Exploring newborn care practices at facility and home in urban Dhaka, Bangladesh

Abstract

Background: Neonatal mortality remains a major global public health concern, with approximately 2.3 million newborn deaths occurring during the first month of life in 2024, many of which were preventable through timely and appropriate Essential Newborn Care (ENC). Recommended ENC practices, including thermal care, early initiation of breastfeeding, hygienic cord care, skin-to-skin contact, and early recognition of danger signs, are crucial for reducing neonatal morbidity and mortality. Despite progress in maternal and child health in Bangladesh, neonatal morbidity and mortality remain high, particularly in urban areas where rapid urbanization, overcrowding, socio-economic disparities, and gaps in newborn care practices continue to affect newborn survival. Limited qualitative evidence exists on caregivers’ knowledge, perceptions, practices, and health system factors influencing newborn care in urban settings, highlighting the need for context-specific research to improve newborn health outcomes.

Objectives: The study aimed to explore comprehensive newborn care practices from health facilities to the community level in urban Dhaka by examining community and health system factors influencing newborn care. Specifically, the study explored mothers’ knowledge, perceptions, and practices regarding essential newborn care and identified and explained the factors influencing newborn care practices in both health facility and home settings.

Methods: A qualitative study using a focused ethnography design was conducted from January to April 2026 in the Maternal and Child Health Training Institute (MCHTI), Azimpur, and the Kamrangirchar urban slum area in Dhaka, Bangladesh. The study population included hospital-delivered mothers, community women, family caregivers, healthcare providers, and health managers involved in newborn care. Purposive sampling was used to recruit participants who could provide in-depth information on newborn care practices and experiences. A total of 66 participants and observations were included, comprising 20 in-depth interviews (IDIs), 2 focus group discussions (FGDs), 6 key informant interviews (KIIs), and 20 non-participant observations. Data were collected using semi-structured interview guides and observation checklists. All interviews and discussions were audio-recorded, transcribed, and translated into English, and observation notes were elaborated on the same day and finally analyzed manually using thematic analysis. Both deductive and inductive coding approaches were applied to identify key themes and patterns. Data triangulation across IDIs, FGDs, KIIs, and observations enhanced the credibility and validity of the findings.

Results: Findings showed that mothers had fragmented and limited knowledge regarding cord care, thermal care, breastfeeding, immunization, and newborn danger signs, with many depending on healthcare providers and family members for guidance. Early breastfeeding, skin-to-skin contact, and recommended cord care practices were inconsistently practiced, while traditional beliefs and socio-cultural influences continued to shape newborn care behaviours, particularly in home settings. Observational findings also revealed gaps between reported guideline-based care and actual practices in health facilities, where informal staff often managed immediate newborn care. Health system barriers, including shortages of trained staff, medicines, equipment, and inadequate infrastructure, further affected the quality of newborn care services. Despite these challenges, mothers expressed positive attitudes toward facility delivery and a strong interest in receiving more counselling and guidance on newborn care. Healthcare providers also emphasised the need for improved training, adequate staffing, better logistics, and strengthened neonatal care services, including NICU support.

Conclusions: Mothers valued newborn care but had limited knowledge of essential newborn care practices. Socio-cultural beliefs and health system barriers, including shortages of trained staff and resources, affected proper newborn care. Improving and strengthening neonatal healthcare services reinforced by quality and community-based care are essential to achieving better newborn health outcomes.