Coverage and factors associated with receipt of early newborn postnatal care components in Afghanistan: findings from the 2022–2023 multiple indicator cluster survey

Abstract

BACKGROUND: Neonatal mortality remains high in low‑ and middle‑income countries, where early postnatal care (PNC) within 48 hours can avert many deaths. Yet neither the national coverage of newborn PNC nor the factors associated with its receipt have been assessed. OBJECTIVES: We assessed the coverage of newborn PNC components and the factors associated with their receipt in Afghanistan. METHODS: We conducted a cross‑sectional analysis of 11,965 mother-infant dyads from the 2022-2023 Afghanistan Multiple Indicator Cluster Survey. The outcome was coded 'yes' if the infant received at least two of the following six newborn PNC components within 2 days of birth: temperature measurement, weighing, cord examination, breastfeeding counseling, observation of breastfeeding, and counseling on danger signs. We fitted a multivariable logistic regression model to identify factors associated with the outcome. RESULTS: Only 41.0% of infants received ≥2 components; merely 1.9% received all six components of PNC. The odds of receiving ≥2 components of PNC were higher among infants whose households had an educated head, whose mothers attended 1-3 or ≥4 antenatal care (ANC) visits, those born in private and public health facilities, and those delivered by cesarean section. Infants in higher wealth quintiles also had progressively greater odds. Conversely, infants perceived as small at birth had lower odds of receiving ≥2 PNC components. CONCLUSION: Four out of ten newborns received ≥2 components of PNC, with marked inequities by head of household education, ANC use, delivery setting, and wealth status. Targeted interventions addressing these inequalities are urgently needed to strengthen early newborn PNC.