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Each day almost 500 newborns die in Pakistan, ranking this country close to Afghanistan and Iraq amongst developing countries in terms of neonatal mortality. This constitutes more than 70% of the infant mortality rate. Among the various determinants of neonatal mortality in Pakistan, most emerge from behaviors and inappropriate practices of mothers, particularly in rural communities. Pakistan has an urban-rural ratio of 12 : 88 and mainly mountainous topography, so healthcare provision to the scattered rural communities of the Azad Jammu and Kashmir (AJK) has been a big challenge. The objective of this research was to study household practices of mothers regarding healthcare seeking for their neonates in rural and urban settings of the capital district of AJK.METHODSThis community-based cross-sectional study was carried out in rural and urban settings of the district Muzaffarabad of AJK. The study was conducted during the 6 months between July and December 2011. Inclusion criterion of participants in the research was mothers who had a neonate with current illness or illness during the previous 2 weeks. One hundred and four eligible mothers, each from rural and urban settings of district Muzaffarabad, were included in the study by utilizing a multistage sampling technique. To assess household practices, recruitment of the mothers was facilitated by lady health workers (LHWs) and interviews were conducted by them at the household level.RESULTSAfter controlling for confounding, significant association was found between rural place of residence and inappropriate household-based practices of mothers. More rural mothers were found to be illiterate compared to urban ones. Tying and cutting the umbilical cord with an unsterilized item, delivery at home attended by unskilled birth attendants, and delay in seeking neonatal health care were more prevalent in rural settings compared to the urban ones. More urban neonates were found to be immunized, dried and wrapped immediately after birth compared to the rural ones.CONCLUSIONSFindings of this study conclude that low level of mother's education and rural residence are associated with their inappropriate household-based practices for neonatal care. Behavior change communication and strengthening primary health care are required to address the demand and supply side issues, together with collaboration for action on social determinants of health.

Household practices of mothers regarding neonatal care in rural & urban settings of the capital district of Azad Jammu & Kashmir