ababa city administration [ 15 ]. The study sample represented 90% of the total population. In these regions, there is a population of 120 million, where of 80% live in rural areas [ 16 ]. Ethiopia has a three-tiered health system: 1) primary care consisting of health posts, health centers, and primary hospitals; 2) secondary care with general hospitals and specialty clinics; and 3) tertiary care with specialized hospitals [ 17 ]. Data source and sampling This study was based on secondary analysis of data from Performance Monitoring for Action (PMA) Ethiopia 2019–2020. The details are published elsewhere [ 15 ]. Briefly, the study employed a two-stage cluster sampling with urban-rural settings and regions as strata. In total, 217 clusters or enumeration areas (EAs) were selected based on probability proportional to regions’ population size, and 35 households in each EA were randomly selected. Pregnant women and postpartum women were invited to join the study. Interviews were made at around seven weeks after birth (median 7.4 weeks, interquartile range 6.9 weeks). Consenting women were interviewed using a questionnaire covering the women’s sociodemographic characteristics (age, education, region, religion, residence, and household wealth), parity, place of delivery, and newborn care practices performed by healthcare staff for a facility delivery, or by family members or other assistants for a home delivery. Measurements The selected outcome variables included thermal care (skin-to-skin care and delayed bathing), cord care practice, and breastfeeding initiation in the first hour. These practices were assessed based on WHO guidelines for essential newborn care as reported by the mother [ 5 ]. Skin-to-skin care was coded as “Yes” if the mother reported that the neonate was placed naked on her chest against her skin immediately after delivery and “No” otherwise. Delayed bathing was coded as “Yes” if the mother reported washing her newborn was postponed until at least 24 hours after delivery and “No” if otherwise. Proper cord care was coded “Yes” if the mother reported not applying anything or only chlorhexidine on the cord stump after cutting and “No” if otherwise. Timely initiation of breastfeeding was coded as “Yes” if the mother reported that she put the baby to her breast within an hour after birth and “No” if otherwise. The selected essential newborn care practices were stratified by delivery place, and household wealth. The wealth index of each household was constructed based on a principal component analysis of household assets, which was expressed as wealth quintiles, from 1 = lowest to 5 = highest. The wealth quintiles were used for the equiplots, equity gaps, and equity ratios, while the continuous wealth index was used for the concentration and slope indices. Analyses Participation was analysed and displayed in a study flow diagram. Characteristics of households, mothers and neonates were crosstabulated against place of delivery. The equity of the selected essential newborn care practices was calculated using four standard equity measures, separately for births at home and in health facilities: equiplot, equity gaps, equity ratios, and concentration indices [ 14 ]. Sampling weights were applied to assure the regional representativeness of the data, and clustering was accounted for in all analyses [ 18 ]. The equity of selected essential newborn care practices was illustrated using equiplots to show gaps across household wealth quintiles among neonates born at health facilities and homes [ 14 ]. The equity gap is the absolute percentage point difference in service coverage between the extreme groups. In this case, the gap was calculated between the highest and lowest wealth quintiles. Similarly, the wealth equity ratio was calculated by dividing the essential newborn practice coverages between mothers in the highest household wealth quintile by the coverages among mothers in the lowest household wealth quintile. The concentration index shows the cumulative percentage of the population, ranked by household wealth as a continuous variable, against the cumulative percentage for each newborn care practice [ 14 , 19 ]. The concentration index will be zero if there is no socioeconomic-related inequity, negative if the essential newborn care practice is higher among those in the lowest household wealth, and positive if the newborn care practice is higher among mothers in the highest household wealth. The slope index of equity (SII) shows the cumulative percentage of inequity in the population, ranked by household wealth, against the cumulative percentage for each essential newborn care practice [ 19 ]. The slope index will be zero if there is no socioeconomic-related inequity, negative if the essential newborn care practice is higher among those in the lowest household wealth, and positive if the essential newborn care practice is higher among mothers in the highest household wealth. The concentration index (CIX) and slope index of equity (SII), including standard errors and p-values, were assessed using commands downloaded from the International Center for Equity in Health [ 14 , 19 ]. Results Study participation A total of 32,792 women were assessed for eligibility. All women of reproductive age were evaluated for eligibility and those who were pregnant or within six weeks postpartum, permanent residents of the households, and consented to participate were included in the study. Of these, 2,581 women were eligible, of which we included 2,453 mothers (95%) who had 2,493 live births, including 40 twins (Fig. 1). More than half (53%) of the neonates were born at health facilities. Figure 1 Study flow. PMA Ethiopia 2019–2020. Sociodemographic characteristics Almost all (92%) urban women and less than half (43%) of the rural women delivered in health facilities (Table 1 ). Nine out of ten women from the highest wealth quintile and three out of ten in the lowest quintile delivered in health facilities. A higher proportion of younger women and those having their first baby delivered in health facilities. Most (85%) of the mothers who had a secondary education or higher gave birth at health facilities, whereas those with no formal education only 38% did so. The place of delivery was similar between boys and girls. Table 1 Sociodemographic characteristics of mothers. PMA Ethiopia 2019–2020 survey, weighted data. Characteristics Category n Place of delivery, % (95% CI) Health facility (N = 1532) Home (N = 961) Region Tigray 421 70 (56, 82) 30 (18, 44) Afar 202 17 (6, 40) 83 (60, 94) Amhara 433 57 (47, 67) 43 (33, 53) Oromia 618 49 (39, 60) 51 (41, 61) SNNP 574 48 (37, 60) 52 (40, 63) Addis Ababa 245 98 (95, 99) 2 (1, 6) Residence Urban 966 92 (87, 96) 8 (3, 17) Rural 1,527 43 (36, 49) 57 (51, 64) Wealth quintiles 1 Poorest 443 28 (22, 36) 72 (64, 78) 2 377 39 (32, 46) 61 (54, 68) 3 380 50 (42, 58) 50 (42, 58) 4 468 58 (48, 68) 42 (32, 52) 5 Least poor 822 94 (88, 97) 6 (2, 15) Age (years) 15–19 218 57 (48, 67) 43 (33, 52) 20–34 1,892 55 (49, 61) 45 (39, 51) 35–49 380 44 (36, 52) 56 (48, 64) Education None 945 38 (32, 44) 62 (56, 68) Primary 899 56 (48, 62) 44 (38, 52) Secondary or higher 646 85 (79, 90) 15 (10, 21) Previous live births None 470 71 (70, 83) 23 (17, 30) 1–3 1,329 56 (50, 63) 44 (37, 50) ≥ 4 691 36 (30, 43) 64 (57, 70) Sex of the baby Boy 1,262 54 (47, 60) 46 (40, 53) Girl 1,231 53 (47, 59) 47 (41, 53) SNNP = Southern Nations, Nationalities, and Peoples Wealth-based equity in essential newborn care for facility births Among facility-delivered neonates, 76% were put naked skin-to-skin on their mothers’ breasts, 73% had delayed bathing at least until 24 hours after birth, 89% had proper cord care, and 69% got breastfeeding initiation during the first hour. Overall, for babies born health facilities the equiplots for skin-to-skin care, delayed bathing until at least 24 hours after birth, proper cord care, and timely breastfeeding initiation showed minimal or no variation across the different household wealth quintiles (Fig. 2). When comparing the extreme wealth groups, there was tiny socio-economic differences in skin-to-skin care (difference = -1, ratio = 1), delayed bathing (difference = 5, ratio = 1), proper cord care (difference = 0, ratio = 1), and timely breastfeeding initiation (difference = 5, ratio = 1) (Table 2 ). Using household wealth as a continuous variable across all respondents, delayed bathing (SII = 0.11, p-value = 0.001 and concentration index = 0.03, p-value = 0.001), and proper cord care (SII = 0.1, p-value = 0.002 and concentration index = 0.02, p-value = 0.002) were slightly more common in infants from better-off households. Figure 2 Wealth-based equity in skin-to-skin care, delayed bathing, proper cord care, and breastfeeding initiation among facility delivered neonates, PMA Ethiopia 2019–2020 survey. Table 2 Wealth-based equity in skin-to-skin care, delayed bathing, proper cord care, and breastfeeding initiation practices in facility-delivered neonates, PMA Ethiopia 2019–2020 survey. Newborn care practices Q1 % Q5 % Difference (Q5-Q1; % points) Ratio (Q5:Q1) value Slope index of inequity/SII Concentration index/CIX Coefficient SE P-value Coefficient SE P-value Skin-to-skin care 77 76 -1 1 -0.1 0.04 0.2 -0.01 0.01 0.2 Delayed bathing 70 75 5 1 0.11 0.04 0.001 0.03 0.01 0.001 Proper cord care 92 92 0 1 0.1 0.03 0.002 0.02 0.01 0.002 Breastfeeding initiation 62 67 5 1 -0.04 0.04 0.4 -0.01 0.01 0.4 Q1 = Quintile 1, Q5 = Quintile 5, SE = Standard error Wealth-based equity in essential newborn care for home births Among home-delivered neonates, 9% were placed skin-to-skin, 39% had their bathing delayed for at least 24 hours, 65% got proper cord care, and 62% got timely breastfeeding initiation. The equiplots showed that skin-to-skin care, delayed bathing, proper cord care, and timely breastfeeding initiation differed across wealth groups with these practices being more common in the least poor groups (Fig. 3). The socioeconomic differences in proper cord care were minimal. When comparing the extreme groups, visible socio-economic inequities were reported in the practices of skin-to-skin care (difference = 21, ratio = 3) and delayed bathing (difference = 25, ratio = 2) (Table 3 ). Using household wealth as a continuous variable, skin-to-skin care (SII = 0.1, p-value = 0.02 and concentration index = 0.2, p-value = 0.01), and delayed bathing (SII = 0.12, p-value = 0.02 and concentration index = 0.1, p-value = 0.03) were more common in the better-off households. Figure 3 Wealth-based equity in skin-to-skin care, delayed bathing, proper cord care, and breastfeeding initiation among home-delivered neonates, PMA Ethiopia 2019–2020 survey. Table 3 Wealth-based equity in skin-to-skin care, delayed bathing, proper cord care, and breastfeeding initiation practices in home-delivered neonates, PMA Ethiopia 2019–2020 survey. Newborn care practices Q1 % Q5 % Difference (Q5-Q1; % points) Ratio (Q5:Q1) value Slope index of inequity/SII Concentration index/CIX Coefficient SE P-value Coefficient SE P-value Skin-to-skin care 9 30 21 3 0.1 0.04 0.02 0.2 0.1 0.01 Delayed bathing 38 63 25 2 0.12 0.1 0.02 0.1 0.02 0.03 Proper cord care 67 72 5 1 -0.1 0.1 0.11 -0.02 0.01 0.1 Breastfeeding initiation 62 77 15 1 0.01 0.1 0.9 0.001 0.02 0.9 Q1 = Quintile 1, Q5 = Quintile 5, SE = Standard error Discussion Overall, the coverage of selected essential newborn care practices was higher in facility deliveries than in home births, where skin-to-skin care and delayed bathing practices were deficient. Almost all the women in the highest quintile and only three out of ten of those in the lowest quintile gave birth in a facility. There were minimal socio-economic differences in the care of infants born at health facilities, while inequities in skin-to-skin care and delayed bathing were prominent among those born at home. Among facility-born neonates, the coverage of selected essential newborn care practices, including early skin-to-skin care, delayed bathing, proper cord care, and timely breastfeeding initiation, was higher, although not optimal. We do not expect wealth-based inequities in newborn care for facility deliveries, given that providers are unlikely to provide services differently. Accordingly, skin-to-skin care and early initiation of breastfeeding were equitably distributed. On the other hand, there were tiny wealth-based inequities for delayed bathing and proper cord care, which are practices that may involve family members. Families usually leave the delivery facility before 24 hours after birth, and may wash the baby sooner than advised once at home [ 20 ]. Nevertheless, WHO recommends that all neonates receive all essential components of newborn care during and immediately after birth [ 5 ]. In facility deliveries, healthcare staff also need to inform families about keeping the baby warm and cord care when returning back home. Besides, health facilities should adhere to the WHO recommendation that mothers with newborns should remain in health facilities for at least 24 hours after birth [ 21 ]. For home births, the coverage of the selected essential newborn care practices was lower, and wealth-based inequities were prominent. Keeping the baby warm is essential for newborn survival and WHO recommends delaying bathing of the newborn baby until at least 24 hours after birth for optimal thermal care [ 5 ]. We have previously reported that the low coverage of skin-to-skin care (9%) and delayed bathing (39%) among home deliveries neonates [ 9 ]. For home deliveries, wealth-based inequities were evident for skin-to-skin care and delayed bathing favoring infants from better-off households. The high proportion of home deliveries (47%) in this study and low coverage of thermal care for home-delivered neonates and which was also less common among the poorest households implies that ensuring equitable and universal coverage of newborn care practices will be a challenge for Ethiopia. [ 5 ]. Strengthening the health extension program to promote facility delivery, improving antenatal counseling and preparedness of home-delivering mothers is crucial to further enhance the coverage and equity of all essential newborn care practices. Furthermore, strong ANC counseling could make sure that families delay bathing irrespective of where they deliver. Our analysis revealed that proper cord care practice was not optimal for home deliveries but was equitable. In contrast, wealth-based inequities in timely breastfeeding initiation were observed in home-delivered neonates favoring infants with the highest household wealth. Facility birth is very important for improved and more equitable newborn care practices [ 2 ]. We have shown that home-born neonates had lower coverage of essential newborn care with wealth-based inequities. A published paper from the same study population has shown that 70% of pregnant women had at least one antenatal care (ANC) visit decreasing to 40% with four or more [ 22 ]. Thus, it is crucial to improve the quality of ANC, including birth preparedness, counseling pregnant women to deliver in a facility, and making them aware of all essential newborn care practices that need to take place at the facility and at home. The study participants were selected from five regions and one city administration, representing 90% of Ethiopia. The findings could be generalizable to the country. We used household wealth as a socio-economic stratifier to analyze the equity distribution of essential newborn care practices for infants born at health facilities and homes. Essential newborn care practices were assessed based on the information reported by mothers. They may have had difficulties remembering or noticing some of the care practices. However, to minimize recall bias, women were interviewed when the infant was around seven weeks old. Conclusion In conclusion, the coverage of selected essential newborn care practices was higher in facility deliveries. For home births, skin-to-skin care and delayed bathing practices were particularly low. Minimal socio-economic differences were found in facility deliveries, while inequities in skin-to-skin care and delayed bathing were visible in home deliveries. Therefore, it is important increasing facility deliveries and improving the discharge counseling of mothers, so they can continue to provide proper care for their newborn at home. Declarations Ethics approval and consent to participate PMA Ethiopia received ethical approval from Addis Ababa University, College of Health Sciences (AAU/CHS) (Ref: AAUMF 01-008) and the Johns Hopkins University Bloomberg School of Public Health (JHSPH) Institutional Review Board (FWA00000287). Written informed consent had been secured from the study participants, and assent was obtained from their partner or family member for those mothers whose ages were below 18 years. Consent for publication Not applicable Availability of data and materials The PMA dataset used in our analyses is open access and available at https://www.pmadata.org/countries/ethiopia. Competing interests The authors declare that they have no competing interests. Funding This research was funded by the Bill and Melinda Gates Foundation (INV-009691 and INV-010320). The funder had no role in the design, data collection, analysis or interpretation of the data. Authors’ contributions TGD, DB, LÅP, KA, AD, TG, SL and SS contributed to the conceptualization of the study, crafting the research questions, protocol development and analysis plan. TGD analysed and interpreted the data and drafted the manuscript. TGD, LÅP, JS, KA, DB, AD, TG, GT, SL, AT, ZA, SS and MZ have substantially revised the manuscript. All authors read and approved the final manuscript. Acknowledgments We are grateful to the Ethiopian Ministry of Health and Addis Ababa University staff for constructive discussions on setting priority research questions and character of the PMA data. References Mcarthur JW, Rasmussen K, Yamey G. How Many Lives are at Stake? Assessing 2030 Sustainable Development Goal Trajectories for Maternal and Child Health. BMJ. 2018;360:1–9. https://doi.org/10.1136/bmj.k373 . Peven K, Mallick L, Taylor C, Bick D, Day LT, Kadzem L, Purssell E. Equity in newborn care, evidence from national surveys in low- and middle-income countries. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4501493","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":315483539,"identity":"13cb07a0-45e8-4acd-9285-98d32edd589c","order_by":0,"name":"Tadesse Delele","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYHACAxDB2MDefABIS8gQVM8D18JzLAGkhYcELRI5BlABAsCe/fDGh1/b7GT7GXI+v7pRY8HDwH746Aa8tvCkFRvLtiUbz2w4u8065xjQYTxpaTfwOyzHTFqyjTlxw8HebcY5bEAtEjxm+LXwvzH/LdlWn7j/MM8z45x/xGiRyDFj/Nh2OHEDGw/z49w2YrTceFYszXDuuPGMM2xmzLl9EjxshPzC3p+88eOPsmrZ/vmPH3/O+VYnx89++BheLSDADI0LNgkwSUg5CDD+gGr9QIzqUTAKRsEoGHkAAOUFR7uoMHLhAAAAAElFTkSuQmCC","orcid":"","institution":"University of Gondar","correspondingAuthor":true,"prefix":"","firstName":"Tadesse","middleName":"","lastName":"Delele","suffix":""},{"id":315483540,"identity":"ce5bb993-a8fe-4e22-a69a-9a3b16513203","order_by":1,"name":"Lars Åke Persson","email":"","orcid":"","institution":"London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lars","middleName":"Åke","lastName":"Persson","suffix":""},{"id":315483542,"identity":"bccba28f-a508-464a-ae6f-e012f3ca867a","order_by":2,"name":"Kassahun Alemu","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Kassahun","middleName":"","lastName":"Alemu","suffix":""},{"id":315483543,"identity":"9bf9a0db-0630-44f8-a691-e159804b15cd","order_by":3,"name":"Joanna Schellenberg","email":"","orcid":"","institution":"London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Joanna","middleName":"","lastName":"Schellenberg","suffix":""},{"id":315483544,"identity":"f21d72e9-7745-4cfd-a261-296bb3258921","order_by":4,"name":"Seblewengel Lemma","email":"","orcid":"","institution":"London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Seblewengel","middleName":"","lastName":"Lemma","suffix":""},{"id":315483546,"identity":"ea5d2a8c-e796-48ff-9018-74a190b4b28b","order_by":5,"name":"Atkure Defar","email":"","orcid":"","institution":"London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Atkure","middleName":"","lastName":"Defar","suffix":""},{"id":315483548,"identity":"6d93c622-fc94-404e-8c70-db0e0c04a28f","order_by":6,"name":"Theodros Getachew","email":"","orcid":"","institution":"Ethiopian Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Theodros","middleName":"","lastName":"Getachew","suffix":""},{"id":315483551,"identity":"41b608a2-756f-4d71-9295-2dcb6d1f0e60","order_by":7,"name":"Girum Taye","email":"","orcid":"","institution":"Ethiopian Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Girum","middleName":"","lastName":"Taye","suffix":""},{"id":315483552,"identity":"9b75534c-67cc-4212-9945-5062c7bde29d","order_by":8,"name":"Solomon Shiferaw","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Solomon","middleName":"","lastName":"Shiferaw","suffix":""},{"id":315483553,"identity":"c20e728c-df52-4d89-97cb-89b8a702728d","order_by":9,"name":"Zewditu Abdissa","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Zewditu","middleName":"","lastName":"Abdissa","suffix":""},{"id":315483554,"identity":"7531922c-53af-42d0-be1f-96a42af444c2","order_by":10,"name":"Amare Tariku","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Amare","middleName":"","lastName":"Tariku","suffix":""},{"id":315483555,"identity":"a205c554-c5e3-4e23-abec-ffbbdd6a8c6e","order_by":11,"name":"Meseret Zelalem","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Meseret","middleName":"","lastName":"Zelalem","suffix":""},{"id":315483556,"identity":"548e8da5-597c-4e45-b9ed-678f2f59b31b","order_by":12,"name":"Della Berhanu","email":"","orcid":"","institution":"London School of Hygiene \u0026 Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Della","middleName":"","lastName":"Berhanu","suffix":""}],"badges":[],"createdAt":"2024-05-30 08:26:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4501493/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4501493/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59053470,"identity":"19497a71-345a-4b3e-ba3c-4f7f6c66851a","added_by":"auto","created_at":"2024-06-25 20:27:19","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":477753,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flow. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ePMA Ethiopia 2019-2020.\u003c/p\u003e","description":"","filename":"1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4501493/v1/943092152413f05e7e47d100.jpeg"},{"id":59053468,"identity":"0ad471a4-0ecb-403d-bc5d-c1f3fef56396","added_by":"auto","created_at":"2024-06-25 20:27:19","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":316746,"visible":true,"origin":"","legend":"\u003cp\u003eWealth-based equity in skin-to-skin care, delayed bathing, proper cord care, and breastfeeding initiation among facility delivered neonates, PMA Ethiopia 2019-2020 survey.\u003c/p\u003e","description":"","filename":"2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4501493/v1/16c1a1428d53f26c656067dd.jpeg"},{"id":59053466,"identity":"ccd49aac-6d89-401c-a599-1a91ea5d4c00","added_by":"auto","created_at":"2024-06-25 20:27:19","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":190411,"visible":true,"origin":"","legend":"\u003cp\u003eWealth-based equity in skin-to-skin care, delayed bathing, proper cord care, and breastfeeding initiation among home-delivered neonates, PMA Ethiopia 2019-2020 survey.\u003c/p\u003e","description":"","filename":"3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4501493/v1/a3b2340ea2d52272ae76c90c.jpeg"},{"id":59054973,"identity":"76b043d2-cf58-4941-a551-1cf8cca129e0","added_by":"auto","created_at":"2024-06-25 20:43:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1624055,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4501493/v1/1a862ae1-38fd-414d-9b51-8e14d5293c71.pdf"},{"id":59053467,"identity":"1733bf86-b7eb-4f1b-ac40-50f379965acc","added_by":"auto","created_at":"2024-06-25 20:27:19","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19304,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable1Sociodemographiccharacteristicsofmothers.docx","url":"https://assets-eu.researchsquare.com/files/rs-4501493/v1/f9bdc686f423287877a8658b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Wealth-based equity in essential newborn care practices in Ethiopia: a cross-sectional study ","fulltext":[{"header":"Background","content":"\u003cp\u003eThe 2030 Sustainable Development Goal (SDG) 3.2 targeted to reduce neonatal mortality to 12/1000 live births or less [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This target demands narrowing the existing gaps in coverage and quality of newborn care within and between countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Meeting the SDG targets in sub-Saharan Africa depends on addressing newborn care inequities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Evidence from low and middle-income countries highlighted important within-country inequities in newborn care for both home and facility births [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePromotion of essential newborn care practices at health facilities and homes is one strategy for improving newborn health outcomes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The World Health Organization (WHO) has recommended essential components in the care of all newborns, including thermal care with skin-to-skin contact and delayed bathing for 24 hours, clean cord care with chlorhexidine application after cutting the cord, and initiation of breastfeeding during the first hour [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEthiopia has implemented a number of health programs to increase facility delivery and improve newborn care practices at home. These include the Health Extension Programme, the volunteer Women\u0026rsquo;s Development Groups, the Community Based Newborn Care (CBNC) programme, and a community-based health insurance scheme. These efforts have led to some improvements in facility delivery and newborn care practices [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on a nationally representative survey 2019\u0026ndash;2020, we have shown that neonates born at health facilities had a higher coverage of essential care practices than home-delivered neonates: skin-to-skin care 76% vs. 9%, delayed bathing until 24 hours after birth 73% vs. 39%, proper cord care 89% vs. 65%, and first-hour initiation of breastfeeding 69% vs. 62% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEvidence from the 2016 and 2019 EDHS and community-based surveys indicated that initial skin-to-skin care and delayed bathing practices favored the better-off, proper cord care practices were equitable, while timely breastfeeding initiation showed no evidence of inequity. Thus, newborn care inequities in Ethiopia favor the better-off subgroups [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEquitable care is a priority for the Ethiopian Ministry of Health [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, equity analyses based on the nationally representative DHS are based on relatively long periods. The performance Monitoring for Action (PMA) survey 2019\u0026ndash;2020 had a short recall period with interviews performed seven weeks after birth [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Therefore, we aimed to investigate the wealth-based inequities in selected essential newborn care practices of Ethiopian infants born at health facilities and homes using absolute and relative equity measures [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eThe study was performed in five Ethiopian regions; Tigray, Afar, Amhara, Oromia, Southern Nations, Nationalities, and Peoples\u0026rsquo; (SNNP) regions, and Addis Ababa city administration [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The study sample represented 90% of the total population. In these regions, there is a population of 120\u0026nbsp;million, where of 80% live in rural areas [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Ethiopia has a three-tiered health system: 1) primary care consisting of health posts, health centers, and primary hospitals; 2) secondary care with general hospitals and specialty clinics; and 3) tertiary care with specialized hospitals [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData source and sampling\u003c/h2\u003e \u003cp\u003eThis study was based on secondary analysis of data from Performance Monitoring for Action (PMA) Ethiopia 2019\u0026ndash;2020. The details are published elsewhere [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Briefly, the study employed a two-stage cluster sampling with urban-rural settings and regions as strata. In total, 217 clusters or enumeration areas (EAs) were selected based on probability proportional to regions\u0026rsquo; population size, and 35 households in each EA were randomly selected. Pregnant women and postpartum women were invited to join the study. Interviews were made at around seven weeks after birth (median 7.4 weeks, interquartile range 6.9 weeks). Consenting women were interviewed using a questionnaire covering the women\u0026rsquo;s sociodemographic characteristics (age, education, region, religion, residence, and household wealth), parity, place of delivery, and newborn care practices performed by healthcare staff for a facility delivery, or by family members or other assistants for a home delivery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements\u003c/h2\u003e \u003cp\u003eThe selected outcome variables included thermal care (skin-to-skin care and delayed bathing), cord care practice, and breastfeeding initiation in the first hour. These practices were assessed based on WHO guidelines for essential newborn care as reported by the mother [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Skin-to-skin care was coded as \u0026ldquo;Yes\u0026rdquo; if the mother reported that the neonate was placed naked on her chest against her skin immediately after delivery and \u0026ldquo;No\u0026rdquo; otherwise. Delayed bathing was coded as \u0026ldquo;Yes\u0026rdquo; if the mother reported washing her newborn was postponed until at least 24 hours after delivery and \u0026ldquo;No\u0026rdquo; if otherwise. Proper cord care was coded \u0026ldquo;Yes\u0026rdquo; if the mother reported not applying anything or only chlorhexidine on the cord stump after cutting and \u0026ldquo;No\u0026rdquo; if otherwise. Timely initiation of breastfeeding was coded as \u0026ldquo;Yes\u0026rdquo; if the mother reported that she put the baby to her breast within an hour after birth and \u0026ldquo;No\u0026rdquo; if otherwise. The selected essential newborn care practices were stratified by delivery place, and household wealth. The wealth index of each household was constructed based on a principal component analysis of household assets, which was expressed as wealth quintiles, from 1\u0026thinsp;=\u0026thinsp;lowest to 5\u0026thinsp;=\u0026thinsp;highest. The wealth quintiles were used for the equiplots, equity gaps, and equity ratios, while the continuous wealth index was used for the concentration and slope indices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAnalyses\u003c/h2\u003e \u003cp\u003eParticipation was analysed and displayed in a study flow diagram. Characteristics of households, mothers and neonates were crosstabulated against place of delivery. The equity of the selected essential newborn care practices was calculated using four standard equity measures, separately for births at home and in health facilities: equiplot, equity gaps, equity ratios, and concentration indices [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Sampling weights were applied to assure the regional representativeness of the data, and clustering was accounted for in all analyses [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe equity of selected essential newborn care practices was illustrated using equiplots to show gaps across household wealth quintiles among neonates born at health facilities and homes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The equity gap is the absolute percentage point difference in service coverage between the extreme groups. In this case, the gap was calculated between the highest and lowest wealth quintiles. Similarly, the wealth equity ratio was calculated by dividing the essential newborn practice coverages between mothers in the highest household wealth quintile by the coverages among mothers in the lowest household wealth quintile.\u003c/p\u003e \u003cp\u003eThe concentration index shows the cumulative percentage of the population, ranked by household wealth as a continuous variable, against the cumulative percentage for each newborn care practice [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The concentration index will be zero if there is no socioeconomic-related inequity, negative if the essential newborn care practice is higher among those in the lowest household wealth, and positive if the newborn care practice is higher among mothers in the highest household wealth. The slope index of equity (SII) shows the cumulative percentage of inequity in the population, ranked by household wealth, against the cumulative percentage for each essential newborn care practice [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The slope index will be zero if there is no socioeconomic-related inequity, negative if the essential newborn care practice is higher among those in the lowest household wealth, and positive if the essential newborn care practice is higher among mothers in the highest household wealth. The concentration index (CIX) and slope index of equity (SII), including standard errors and p-values, were assessed using commands downloaded from the International Center for Equity in Health [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy participation\u003c/h2\u003e \u003cp\u003eA total of 32,792 women were assessed for eligibility. All women of reproductive age were evaluated for eligibility and those who were pregnant or within six weeks postpartum, permanent residents of the households, and consented to participate were included in the study. Of these, 2,581 women were eligible, of which we included 2,453 mothers (95%) who had 2,493 live births, including 40 twins (Fig.\u0026nbsp;1). More than half (53%) of the neonates were born at health facilities.\u003c/p\u003e \u003cp\u003eFigure 1 Study flow. PMA Ethiopia 2019\u0026ndash;2020.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic characteristics\u003c/h2\u003e \u003cp\u003eAlmost all (92%) urban women and less than half (43%) of the rural women delivered in health facilities (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Nine out of ten women from the highest wealth quintile and three out of ten in the lowest quintile delivered in health facilities. A higher proportion of younger women and those having their first baby delivered in health facilities. Most (85%) of the mothers who had a secondary education or higher gave birth at health facilities, whereas those with no formal education only 38% did so. The place of delivery was similar between boys and girls.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of mothers. PMA Ethiopia 2019\u0026ndash;2020 survey, weighted data.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePlace of delivery, % (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eHealth facility (N\u0026thinsp;=\u0026thinsp;1532)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eHome\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(N\u0026thinsp;=\u0026thinsp;961)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTigray\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70 (56, 82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (18, 44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (6, 40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83 (60, 94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (47, 67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43 (33, 53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOromia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e618\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (39, 60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51 (41, 61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSNNP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (37, 60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52 (40, 63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAddis Ababa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98 (95, 99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1, 6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92 (87, 96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (3, 17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (36, 49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57 (51, 64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eWealth quintiles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 Poorest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (22, 36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (64, 78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (32, 46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61 (54, 68)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (42, 58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50 (42, 58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (48, 68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (32, 52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 Least poor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94 (88, 97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (2, 15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (48, 67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43 (33, 52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (49, 61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45 (39, 51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (36, 52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (48, 64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (32, 44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62 (56, 68)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (48, 62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44 (38, 52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e646\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85 (79, 90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (10, 21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePrevious live births\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (70, 83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23 (17, 30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (50, 63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44 (37, 50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (30, 43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64 (57, 70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex of the baby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (47, 60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46 (40, 53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGirl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (47, 59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47 (41, 53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSNNP\u0026thinsp;=\u0026thinsp;Southern Nations, Nationalities, and Peoples\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eWealth-based equity in essential newborn care for facility births\u003c/h2\u003e \u003cp\u003eAmong facility-delivered neonates, 76% were put naked skin-to-skin on their mothers\u0026rsquo; breasts, 73% had delayed bathing at least until 24 hours after birth, 89% had proper cord care, and 69% got breastfeeding initiation during the first hour.\u003c/p\u003e \u003cp\u003eOverall, for babies born health facilities the equiplots for skin-to-skin care, delayed bathing until at least 24 hours after birth, proper cord care, and timely breastfeeding initiation showed minimal or no variation across the different household wealth quintiles (Fig.\u0026nbsp;2). When comparing the extreme wealth groups, there was tiny socio-economic differences in skin-to-skin care (difference = -1, ratio\u0026thinsp;=\u0026thinsp;1), delayed bathing (difference\u0026thinsp;=\u0026thinsp;5, ratio\u0026thinsp;=\u0026thinsp;1), proper cord care (difference\u0026thinsp;=\u0026thinsp;0, ratio\u0026thinsp;=\u0026thinsp;1), and timely breastfeeding initiation (difference\u0026thinsp;=\u0026thinsp;5, ratio\u0026thinsp;=\u0026thinsp;1) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Using household wealth as a continuous variable across all respondents, delayed bathing (SII\u0026thinsp;=\u0026thinsp;0.11, p-value\u0026thinsp;=\u0026thinsp;0.001 and concentration index\u0026thinsp;=\u0026thinsp;0.03, p-value\u0026thinsp;=\u0026thinsp;0.001), and proper cord care (SII\u0026thinsp;=\u0026thinsp;0.1, p-value\u0026thinsp;=\u0026thinsp;0.002 and concentration index\u0026thinsp;=\u0026thinsp;0.02, p-value\u0026thinsp;=\u0026thinsp;0.002) were slightly more common in infants from better-off households.\u003c/p\u003e \u003cp\u003eFigure 2 Wealth-based equity in skin-to-skin care, delayed bathing, proper cord care, and breastfeeding initiation among facility delivered neonates, PMA Ethiopia 2019\u0026ndash;2020 survey.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWealth-based equity in skin-to-skin care, delayed bathing, proper cord care, and breastfeeding initiation practices in facility-delivered neonates, PMA Ethiopia 2019\u0026ndash;2020 survey.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNewborn care practices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eQ1 %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eQ5 %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDifference (Q5-Q1; % points)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRatio (Q5:Q1) value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eSlope index of inequity/SII\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003eConcentration index/CIX\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCoefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCoefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkin-to-skin care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelayed bathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProper cord care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding initiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eQ1\u0026thinsp;=\u0026thinsp;Quintile 1, Q5\u0026thinsp;=\u0026thinsp;Quintile 5, SE\u0026thinsp;=\u0026thinsp;Standard error\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eWealth-based equity in essential newborn care for home births\u003c/h2\u003e \u003cp\u003eAmong home-delivered neonates, 9% were placed skin-to-skin, 39% had their bathing delayed for at least 24 hours, 65% got proper cord care, and 62% got timely breastfeeding initiation.\u003c/p\u003e \u003cp\u003eThe equiplots showed that skin-to-skin care, delayed bathing, proper cord care, and timely breastfeeding initiation differed across wealth groups with these practices being more common in the least poor groups (Fig.\u0026nbsp;3). The socioeconomic differences in proper cord care were minimal. When comparing the extreme groups, visible socio-economic inequities were reported in the practices of skin-to-skin care (difference\u0026thinsp;=\u0026thinsp;21, ratio\u0026thinsp;=\u0026thinsp;3) and delayed bathing (difference\u0026thinsp;=\u0026thinsp;25, ratio\u0026thinsp;=\u0026thinsp;2) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Using household wealth as a continuous variable, skin-to-skin care (SII\u0026thinsp;=\u0026thinsp;0.1, p-value\u0026thinsp;=\u0026thinsp;0.02 and concentration index\u0026thinsp;=\u0026thinsp;0.2, p-value\u0026thinsp;=\u0026thinsp;0.01), and delayed bathing (SII\u0026thinsp;=\u0026thinsp;0.12, p-value\u0026thinsp;=\u0026thinsp;0.02 and concentration index\u0026thinsp;=\u0026thinsp;0.1, p-value\u0026thinsp;=\u0026thinsp;0.03) were more common in the better-off households.\u003c/p\u003e \u003cp\u003eFigure 3 Wealth-based equity in skin-to-skin care, delayed bathing, proper cord care, and breastfeeding initiation among home-delivered neonates, PMA Ethiopia 2019\u0026ndash;2020 survey.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWealth-based equity in skin-to-skin care, delayed bathing, proper cord care, and breastfeeding initiation practices in home-delivered neonates, PMA Ethiopia 2019\u0026ndash;2020 survey.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNewborn care practices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eQ1 %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eQ5 %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDifference (Q5-Q1; % points)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRatio (Q5:Q1) value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eSlope index of inequity/SII\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003eConcentration index/CIX\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCoefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCoefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkin-to-skin care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelayed bathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProper cord care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding initiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eQ1\u0026thinsp;=\u0026thinsp;Quintile 1, Q5\u0026thinsp;=\u0026thinsp;Quintile 5, SE\u0026thinsp;=\u0026thinsp;Standard error\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOverall, the coverage of selected essential newborn care practices was higher in facility deliveries than in home births, where skin-to-skin care and delayed bathing practices were deficient. Almost all the women in the highest quintile and only three out of ten of those in the lowest quintile gave birth in a facility. There were minimal socio-economic differences in the care of infants born at health facilities, while inequities in skin-to-skin care and delayed bathing were prominent among those born at home.\u003c/p\u003e \u003cp\u003eAmong facility-born neonates, the coverage of selected essential newborn care practices, including early skin-to-skin care, delayed bathing, proper cord care, and timely breastfeeding initiation, was higher, although not optimal. We do not expect wealth-based inequities in newborn care for facility deliveries, given that providers are unlikely to provide services differently. Accordingly, skin-to-skin care and early initiation of breastfeeding were equitably distributed. On the other hand, there were tiny wealth-based inequities for delayed bathing and proper cord care, which are practices that may involve family members. Families usually leave the delivery facility before 24 hours after birth, and may wash the baby sooner than advised once at home [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Nevertheless, WHO recommends that all neonates receive all essential components of newborn care during and immediately after birth [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In facility deliveries, healthcare staff also need to inform families about keeping the baby warm and cord care when returning back home. Besides, health facilities should adhere to the WHO recommendation that mothers with newborns should remain in health facilities for at least 24 hours after birth [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor home births, the coverage of the selected essential newborn care practices was lower, and wealth-based inequities were prominent. Keeping the baby warm is essential for newborn survival and WHO recommends delaying bathing of the newborn baby until at least 24 hours after birth for optimal thermal care [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. We have previously reported that the low coverage of skin-to-skin care (9%) and delayed bathing (39%) among home deliveries neonates [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. For home deliveries, wealth-based inequities were evident for skin-to-skin care and delayed bathing favoring infants from better-off households. The high proportion of home deliveries (47%) in this study and low coverage of thermal care for home-delivered neonates and which was also less common among the poorest households implies that ensuring equitable and universal coverage of newborn care practices will be a challenge for Ethiopia. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Strengthening the health extension program to promote facility delivery, improving antenatal counseling and preparedness of home-delivering mothers is crucial to further enhance the coverage and equity of all essential newborn care practices. Furthermore, strong ANC counseling could make sure that families delay bathing irrespective of where they deliver.\u003c/p\u003e \u003cp\u003e Our analysis revealed that proper cord care practice was not optimal for home deliveries but was equitable. In contrast, wealth-based inequities in timely breastfeeding initiation were observed in home-delivered neonates favoring infants with the highest household wealth.\u003c/p\u003e \u003cp\u003eFacility birth is very important for improved and more equitable newborn care practices [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe have shown that home-born neonates had lower coverage of essential newborn care with wealth-based inequities. A published paper from the same study population has shown that 70% of pregnant women had at least one antenatal care (ANC) visit decreasing to 40% with four or more [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Thus, it is crucial to improve the quality of ANC, including birth preparedness, counseling pregnant women to deliver in a facility, and making them aware of all essential newborn care practices that need to take place at the facility and at home.\u003c/p\u003e \u003cp\u003eThe study participants were selected from five regions and one city administration, representing 90% of Ethiopia. The findings could be generalizable to the country. We used household wealth as a socio-economic stratifier to analyze the equity distribution of essential newborn care practices for infants born at health facilities and homes. Essential newborn care practices were assessed based on the information reported by mothers. They may have had difficulties remembering or noticing some of the care practices. However, to minimize recall bias, women were interviewed when the infant was around seven weeks old.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the coverage of selected essential newborn care practices was higher in facility deliveries. For home births, skin-to-skin care and delayed bathing practices were particularly low. Minimal socio-economic differences were found in facility deliveries, while inequities in skin-to-skin care and delayed bathing were visible in home deliveries. Therefore, it is important increasing facility deliveries and improving the discharge counseling of mothers, so they can continue to provide proper care for their newborn at home.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePMA Ethiopia received ethical approval from Addis Ababa University, College of Health Sciences (AAU/CHS) (Ref: AAUMF 01-008) and the Johns Hopkins University Bloomberg School of Public Health (JHSPH) Institutional Review Board (FWA00000287).\u0026nbsp;Written informed consent had been secured from the study participants, and assent was obtained from their partner or family member for those mothers whose ages were below 18 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe PMA dataset used in our analyses is open access and available at https://www.pmadata.org/countries/ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by the\u0026nbsp;Bill and Melinda Gates Foundation (INV-009691 and INV-010320). The funder had\u0026nbsp;no role in the design, data collection, analysis or interpretation of the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTGD, DB,\u0026nbsp;L\u0026Aring;P, KA, AD, TG, SL and SS contributed to the conceptualization of the study, crafting the research questions, protocol development and analysis plan. TGD analysed and interpreted the data and drafted the manuscript. TGD, L\u0026Aring;P, JS, KA, DB, AD, TG, GT, SL, AT, ZA, SS and MZ have substantially revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the Ethiopian Ministry of Health and Addis Ababa University staff for constructive discussions on setting priority research questions and character of the PMA data.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eMcarthur JW, Rasmussen K, Yamey G. How Many Lives are at Stake? Assessing 2030 Sustainable Development Goal Trajectories for Maternal and Child Health. BMJ. 2018;360:1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmj.k373\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePeven K, Mallick L, Taylor C, Bick D, Day LT, Kadzem L, Purssell E. 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BMC Pregnancy Childbirth. 2024;24:330. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12884-024-06536-6\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Essential newborn care, equity, household wealth, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-4501493/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4501493/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe World Health Organization has listed several newborn care practices as essential for health and survival. Reports from low-income countries, including Ethiopia, show inequities in practices but need more comprehensiveness. We aimed to analyze wealth-based equity of selected essential newborn care practices, i.e., skin-to-skin care, delayed bathing, proper cord care, and timely breastfeeding initiation among neonates born at health facilities and homes in Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe Performance Monitoring for Action Ethiopia 2019\u0026ndash;2020 survey was conducted in five Ethiopian regions, representing 90% of the total population. We used data on 2,493 newborns. Wealth quintiles were based on principal component analysis of household assets. Wealth-based equity of selected essential newborn care practices was analyzed separately for facility and home deliveries using equiplot, equity gaps, equity ratios, and concentration indices.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall, the equiplots for skin-to-skin care and delayed bathing practices showed minimal inequities for babies born in health facilities. When comparing the extreme groups, socio-economic differences were seen in delayed bathing and timely breastfeeding initiation. Using wealth as a continuous variable across all respondents, delayed bathing and proper cord care were more frequent in the better-off households. In home births, the equiplots showed that all selected essential newborn care practices were more common in the least poor groups. While comparing the extreme groups, socio-economic inequities were present in skin-to-skin care and delayed bathing practices. Using wealth as a continuous variable, skin-to-skin care and delayed bathing were more common in better-off households.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe coverage of selected essential newborn care practices was higher in facility deliveries. There were minimal socio-economic differences in newborn care of facility births, while inequities in skin-to-skin care and delayed bathing were prominent in home births. Initiatives should focus on increasing facility delivery and improving newborn care practices at home to ensure newborn care equity in Ethiopia.\u003c/p\u003e","manuscriptTitle":"Wealth-based equity in essential newborn care practices in Ethiopia: a cross-sectional study ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-25 20:27:14","doi":"10.21203/rs.3.rs-4501493/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"08849396-a415-462f-8bad-0b7237c4a38f","owner":[],"postedDate":"June 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-25T20:27:17+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-25 20:27:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4501493","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4501493","identity":"rs-4501493","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}