Although infant mortality rates have dropped dramatically over the past 15 years, a new report in the journal Healthcare has identified significant shortcomings in newborn care in Cambodia.

After interviewing mothers, caretakers and midwives in charge of delivering and caring for newborn babies in Takeo province, the study’s authors documented numerous cases where basic hygiene practises were neglected.

They also noted that many mothers lack adequate information about how to breastfeed, check their baby’s breathing and temperature, and identify common illnesses such as infection.

“The current study highlighted many gaps in practices in these areas that may impact on newborn survival, growth and development,” wrote the report’s authors.

As Cambodia worked to reduce the rates of maternal and infant mortality, delivery moved away from the home and into health care centres, the report’s authors noted.

According to UNICEF, Cambodia’s under-5 mortality rate fell from 124 to 35 in every 1,000 live births between 2000 and 2014. This was in large part due to the higher percentage of babies delivered by midwives in health centres.

Nevertheless, some parts of the country are “still lagging behind” due to poor-quality health services, UNICEF noted in a statement.

For example, the study found that newborns are often cleaned and dried with sarongs brought from home, and then wrapped in the same wet, dirty sarongs. Most facilities lacked clean linen for cleaning and drying newborns.

Many health centres were also missing waste receptacles and hand-washing stations, and waste receptacles were often dirty and overflowing when they were available. Latrines were equally dirty and lacked hand-washing facilities.

Meanwhile, many midwives reported a lack of clean medical gloves, and often used the same gloves throughout delivery and post-partum care. Areas where mothers slept were almost never cleaned by health centre staff, and sleeping mats and bed covers were reused.

Once at home, families from across the socio-economic spectrum lacked information about how to care for newborns, especially ones with special needs.

“I did not think there was any special care for smaller babies versus normal babies, I only just did whatever came to my mind to care for the baby,” said the father of one underweight baby.

Material from insect nests was often applied to babies’ umbilical cords until they fell off. “I advise [parents] not to put anything on the cord except for betadine … But other than that, I don’t really advise them on how to take care of the newborn,” said one 24-year-old midwife.

According to Abigail Beeson, a health specialist with Save the Children Cambodia, further education is needed so that community members understand the importance of a baby’s first days.

“Overall infant mortality rates have been dropping, but a majority of deaths still take place in the first three days of life,” Beeson said.

“The government has revised some policies that put a greater emphasis on post-natal care so that babies get adequate care in the first 28 days, but we still see a lack of understanding from community members about the importance of some of these.”