Section (1):-health care providers

Table (1):- Distribution of doctors in the labor room and pediatric section in the study according to gender and category

Item Gender Males Females Total Category Consultant Registrar Medical Total

Doctors in labor room Number % 55 46 101 30 61 10 101 54.5% 45.5% 100.0 29.7% 60.4% 9.9% 100.0

Doctors in pediatric section Number % 43 64 107 30 54 23 107 40.2% 59.8% 100.0 28.0% 50.5% 21.5% 100.0

In the labor room male doctors (54.5%) are more than females (45.5%). In the pediatric

section females (59.8%) are more than males.

Table (1-2):- Provides Information about Training Courses in Neonatal Resuscitation Programmed (NRP) and Years of Experience Item Doctors in LR Number % Training courses in NRP taken During Formal Training: 17 16.8% Undergraduate After Graduation 46 45.5% No Training 38 37.6% Total 101 100.0 The Number of NRP Courses Attended 13 76.5 1 Course 3 17.6 2 Courses 1 5.9 3 Courses 4 Courses Total Last Course Attended 7 41.2 1 Year Ago Doctors in Ped. Number % 13 48 46 107 8 1 1 1 12.1 44.9 43.0 100 61.5 7.7 7.7 7.7 Sisters Number 5 8 34 47 1 2 1 1 % 10.6 17.1 72.3 100 20.0 40.0 20.0 20.0 Midwives Number % 31 16 47 11 10 6 2 66 34 100 35.5 32.2 19.4 6.5

23.1

20.0

4 23.5 2 Years Ago 2 11.8 3 Years Ago More than 3 Years 4 23.5 Total Years of Experience After Graduation 41 41.0 Less than 5 Years 43 12.5 5 10 Years 8 8.0 10 15 Years More than 15 Years 8 8.0 Total

3 3 4

23.1 23.1 30.8

1 -

20.0 60.0

46 41 12 6

43.4 38.7 11.3 6.6

41 6 1 -

85.4 12.5 2.10 -

3 12 12 20

6.4 25.5 25.5 42.6

Most of the training for doctors in labour room (45.5%) and doctors in paediatrics (44.9%) occurred after graduation, while most sisters and midwives had no training. Most of the training courses taken by the staff were one course and the last course being one year to 3 years ago.

Knowledge of midwives Overall knowledge of midwives The mean level of knowledge = 48.9 Minimum = 12.2 SD= 20.1

Maximum = 95.9

Knowledge about infection control

Poor (less than 25) Less than average (25 50) Above average (50 75) High ( more than 75) Total
1 4 2 40 2.1 8.5 4.3 85.1

47

100.0

Knowledge about follow up fetus and help neonate

Poor

(less than 25)

17.0

Less than average (25 50) Above average (50 75) High ( more than 75) Total

17 17 5

36.2 36.2 10.6

47

100.0

Overall knowledge about infection control, follow up for fetus and sick neonate management among midwives Mean Std. deviation Minimum Maximum infection control 90.7801 23.77646 .00 100.00 follow up for fetus 45.7447 19.86205 10.87 95.65 sick neonate management
50.4965 12.25689 20.00 66.67

Overall knowledge of midwives (in groups of knowledge) Level of knowledge Poor (less than 25) Less than average (25 50) Above average (50 75) High ( more than 75) Total Number 6 18 17 6 47 % 12.8 38.3 36.2 12.8 100.0

Relationship between overall knowledge of midwives and type of job

Type of job Health visitor Nurse midwife 33.3% 66.7% 50.0% 50.0% 23.5% 76.5% 16.7% 66.7% p value = .115 Sister .0% .0% .0% 16.7%

Poor (less than 25) Less than average (25 50) Above average (50 75) High ( more than 75) Chi-Square = 10.245

There was no significant relationship between overall knowledge of midwives and type of job

Relationship between overall knowledge of midwives and years of experience

Less than 5 .0% .0% 11.8% 16.7% p= .626 Years of experience 5 - 10 11 15 50.0% 16.7% 22.2% 27.8% 17.6% 23.5% 33.3% 33.3% More than 15 33.3% 50.0% 47.1% 16.7%

Poor (less than 25) Less than average (25 50) Above average (50 75) High ( more than 75) Chi-Square = 7.109

There was no significant relationship between overall knowledge of midwives and years of experience

Relationship between overall knowledge of midwives and having training courses

Having training courses Yes No 83.3% 44.4% 76.5% 83.3% p value = .104

Poor (less than 25) Less than average (25 50) Above average (50 75) High ( more than 75) Chi-Square = 6.161

16.7% 55.6% 23.5% 16.7%

There was no significant relationship between overall knowledge of midwives and having training courses

Knowledge of sisters
Knowledge about infection control

Grades of knowledge
Poor (less than 25) Less than average (25 50) Above average (50 75) Missing Total

Number
13 20 14 1 48

%
27.1 41.7 29.2 2.1 100.0

Sick neonate management

Grades of knowledge
Poor (less than 25) Less than average (25 50) Above average (50 75) Missing Total

Number
2 13 32 1 48

%
4.2 27.1 66.7 2.1 100.0

Over all knowledge

Grades of knowledge
Poor (less than 25) Less than average (25 50) Above average (50 75) Missing Total

Number
4 23 20 1 48

%
8.3 47.9 41.7 2.1 100.0

Overall ideal attitude

Grades of knowledge
Poor (less than 25) Less than average (25 50) Above average (50 75) Total

Number
11 36 1 48

%
22.9 75.0 2.1 100.0

Relationship between overall ideal attitudes and over all knowledge over all ideal attitude over all knowledge Less than 25 25 - 50 Poor (less than 25) 9.1% 45.5% Less than average (25 50) 8.6% 51.4% Above average (50 75) .0% .0% Chi-Square= 1.502 p value = .826

50 - 75 45.5% 40.0% 100.0%

There was no significant relationship between overall ideal attitudes and over all knowledge

Knowledge of Doctor in pediatric

Statistics Mean Std. Deviation Minimum Maximum Infection 20.3774 19.51432 .00 60.00 Sick neonate managen 53.7107 22.28873 .00 100.00

Knowledge about infection control

Grades of knowledge
Poor (less than 25) Less than average (25 50) Above average (50 75) Missing Total

Number
67 33 6 1 107

%
62.6 30.8 5.6 .9 100.0

Sick neonate management

Grades of knowledge
Poor (less than 25) Less than average (25 50) Above average (50 75) Missing Total

Number
11 19 65 1 107

%
10.3 17.8 60.7 .9 100.0

Over all knowledge

Grades of knowledge
Poor (less than 25) Less than average (25 50) Above average (50 75) Missing Total

Number
13 37 46 1 107

%
12.1 34.6 43.0 .9 100.0

Overall ideal attitude

Grades
Poor (less than 25) Less than average (25 50) Above average (50 75)

Number
57 49 1

%
53.3 45.8 .9

Total

107

100.0

Relationship between overall ideal attitudes and over all knowledge over all ideal attitude over all knowledge Less than 25 25 - 50 50 - 75 Higher than 75 7.1% Poor (less than 25) 16.1% 32.1% 44.6% 12.2% Less than average (25 8.2% 36.7% 42.9% 50) .0% 100.0% .0% .0% Above average (50 75) Chi-Square= 4.113 p value = .661

There was no significant relationship between overall ideal attitudes and over all knowledge

Knowledge of Doctor in labour room

Knowledge about infection control

Grades of knowledge
Poor (less than 25) Less than average (25 50) Above average (50 75) Higher than 75 Missing Total

Number
33 32 30 3 3 101

%
32.7 31.7 29.7 3.0 3.0 100.0

Knowledge about how to follow up the fetus

Grades of knowledge
Poor (less than 25) Less than average (25 50) Above average (50 75) Higher than 75 Missing Total

Number
5 3 85 5 3 101

%
5.0 3.0 84.2 5.0 3.0 100.0

Knowledge about how to help neonate

Grades of knowledge
Poor (less than 25) Less than average (25 50) Above average (50 75) Higher than 75 Missing Total

Number 20 8 66 4 3 101

% 19.8 7.9 65.3 4.0 3.0 100.0

Over all knowledge

Grades of knowledge
Poor (less than 25) Less than average (25 50) Above average (50 75) Higher than 75 Missing Total Over all ideal attitude

Number
11 35 48 4 3

%
10.9 34.7 47.5 4.0 3.0

101

100.0

Grades
Poor (less than 25) Less than average (25 50) Above average (50 75) Total

Number
47 52 2

%
46.5 51.5 2.0

101

100.0

Relationship between overall ideal attitudes and over all knowledge over all ideal attitude over all knowledge Less than 25 25 - 50 50 - 75 Poor (less than 25) 15.2% 28.3% 50.0% Less than average (25 8.0% 44.0% 46.0% 50) Above average (50 75) .0% .0% 100.0% Chi-Square= 6.179 p value = .403

Higher than 75 6.5% 2.0% .0%

Knowledge about guidelines among care providers

Care provider Sisters doctors in labor room doctors in pediatric section Mean 77.6042 56.4356 49.2991 SD 39.69283 41.02643 44.30516 Minimum .00 .00 .00 Maximum 100.00 100.00 100.00

Section (2): Availability of resources, infrastructures and instruments

Presence of intensive care unit and neonatal care unit in the hospital (n=15) Presence intensive care unit neonatal care unit Number % Number % Yes 7 46.7 14 93.3 No 8 53.3 1 6.7 Total 15 100 15 100 Intensive care unit is present in46.7% of the hospitals, while the neonatal care unit is present in 93.3%

Different types of neonatal care units that are present in the hospitals studied Different types Preterm section Term Septic Total Number 5 4 6 15 % 33.3 26.7 46.7 100

Position of the neonatal care unit (Nursery) in the hospital Position Number Near to delivery Far away from delivery room No connection with accessory area for sterillization accessory room for mpthers feeding accessory recreative rooms for staff

% 9 1 1 11 10 10 60.0 6.7 6.7 73.3 66.7 66.7

Availability of electricity, water and controlled environment in the hospitals studied Items Yes available % (No.) electricity continuously 13 86.7 back-up power supply in the case of a power cut 14 93.3 running water continuously available 13 86.7 controlled environment 11 73.3

Availability of infrastructures related to delivery room (n= 15) infrastructures related to delivery room Presence of a theatre Presence of delivery room Availability of electricity Backup power supply Availability of continuous running water Presence of a controlled environment No. 12 12 10 13 11 10 % 80.0 80.0 66.7 86.7 73.3 66.7

Laboratory Support Lab Support BLOOD GLUCOSE HAEMOGLOBIN HEAMATOCRIT IMMATURE TO TOTAL NEUTROPHIL RATIO FULL BLOOD COUNT LEUKOCYTES COUNT BLOOD GASES ANALYSIS BLOOD GROUPING AND CROSS MATCH BLOOD BILIRUBIN RHESUS ANTIBODIES URINE PROTINE Frequency (%) 15 (100%) 15 (100%) 15 (100%) 13 (86.7%) 15 (100%) 15 (100%) 6 (40%) 15 (100%) 15 (100%) 15 (100%) 15 (100%)

URINE MICROSCOPY BACTERIOLOGY - CLUTURE BACTERIOSCOPY -SMEARCOAGULATION TESTS LIVER FUNCTION RENAL FUNCTION TESTS ELECTROOLYTES HIV TEST COOMBS TEST DIRECT AND INDIRECT MAJOR BLOOD GROUPS AND RH TYPING SERUM PROTIEN AND ALBUMIN URINALYSIS SEROLIGIC TEST FOR SYPHILIS

15 (100%) 12 (80%) 10 (71.4%) 12 (80%) 15 (100%) 15 (100%) 14 (93.3%) 15 (100%) 13 (92.9%) 14 (100%) 14 (100%) 13 (92.9%) 13 (92.9%)

Table (2-2):Delivery and Newborn Tests Frequency (%) ARE MICRO-SAMPLING METHODS FOR 10 (66.7%) GLYCAEMIA, BILIRUBINEMA, HB AVAILABLE FOR NEW-BORN BABIES? ESSENTIAL TEST FOR DELIVERY AND 13 (86.7%) NEWBORN CARE ARE FREE FORM CHARGE?

):- Drugs Supply

Table (3-1):- Antibiotics, antiviral and antifungal Drugs

Drug

Frequency (%) ACYCLOVIR 9 (60.0%) AMIKACIN 7 (46.7%) AMPHOTERICIN B 6 (40.0%) AMPCILIN 9 (60.0%) CEFOTAXIME 12 (80.0%) CEFOTAZIDIME 12 (80.8%) CEFRIAXONE 13 (86.7%) ERYTHROMYCINE 14 (93.3%)

FLUCONAZOL GENTAMICIN METRONIDZOL NTILMICIN VANCOMICYN

10 (66.7%) 15 (100.0%) 15 (100.0%) 5 (33.3%) 11 (73.3%)

Table (3-2):- Cardiovascular Drugs

Drug

ALPROSTADIL ADENOSINE CAPTOPRIL DIGOXIN DOBUTAMIN DOPAMINE ENOXAPARIN EPINEPHRINE FLECAINIDE IBUPROFEN LYSIB\NE INDOMETHACIN 6 (40.0%) LIDOCAINE OR 12 (80.0%) ANTIARRHYTHMIC PROPAOLOLO 11 (73.3%)
Table (3-3):- Central Nerves System Drugs

Frequency (%) 7 (46.7%) 6 (40.0%) 10 (66.7%) 11 (73.3%) 8 (53.3%) 14 (93.3%) 7 (46.7%) 13 (86.7%) 7 (46.7%) 10 (66.7%)

Drug CHLORAL HYDRATE

Frequency (%) 2 (13.3%)

FENTANY 1 MIDAZOLAM MORPHINE NALOXONE PHENOBRABITAL PHENYTOIN

Table (3-4):- Diuretics

2 (13.3%) 6 (40.0%) 10 (66.7%) 8 (53.3%) 11 (73.3%) 14 (93.3%)

Name FUROSEMIDE HYDROCHLOOROTHIAZIDE SPIRONOLACTONE

Frequency (%) 15 (100.0%) 9 (60.0%) 11 (73.3%)

Table (3-5):- Respiratory Drugs

Drug AMINOPHLLINE CAFFIENE DEXAMETHASONE SURFACATANTS

Frequency (%) 15 (100.0%) 4 (26.7%) 14 (93.3%) 7 (46.7%)

Table (3-6):- Miscellaneous Drugs

Drug G-GLOULINE PROTOCL

Frequency (%) 4 (26.7%)

HYDROCORTISONE 11 (73.3%) INSULINE ISTONIC CRYSTALLOID 14 (93.3%) 14 (93.3%)

Table (3-7):- Vitamins and Minerals

Drug CALCIUM CLACIUM GLUCONTE FERROUS SULFFATE POTASSIUM SODIUM CHLORIDE VITAMIN K . Equipments -1-

Frequency 13 (86.7%) 13 (86.7%) 13 (86.7%) 14 (93.3%) 14 (93.3%) 13 (86.7%)

Table (4-1):- Illustrate the present of essential equipments in labour room and nursery

Adequate lighting Wall clock Towels for drying newborn Normal Thermometer Low reading thermometer Weight Scale for Newborns Radiant Warmer Phototherapy Lamps Incubator

Labour Room (%) 11 (91.7%) 8 (66.7%) 9 (75.0%) 9 (75.0%) 12(100%) 9 (75.0%) 6 (50.0%) 7 (58.3%) 0%

Nursery (%) 14 (100%) 10 (71.4%) 13 (92.9%) 13 (92.9%) 13 (92.9%) 12 (85.7%) 10 (71.4%) 13 (92.9%) 14 (100%)

CPAP Systems Mechanical ventilator Saturometer/Pulse-Oximeter Glucometer Transport Incubator with Ventilation System

2 (16.7%) 1 (8.3%) 6 (50.0%) 4 (33.3%) 1(8.3%)

4 (28.6%) 5 (35.7%) 12 (85.7%) 13(92.9%) 3 (21.4%)

Table (4-2):- Illustrate the present of guidelines in labour room and nursery

Infection Control Guidelines Guidelines for Management of Pre-Term Neonate Guidelines for Resuscitation and Care of the Newborn Guidelines for Management of Sick Newborn Guidelines for Management of Low Birth Weight

Labour Room (%) 4 (33.3%) 2 (16.7%) 6 (50.0%) 2 (16.7%) 3 (25.0%)

Nursery (%) 6 (42.9%) 6 (42.9%) 7 (50.0%) 7 (50.0 %) 7 (50.0%)

Table (4-3):- ):- Illustrate the present of equipments of oxygen supply in labour room and nursery Labour Room (%) Oxygen source: Oxygen Cylinder Oxygen Source: Oxygen Concentrator Oxygen Source: Oxygen Central Supply Flow Meters for Oxygen Equipment for the Administration of Oxygen Nasal Prong Equipment for the Administration of Oxygen Catheters Equipment for the Administration of Oxygen Masks Medical Air Centralized 10 (82.3%) 4 (33.3%) 3 (25.0%) 5 (41.7%) 9 (75.0%) 6 (50.0%) 7 (58.3%) 6 (50.0%) Nursery (%) 13 (92.9%) 6 (42.9%) 6 (42.9%) 8 (57.1%) 13 (92.9%) 8 (57.1%) 9 (64.3%) 12 (85.7%)

Table (4-4):- Illustrate the present of essential infection control equipment and supply in labour room and nursery

Sterilization Sterile Gauze Infusion Sets Syringes Suturing Set Sterile Gloves Station for hand washing

Labour Room (%) 11 (91.7%) 11 (91.7%) 8 (66.7%) 10 (83.3%) 9 (75.0%) 11 (91.7%) 10 (83.3%)

Nursery (%) 13 (92.9%) 14 (100%) 13 (92.9%) 14 (100%) 13 (92.9%) 14 (100%) 13 (92.9%)

Table (4-5):- Illustrate the present of other equipment and material in labour room and nursery Labour Room (%) 9 (75.0%) 11 (91.7%) 11 (91.7%) 9 (75.0%) 10 (83.3%) 10 (83.3%) 10 (83.3%) 9 (75.0%) 3 (25.0%) 3 (16.7%) 5 (41.7%) 9 (75.0%) 8 (66.7%) Nursery (%) 0% 0% 0% 0% 11 (78.6%) 10 (71.4%) 9 (64.3%) 9 (64.3%) 8 (57.1%) 6 (42.9%) 8 (57.1%) 10 (71.4%) 0%

Cord Cutting/Cord Clamping Set Vacuum Extractor Venture Forceps Delivery beds Suction Device Face Masks Resuscitation Bags Breathing Valves Tracheal Tubes Laryngoscope with Tow Blades Oropharyngeal Airways Sphygmomanometer Foetal Stethoscope

Equipment -2Presence of labour rooms and nurseries

Frequency labour room nursery Total 12 14 26

Percent 46.2 53.8 100.0

Labor rooms n = 12,

nurseries n= 14

):- Illustrate the present of essential equipments in labour room and nursery

Item adequate lighting refrigerator with thermometer wall thermometer wall clock heat source towels for drying newborn heating lamp for neonates station for hand washing disposal container for sharps only normal thermometer weight scale for new born sphygmomanometer fetal stethoscope phototherapy lamp

labor room nursery available no. available % available no. available % 11 91.7 14 100.0 7 58.3 12 85.7 6 50.0 9 64.3 8 66.7 10 71.4 8 66.7 13 92.9 9 75.0 13 92.9 9 75.0 13 92.9 10 83.3 13 92.9 11 91.7 13 92.9 9 75.0 13 92.9 9 75.0 12 85.7 9 75.0 10 71.4 8 66.7 0 0 8 66.7 14 100.0

Illustrate the present of guidelines in labour room and nursery

Items

infection control guidelines guidelines for management of pre-term neonate guidelines for resuscitation and care of the newborn guidelines for management of low birth guidelines for management of sick newborn

labor room nursery available available % available no. available % no. 4 33.3 6 42.9 2 6 3 2 16.7 50.0 25.0 16.7 6 7 7 7 42.9 50.0 50.0 50.0

Illustrate the present of equipments of oxygen supply in labour room and nursery

Items available no. oxygen source ,oxygen cylinder oxygen source ,oxygen concentrator oxygen source ,oxygen central supply flow meters for oxygen equipment for the administration of oxygen nasal prong equipment for the administration of oxygen catheters equipment for the administration of oxygen masks 10 4 3 5 9 6 7

labor room nursery available % available no. available % 83.3 13 92.9 33.3 6 42.9 25.0 6 42.9 41.7 8 57.1 75.0 50.0 58.3 13 8 9 92.9 57.1 64.3

Illustrate the present of essential infection control equipment and supply in labour room and nursery

Items

labor room available no.

available % 11 11 8 8 9 10 10 9 11 2 10 10 8 9 10 91.7 91.7 66.7 66.7 75.0 83.3 83.3 75.0 91.7 16.7 83.3 83.3 66.7 75.0 83.3

nursery available no.

available %

sterilization sterile gauze infusion sets infusion pumps/dosimeter iv catheters syringes needles suturing set sterile gloves resterilized gloves disposable gloves sturing material catgut synthetic absorbable non absorbable

13 14 13 13 12 14 14 13 14 3 14 8 7 8

92.9 100.0 92.9 92.9 85.7 100.0 100.0 92.9 100.0 21.4 100.0 57.1 50.0 57.1

Illustrate the present of other equipment and material in labour room and nursery labor room available no. balance for baby cord cutting /cord clamping set vacuum exertactor venture forceps 8 9 11 11 nursery available no. 8 0 0 0

available % 66.7 75.0 91.7 91.7

available % 57.1 0 0 0

face masks resuscitation bags breathing vavles tracheal tubes laryngoscope with tow blades oropharyngleal airways blood pressure-cuffs heated mattresses coats radiiant warmer incubrator beds functional regular dellivery bed suction device

labor room nursery available available % available available no. no. % 10 83.3 10 83.3 10 83.3 9 64.3 9 75.0 9 64.3 3 25.0 8 57.1 2 16.7 6 42.9 5 41.7 8 57.1 8 66.7 9 64.3 2 16.7 8 57.1 6 50.0 10 71.4 8 66.7 14 100.0 6 50.0 4 28.6 11 91.7 7 50.0 11 91.7 8 57.1 9 75.0 14 100.0 10 83.3 11 78.6

Items

photoltherapy lamps medical air centerlized oxygen air compressors cpap systems mechanical

labor room nursery available available available available no. % no. % 7 58.3 13 92.9 6 50.0 12 85.7 6 50.0 12 85.7 4 33.3 10 71.4 2 16.7 4 28.6 1 8.3 5 35.7

hfov ventilator multi-function mpnitor saturimeter/pulse-oximeter infusion pumps eco-sonography dedicated x-ray glucometre bilirubinometre hemogasesanalyser transport incubator with ventilationsystem availability of lab investigation on mini blood sample

12 12 6 3 1 1 4 1 12 1 3

100.0 100.0 50.0 25.0 8.3 8.3 33.3 8.3 100.0 8.3 25.0

1 4 12 10 1 1 13 3 2 7 10

7.1 28.6 85.7 71.4 7.1 7.1 92.9 21.4 14.3 50.0 71.4

Section (3): Questionnaire of mothers

Age of mothers Mean age = 27.7 years Minimum = 15.0 years Maximum = 45 years SD = 5.8 years

Residence of mothers Residence Rural Urban Total

Number 54 173 227

% 23.8 76.2 100.0

Occupation of mothers Occupation Midwife Professional Worker Others Total

Number 147 58 20 2 227

% 64.8 25.6 8.8 .9 100.0

Education level of mothers Education level Illiterate Primary/Basic Secondary University Total Number 73 29 56 69 227 % 32.2 12.8 24.7 30.4 100.0

Method of being referred to the hospital Method Referred by a health worker Coming directly (by her own) Total Number 72 155 227 % 31.7 68.3 100.0

Level (place) of referral Level Public health center Private clinic Total

Number 71 1 72

% 98.6 1.4 100.0

Satisfaction of respondents about specific items Items Cleanliness and ventilation of waiting place Space of the waiting place Nursing staff Enough time given to you discussing the case of your child with the doctor Cost of doing analysis Quality of investigations Availability of drugs Cost of drugs Satisfied 211(93.0%) 209 (92.1%) 217 (95.6%) 214 (94.3%) 198 (87.2%) 217 (95.6%) 208 (91.6%) 188 (82.8%) Average satisfaction 10 (4.4%) 10 (4.4%) 6(2.6%) 5 (2.2%) 16 (7.0%) 9 (4.0%) 13 (5.7%) 29 (12.8%) Not satisfied 6(2.6%) 8 (3.5%) 4 (1.8%) 8 (3.5%) 13 (5.7%) 1 (0.4%) 6 (2.6%) 10 (4.4%)

Overall satisfaction

Level of satisfaction Very satisfied Satisfied Somehow satisfied Not satisfied

Scores of satisfaction
26 26 10 6

Per cent (%)

11.5 11.5 4.4 2.6

Relationship between satisfaction and residence Residence Rural Urban Level of satisfaction Not satisfied Somehow satisfied Satisfied Very satisfied 9.3% 11.1% 9.3% 70.4% .6% 2.3% 12.2% 84.9% p value = .000

Chi-Square = 20.200

Relationship between satisfaction and occupation Occupation Housewife Professional Worker Others Level of satisfaction Not satisfied Somehow satisfied Satisfied Very satisfied 4.1% 6.1% 15.6% 74.1% .0% .0% 3.4% 96.6% .0% 5.0% .0% 95.0% .0% .0% 50.0% 50.0%

Chi-Square = 20.572

p value =.015

Relationship between satisfaction and education level education level Level of satisfaction Not satisfied Somehow satisfied Satisfied Very satisfied Illiterate 1.4% 4.1% 13.7% 80.8% Primary/ Basic 10.3% 10.3% 20.7% 58.6% Secondary 1.8% 5.4% 7.1% 85.7% University 1.4% 1.4% 8.7% 88.4% Chi-Square = 17.545 p value =.041

Summary of results of in-depth interview of staff Labor room

Most labor rooms in the hospitals have local guidelines (for management of normal labor, obstructed labor, infection control, management of preterm babies, low birth and sick neonates). Some hospitals have no guidelines for the above items. In most of the cases the staff depends on the local guidelines or the clinical experience for management of the above conditions. In almost all hospitals there is no essential drug list for neonatal conditions. In almost all hospitals there are discharge and referral clinics (weekly). Intervention for managing neonates is done mostly through general routine work. Performance of doctors and midwives is assessed in the labour room through inspection and follow up of their work. Pediatricians are called when there is problem or emergency. The main problems facing effective diagnosis and management of neonates in labor room are shortage of staff and equipment.

Neonatal unit
Most of the neonatal units have no protocols and guidelines for infection control, management of preterm babies, low birth and sick neonates. Some have got local and others international guidelines for the above items. In most of the cases the staff depends the clinical experience for management of the above conditions.

In almost all hospitals there is no essential drug list for neonatal conditions. Some of the hospitals have discharge and referral clinics (weekly). Some also hold clinical meetings weekly or monthly. Intervention for managing neonates is done mostly through general routine work. Performance of doctors and sistersis assessed through inspection and follow up of their work in the section. The main problems facing effective diagnosis and management of neonates are shortage of staff and equipment.