REGULAR ARTICLE Community neonatal practices and its association with skilled birth attendance in rural Haryana, India Ravi P Upadhyay, Sanjay K Rai, Krishnan Anand (kanandiyer@yahoo.com) Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India Keywords Domiciliary, Neonatal care, North India, Rural, Skilled birth attendant Correspondence Dr Krishnan Anand, Additional Professor, Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India Tel: +91-011-26594253 | Fax: 011-26589399 | Email: kanandiyer@yahoo.com Received 22 July 2012; revised 7 August 2012; accepted 16 August 2012. DOI:10.1111/j.1651-2227.2012.02833.x ABSTRACT Aim: The study aimed to document home-based neonatal care practices and their association with type of birth attendance. Methods: This study was conducted in rural Haryana on mothers who had delivered a live baby one to 2 months prior to interview. The study instrument, administered through home visits, had questions related to cord care, breastfeeding, thermal care, baby handling and healthcare seeking. Logistic regression was performed to test for association [OR; 95% CI] of key newborn care practices with skilled birth attendance. Results: Of the 415 mothers interviewed, 26.7% applied nothing on umbilicus; 15% were kept in skin-to-skin contact with mother; 20.2% were exclusively breastfed in first month. Seeking care in private sector and cost incurred in the treatment for a neonatal illness was significantly higher for male babies. Delivery by skilled birth attendant (68.5%) was associated with applying nothing on the cord [1.8; 1.01–3.25], in skin-to-skin contact with mother for ‡6 h a day [2.21; 1.18–4.13], bathing the baby after third day [14.63; 6.85–31.21] and exclusive breastfeeding [8.84; 3.42–22.8]. Conclusion: The results of this study call for not only upscaling skilled birth atten- dance but also improving the quality of care currently provided. INTRODUCTION The fourth Millennium Development Goal (MDG) target for child survival is to reduce under-5 child mortality by two-thirds by 2015, and a substantial reduction in the neo- natal deaths is crucial to meeting this goal (1). Each year in India, an estimated 0.9 million newborns die before they complete their first month of life (2,3). India’s neonatal mortality rate (NMR) dropped significantly, that is, by 25%, from 69 per 1000 live births in 1980 to 53 per 1000 live births in 1990 followed by a 15% decline from 51 to 44 per 1000 live births between 1991 and 2000 (3). From 2001 to 2009, the drop has been stagnant at just 15%. Based on modelling of limited empirical data, it has been suggested that 18–32% of neonatal mortality could be averted through high coverage of a package of preventive family and community neonatal care (4). A study from rural Haryana had showed that socio-economic and com- munity-level determinants were important in modifying neonatal outcomes (5). Further, studies in India have docu- mented the role of cultural beliefs in negatively influencing domiciliary newborn care practices (6–9). These studies highlight the importance of understanding domiciliary newborn care practices and working towards modifying harmful ones. Skilled attendance at birth is considered to be one of the most critical interventions for ensuring safe motherhood (10–12). It remains particularly low in sub-Saharan Africa and southern Asia (1). In India, nearly 27.0 million babies are born each year, of which around 53% of the deliveries take place at home, largely unattended by a skilled care pro- vider (13). Considering the fact that substantial reduction in neonatal mortality is essential for attaining Millennium Development Goal-4, it becomes important and imperative to understand the domiciliary newborn care practices and to document their association with the type of birth atten- dance. Key notes • Domiciliary newborn care practices are influenced by skilled birth attendance. • The potential of skilled birth attendance in changing newborn care practices needs to be exploited by better training of the attendee in counselling regarding new- born care. • While difference in healthcare seeking between sexes in Indian subcontinent is well documented, this is perhaps for the first time that this has been reported in the neo- natal period. Acta Pædiatrica ISSN 0803–5253 ª2012 The Author(s)/Acta Pædiatrica ª2012 Foundation Acta Pædiatrica 2012 101, pp. e535–e539 e535