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).