Prevalence and predictors of mother and newborn skin-to-skin contact at birth in Sierra Leone: Insights from the 2019 demographic health survey
Augustus Osborne, Ahmed Vandy, Camilla Bangura, Baindu Abu, Umaru SesayBackground
Skin-to-skin contact (SSC) is a vital maternal and neonatal practice that improves survival and promotes breastfeeding. Despite its benefits, SSC remains underutilised in low-resource settings, including Sierra Leone, where maternal and neonatal mortality rates are among the highest globally.
Objectives
To determine the prevalence and predictors of SSC among women aged 15–49 years in Sierra Leone using the 2019 Sierra Leone Demographic and Health Survey (SLDHS).
Design
This population-based, cross-sectional analytical study used secondary data from the 2019 SLDHS.
Methods
A weighted sample of 7,377 women who had given birth within five years preceding the survey and had complete data on SSC practice was included. Maternal practice of SSC was defined as placing a naked newborn on the mother’s bare chest immediately after birth, assessed as a binary self-reported outcome. Predictors included individual, household, and community-level factors such as birth weight, delivery method, place of delivery, health insurance coverage, regional differences, and community literacy. Bivariate and multivariable logistic regression analyses were conducted, guided by the Health Belief Model, to identify predictors of SSC.
Results
The prevalence of SSC was 60.8%. Mothers of low-birth-weight infants (AOR = 0.76, 95% CI: 0.67–0.86) and caesarean deliveries (AOR = 0.40, 95% CI: 0.27–0.61) were less likely to practice SSC. Facility-based deliveries increased SSC likelihood (AOR = 5.58, 95% CI: 4.50–6.93), while health insurance coverage doubled odds (AOR = 2.21, 95% CI: 1.54–3.18). Regional disparities and higher community literacy also positively influenced SSC, with mothers from other regions less likely to practice SSC compared to Eastern regions.
Conclusion
Although SSC prevalence in Sierra Leone is encouraging, barriers such as low birth weight, caesarean deliveries, and socio-economic inequalities hinder universal adoption. Strengthening facilities, expanding community education, and ensuring equitable healthcare access are essential to improve SSC and maternal–neonatal outcomes.