<h4>Objective</h4>To assess readiness and quality of essential newborn care and neonatal resuscitation practices in public health facilities in Afghanistan.<h4>Design</h4>Cross-sectional assessment.<h4>Setting</h4>226 public health facilities in Afghanistan, including 77 public health facilities with at least five births per day (high-volume facilities) and 149 of 1736 public health facilities with fewer than five births per day (low-volume facilities).<h4>Participants</h4>Managers of 226 public health facilities, 734 skilled birth attendants (SBAs) working at these facilities, and 643 women and their newborns observed during childbirth at 77 high-volume health facilities.<h4>Outcome measures</h4>Availability of knowledgeable SBAs, availability of supplies and compliance with global guidelines for essential newborn care and neonatal resuscitation practices.<h4>Results</h4>At high-volume facilities, 569/636 (87.9%) of babies were dried immediately after birth, 313/636 (49.2%) were placed in skin-to-skin contact with their mother and 581/636 (89.7%) had their umbilical cord cut with a sterile blade or scissors. A total of 87 newborn resuscitation attempts were observed. Twenty-four of the 87 (27.5%) began to breath or cry after simply clearing the airway or on stimulation. In the remaining 63 (72.5%) cases, a healthcare worker began resuscitation with a bag and mask; however, only 54 (62%) used a correct size of mask and three babies died as their resuscitation with bag and mask was unsuccessful.<h4>Conclusions</h4>The study indicates room for improvement of the quality of neonatal resuscitation practices at public health facilities in Afghanistan, requiring only strengthening of the current best practices in newborn care. Certain basic and effective aspects of essential newborn care that can be improved on with little additional resources were also missing, such as skin-to-skin contact of the babies with their mother. Improvement of compliance with the standard newbo Outcome measures Availability of knowledgeable SBAs, availability of supplies and compliance with global guidelines for essential newborn care and neonatal resuscitation practices. Results At high-volume facilities, 569/636 (87.9%) of babies were dried immediately after birth, 313/636 (49.2%) were placed in skin-to-skin contact with their mother and 581/636 (89.7%) had their umbilical cord cut with a sterile blade or scissors. A total of 87 newborn resuscitation attempts were observed. Twenty-four of the 87 (27.5%) began to breath or cry after simply clearing the airway or on stimulation. Interviews revealed notable gaps in knowledge of essential newborn care among SBAs. Across all levels of facilities, knowledge of basic equipment and One or more item of the essential supplies needed for resuscitation of babies not breathing at birth were also lacking at all levels of facility. A total of 71.7% (n=165) of facilities had a functional suction device for mucus extraction in the delivery room. Of facilities visited, 64.8% (n=157) had a size 0 mask, 74.9% (n=175) had a size 1 mask and 82.7% (n=191) had a newborn sized ambu bag. Availability of supplies and equipment varied by item, with no clear patterns across facility types ( table 2 ). Not all clients were observed at all stages of care. During observation of 636 births, 87.9% of babies (n=569) were dried immediately after birth, 49.2% (n=313) were immediately placed in skin-to-skin contact with the mother, and an SBA cut the cord of 89.7% (n=581) of the babies with a sterile blade or scissors. During the first hour after birth, an SBA checked the temperature of 22.1% of newborns (n=143), a total of 32.1% of newborns (n=204) remained in skin-to-skin contact with their mother and 38.4% of women (n=244) were assisted to start breast feeding within first hour after birth. Other practices, which are no longer recommended, were documented in a small but notable proportion of births observed. One newborn (0.2%) was bathed within the first hour after birth, and 90 (14.2%) of newborns had their mouth and nose aspirated without any indication. In addition, 12 (1.9%) newborns were slapped by health providers and 29 (4.6%) were held upside down after birth, both of which are not recommended practices ( table 4 ). Table 4 Potentially harmful practices observed during assessment visit % of births observed All public sector (n=636) Harmful or inappropriate practices that are never indicated Bathing of newborn within first hour after birth 0.2% (1) Practices done without an appropriate indication Routine aspiration of newborn mouth and nose at birth 14.2% (90) Disrespectful or abusive practices Slapping newborn 1.9% (12) Holding newborn upside down 4.6% (29) During assessment visits, a total of 87 newborn resuscitation attempts were observed at 39 of the 77 public hospitals with an average of at least five births per day. In 87.4% (n=76) of cases, a healthcare worker cleared the newborn’s airway and rubbed its back to stimulate airflow. In 10.3% (n=9) of cases, either the airway was cleared (8.0%, n=7) or stimulation given (2.3%; n=2) but not both. Twenty-four of the 87 newborns not breathing at birth (27.6%) began to breathe or cry after these simple actions. In the remaining 63 cases (72.4%), a healthcare worker began resuscitation efforts with a bag and mask. Quality of resuscitation efforts varied. For example, we cannot assess the relationship between individual provider knowledge and performance; the units of analysis for this assessment were the health facility and case (client–provider interaction), and the same provider may have been observed providing care to multiple clients. Similarly, essential newborn care practices were only observed for babies born via normal vaginal delivery and immediately crying at birth; we did not document essential newborn care provided to babies born via caesarean surgery or following resuscitation of newborns not breathing or crying at birth.

community. Immediately after birth, the infant was assessed for breathing. If the infant was not breathing, then the midwife would hang the infant upside by his The Inuit are Indigenous people who live in the arctic and subarctic regions of the North American continent (parts of Alaska, Canada, and Greenland). Modern Inuit (descendents of Thule Inuit) are culturally related to Iñupiat (northern Alaska) and Yupik (Siberia and western Alaska), and the Aleut, who live in the Aleutian Islands of Siberia and Alaska. The term "Eskimo" or Esquimaux has histori In Inuit culture, marriage was not a choice, but a necessity. Inuit men and women needed each other to survive. Married couples had to work… In Inuit culture, marriage was not a choice, but a necessity. Inuit men and women needed each other to survive. Married couples had to work together to overcome nearly impossible living conditions. Because every individual had to rely on a partner to survive, marriages were often arranged at birth to ensure the survival of the family. Love marriages, or choice marriages, existed, but these were all but arranged because there were usually few eligible partners. A young woman was eligible for marriage after puberty, but a man had to prove he was efficient enough in hunting to support a family before he could marry. Inuit marriages rarely included large ceremonies; couples were often considered married after the birth of their first child. There were monogamous and polygamous marriages, but polygyny was rare because few men could afford to support multiple wives. Families exchanged gifts before marriages, but no official bride price or dowry was paid. Although men were considered the head of the family, both genders could demand a divorce. However, divorce was frowned upon because it was bad for the family and the community as a whole. Spouses were sometimes traded or exchanged, and women had some say in this process. This was a common alternative to divorce because neither family would be without a component vital to its survival — a mother and a wife. In Inuit culture, the family was typically represented by a qullik (lamp) or a hearth, which was the property and responsibility of the wife. This lamp had significant symbolic meaning in the family, the community, and the culture.