Appropriate home-based newborn care in a rural community in West Bengal, India using mixed-methods lot quality assurance sampling

Home-Based Newborn Care (HBNC) is a Government of India initiative to reduce neonatal mortality. This study assessed coverage of appropriate HBNC services in a community development block in West Bengal, identified subcentres with acceptable coverage, and explored perceptions of beneficiaries and challenges of Accredited Social Health Activists (ASHAs). A mixed-methods, cross-sectional study employing Lot Quality Assurance Sampling (LQAS) was conducted in Barrackpore-II block, North 24 Parganas, West Bengal. A total of 434 mother-child dyads with infants aged 43-60 days were surveyed. Each of the 31 subcentres constituted a lot, with a sample size of 14 and a decision value of 4, based on threshold values of 50% and 85%. HBNC services were deemed 'appropriate' if all home visits adhered to the prescribed schedule (±1 day), i.e., 'complete' and were 'effective'. Essential components of an effective visit included promotion of exclusive breastfeeding, eye and cord care, temperature and weight measurement, and proper hand hygiene. Qualitative data were obtained through 19 in-depth interviews and eight focus group discussions. Nearly half of the lots (48.4%) had unacceptable HBNC coverage, and estimated overall coverage was 67.6%. Key challenges for ASHAs included socio-economic disparities, low perceived credibility, irregular payments, and inadequate co-ordination. Beneficiary perception regarding HBNC was influenced by the fulfilment of expected support from ASHA. Strengthening both demand-factors (community awareness and perceived credibility of services) and supply-factors (capacity building, timely remuneration, and robust inter-sectoral co-ordination) are crucial to improving effectiveness of Home-Based Newborn Care.