Comprehensive and standard newborn care practices are critical interventions for reducing approximately two-thirds of neonatal deaths (1–3). Safe cord care and skin-to-skin contact between the mother and her baby immediately after birth are included as part of these interventions, and they benefit both maternal and infant health (1, 4).

Skin-to-skin contact, both psychologically and physiologically, is thought to be a “sensitive period” for determining future physiology and behavior. It is a non-pharmacological treatment for discomforts that involves the fulfillment of basic biological demands and is capable of inducing neurobehavioral changes (5–7). Standardization of these practices is crucial for the physiological and psychological wellbeing of mothers and infants (8). Proper newborn care, such as safe cord care and skin-to-skin contact, is especially important for the at-risk newborn in resource-limited settings (9). Among the benefits are the stimulation of breastfeeding patterns, the stabilization of the newborns' body temperature, and the improvement of bonding (10, 11), and decreasing the maternal depressive symptoms and physiological stress during the post-partum time are vital ones (12, 13).

Even though skin-to-skin contact between neonates and their mothers has numerous benefits for improving the baby's survival, it is being poorly practiced, particularly in resource-limited settings (14). According to studies, Ethiopia has a low SSC practice that ranges from 28.1 to 35.3% in different parts of the country (15, 16). Several studies reported that factors such as maternal education, number of ANC visits, the residence of the family, newborn birth weight, time of breastfeeding initiation after delivery, optimum breastfeeding content-wise, maternal knowledge status toward skin-to-skin contacts, maternal and infant benefits, preterm, Apgar score, route of delivery, the health status of the newborn, place of delivery, and late initiation of ANC follow-up affect the level of skin-to-skin practices (14–18).

A study found that only 46.9% of neonates had a safe cord practice (1). The safe cord care practice could be determined by factors such as maternal age, maternal educational level, sex of the delivered baby, place of delivery, awareness about hygienic safe cord care, source of knowledge about safe cord care, maternal occupation, and parity (2, 19, 20).

Despite the fact that safe cord care and skin-to-skin contact are important in reducing neonatal deaths, limited data revealed a lack of practice. Furthermore, the determinants of low implementation of these interventions in Ethiopia are not well-understood. Evidence also suggests that quantitative data on skin-to-skin contact (SSC) is extremely scarce in Sub-Saharan African countries and should be investigated. Thus, the purpose of this study was to determine the level of practice and determinants of safe cord care and skin-to-skin contact among post-partum women in public health facilities in Eastern Ethiopia.

Despite numerous benefits of CC and SSC, they are not widely practiced in Ethiopian health facilities; thus, this study aimed to investigate the level of practice and determinants of safe cord care and skin-to-skin contact care among post-partum women in public health facilities.

According to this study, 71.7% practice safe cord care (95% CI: 64.5, 81.7). This is consistent with studies conducted in Sidama, Ethiopia 73%) (28), four Ethiopian regions 65.2%, (29) and Nigeria 77.8% (30). While the findings of this study were higher than that of studies done in Ghana 35.7% (31). In contrast to this, it was lower than previous studies conducted in Nigeria 32.7% (22). This variation could be attributed to differences in sample size and socio-cultural differences among study participants. According to this study, the proportion of skin-to-skin contact care is 53.2% (95% CI: 43.6, 58.8). The findings of this study were consistent with previous studies conducted in Mekelle (43.9%) (32), Sidama, Ethiopia 52% (28), and rural Ethiopia (44.1%) (33). However, this study's findings were higher than those of studies conducted in southern Ethiopia 35.3% (25), four Ethiopian regions 25.8% (29), rural Ghana 10% (34), Gambia 35.7% (14), and Brazil 37.5% (35). The disparity may be due to differences in health facility setup, differences in maternal knowledge, differences in sociodemographic characteristics, and differences in sample size. Our study pointed out that mothers between the ages of 20 and 29 were 2.93 times more likely to practice safe cord care than mothers under the age of 19. The possible justification is that as people get older, their exposure to information grows, which increases the practice of clean cord care. In this study, mothers with a college education or higher were 1.83 times more likely to practice safe cord care than mothers with no formal education. This is in line with the findings of a study conducted in Ghana (31). The possible justification is that as mothers' educational status improves, so will their knowledge of the benefits of clean cord care, which will increase the practice of clean cord care.

When compared to respondents with poor knowledge levels, mothers with good knowledge were 11.3 times more likely to practice safe cord care. This finding is consistent with a study conducted in Nigeria (30). One possible explanation is that mothers who understand the importance of clean cord care (prevention of umbilical cord infection, rapid healing) will practice it. According to a systematic review and meta-analysis, most women applied substances to the cord to prevent infections or help the wound heal, but their practice was not clean, resulting in infection and neonatal death (36). As a result, it is critical to advise post-partum women to practice clean cord care.

This study also revealed that mothers between the ages of 20 and 29, 30–39, and over 40 were 11, 4, and 14 times more likely to practice skin-to-skin contact care than mothers under the age of 19. SSC care practice was 3.70 times more likely in multigravida mothers than in primigravida mothers. The possible justification is that as one's age and childbirth experience increase, so does the likelihood of receiving information about skin-to-skin contact, which in turn plays a pivotal role in enhancing skin-to-skin contact practice. In this study, mothers whose occupations were merchant and self-employed were 0.55 and 0.49 times less likely to practice SSC care, respectively, than mothers whose occupation was a housewife. This is because mothers who work as housewives have more time to access media and quality health care services, and they may be more aware of the benefits of skin-to-skin care practices, which in turn increases the likelihood of skin-to-skin contact practice. Another possible explanation is that because those housewives did not work, they spent most of their time with their newborns, which may have increased the practice of skin-to-skin contact.

The odds of SSC care practice among mothers who had a gestational age of 37–42 weeks at birth were 1.82 times that of mothers who had a gestational age of fewer than 37 weeks. This is due to the increased risk of preterm birth complications such as respiratory distress syndrome, Meconium aspiration syndrome, congenital anomalies, neonatal jaundice, and neonatal sepsis (28, 37–39). As a result, the newborn may be separated from mothers to receive treatments in the neonatal intensive care units, reducing the mother's time to practice skin-to-skin care.

Mothers with good knowledge levels were 3.19 times more likely to practice SSC care as compared to respondents with poor knowledge levels. The finding of the study is consistent with the study done in Gurage, south Ethiopia (16). The reason could be that mothers who have a good understanding of the benefits and drawbacks of skin-to-skin care are more likely to practice it.

The practicing level of safe cord care and skin-to-skin contact was high compared to other studies done in Ethiopia. In this study, the Age of mothers, marital status, occupational status, gestational age at birth, and knowledge of post-partum women on SSC and CC were significantly associated with skin-to-skin contact practice, whereas the age of mothers, educational status, and knowledge of post-partum women on SSC and CC were not significantly associated with SSC. To reduce neonatal mortality due to avoidable umbilical cord infections, clean cord care practice should be strengthened and intensified. Furthermore, skin-to-skin contact practice should be strengthened to enhance the survival of at-risk neonates.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

Ethical approval was taken from the Institutional Health Research Ethics Review Committee (IHRERC) of the College of Health and Medical Sciences of Haramaya University. Written informed consent to participate in this study was provided by the participants for those who are ≥ 18 years old and legal guardian/next kin for those <18 years old.

AE and TG conceived the idea and had major roles in the data review, drafting, and writing the result. AD, AA, AB, and YD contributed to data analysis, drafting, and manuscript preparation. All authors read and approved the final version of the manuscript to be published and agreed on all aspects of this work.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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