Predictors of immediate mother-newborn skin-to-skin contact and missed contact in health facilities in Malawi: a multilevel analysis of the Malawi Demographic and Health Survey-2024.

AIM: This study aimed to examine the prevalence and predictors of immediate mother-newborn skin-to-skin contact (SSC) in Malawi and factors associated with missed SSC despite being delivered in health facilities.

BACKGROUND

SSC immediately after birth is an evidence-based essential newborn care intervention associated with improved thermoregulation, early breastfeeding initiation, maternal-infant bonding, and neonatal survival. Although facility delivery is expected to promote SSC, a substantial proportion of newborns in low- and middle-income countries still do not receive this recommended practice.

METHODS

We analysed data from the Malawi Demographic and Health Survey 2024. After restricting to the most recent live birth per woman and applying a complete-case approach across the outcome and all explanatory variables, the final analytic sample comprised 6,065 mother-newborn pairs (weighted sample: 6,142). The outcome was maternal report of immediate SSC after birth. Weighted descriptive statistics, chi-square tests, and multilevel logistic regression were used to identify factors associated with SSC. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) are reported.

FINDINGS: Overall, 77.3% of newborns experienced SSC. In the fully adjusted model, caesarean delivery (aOR = 0.13, 95% CI: 0.10-0.17) and multiple births (aOR = 0.47, 95% CI: 0.26-0.86) were associated with lower adjusted odds of receiving SSC. Institutional delivery (aOR = 5.20, 95% CI: 1.86-14.56) and antenatal care attendance were associated with higher adjusted odds of receiving SSC. Among institutional deliveries, caesarean delivery and multiple births (aOR = 0.44, 95% CI: 0.24-0.80) remained associated with lower odds of receiving SSC. Cluster-level variation was substantial (ICC = 0.172-0.173).