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Nyaloko MJ, Lubbe W, Moloko-Phiri SS, Shopo KD. Parental experiences of caring for preterm infants in the neonatal intensive care unit, Limpopo Province: a descriptive qualitative study exploring the cultural determinants. BMC Health Serv Res 2024; 24:669. [PMID: 38807150 PMCID: PMC11134925 DOI: 10.1186/s12913-024-11117-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Parent-infant interaction is highly recommended during the preterm infant hospitalisation period in the Neonatal Intensive Care Unit (NICU). Integrating culturally sensitive healthcare during hospitalisation of preterm infants is critical for positive health outcomes. However, there is still a paucity of evidence on parental experience regarding cultural practices that can be integrated into preterm infant care in the NICU. The study explored and described the cultural determinants of parents that can be integrated into the care of preterm infants in the NICU. METHODS A descriptive qualitative research design was followed where twenty (n=20) parents of preterm infants were purposively selected. The study was conducted in the NICU in Limpopo using in-depth individual interviews. Taguette software and a thematic analysis framework were used to analyse the data. The COREQ guidelines and checklist were employed to ensure reporting standardisation. RESULTS Four themes emerged from the thematic analysis: 1) Lived experienced by parents of preterm infants, 2) Interactions with healthcare professionals, 3) Cultural practices concerning preterm infant care, and 4) Indigenous healthcare practices for preterm infants. CONCLUSIONS The study emphasised a need for healthcare professionals to understand the challenges parents of preterm infants face in NICU care. Furthermore, healthcare professionals should know indigenous healthcare practices to ensure relevant, culturally sensitive care.
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Affiliation(s)
- Madimetja J Nyaloko
- NuMIQ Research Focus Area, North-West University, Potchefstroom, South Africa.
| | - Welma Lubbe
- NuMIQ Research Focus Area, North-West University, Potchefstroom, South Africa
| | | | - Khumoetsile D Shopo
- NuMIQ Research Focus Area, North-West University, Potchefstroom, South Africa
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Campbell JE, Beetch J, Cooper T, Cheng J. Infant mortality and its determinants in Uganda 2016: Using a geographically weighted regression approach. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002669. [PMID: 38117756 PMCID: PMC10732401 DOI: 10.1371/journal.pgph.0002669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/01/2023] [Indexed: 12/22/2023]
Abstract
Infant mortality (IM) represents the overall health of a country or region as it relates to access to medicine, health care, and clean water in a population. IM remains understudied in many areas of Uganda, as many studies are from urban the capital (Kampala). The long-term goal of this research is the mitigation of IM and poor pregnancy outcomes in Uganda. Insights gained from geographic distribution of IM will allow adaptation of diagnosis, treatments, and interventions within the studied areas. Through using OLS and geographically weighted regression, this study has explored the significant factors and their heterogeneous and scaling effects in 2016 across Uganda. The empirical findings from this study include a significant association between IM and both being unmarried and preferring to speak Luganda when interviewed. Those unmarried may lack a social network to assist with income, childcare, and household chores representing decreased resources. Additionally, being interviewed in Luganda was associated over a large geographic area, which may represent not being comfortable in English, which is the language of education, commerce, and presumably health care, thus suggesting a disconnect with health care settings. These data suggest that strides can be made in Uganda by providing targeted resources to areas with high rates of unmarried mothers and those areas with high rates of Luganda as their language of choice.
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Affiliation(s)
- Janis E. Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Jessica Beetch
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Townsend Cooper
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Jianquan Cheng
- Department of Natural Sciences, Manchester Metropolitan University, Chester, United Kingdom
- Key Laboratory of Environment Change and Resources Use in Beibu Gulf, Centre for Health Geographic Information and Education, Nanning Normal University, Nanning, PR China
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Wenani D, Burgoine K, Williams SLA, Musaba M, Gebremichael T, Clarke A, Blanks KJ, Nantale R, Nawanga J, Kiguli S, English M, Waiswa P, Darmstadt GL, Matovu JK, Mukunya D. Perceptions, beliefs, and current practices regarding neonatal skin care and emollient use in eastern Uganda: a qualitative study. BMC Pediatr 2023; 23:223. [PMID: 37147698 PMCID: PMC10163695 DOI: 10.1186/s12887-023-04040-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/27/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND The skin is a major route of infection in the neonatal period, especially in low birthweight (LBW) infants. Appropriate and safe neonatal skin care practices are required to reduce this risk. The perceptions and beliefs of mothers and other caregivers towards various neonatal skin care practices in our setting have been documented. Data from Asia suggests that the application of emollient to the skin of LBW infants can promote growth, reduce serious neonatal infections, and potentially reduce mortality. This is the first study to explore the acceptability of emollients and massage as part of neonatal skin care in a low-resource setting in sub-Saharan Africa (SSA) that is representative of the majority of government health facilities in Uganda and many in SSA. OBJECTIVE To explore perceptions, beliefs, and current practices regarding neonatal skin care and emollient use in eastern Uganda. METHODS We conducted a qualitative study consisting of three focus group discussions (30 participants), eight in-depth interviews with mothers/caregivers of preterm and term neonates and 12 key informant interviews with midwives, doctors and community health workers involved in neonatal care, to explore the perceptions and practices surrounding neonatal skin care and emollient use. Data collected were transcribed and analyzed using thematic content analysis. RESULTS Mothers perceived that skin care began in utero. Skincare practices depended on the place of delivery; for deliveries in a health facility the skincare practices were mainly based on the health worker's advice. Vernix caseosa was often washed off due to its perceived undesirability and was attributed to sexual intercourse in the last trimester. Despite their deleterious attributes found in previous studies, petrolatum-based oils, petrolatum-based jellies and talcum baby powders were the most commonly reported items used in neonatal skin care. In our population, there was high acceptability of emollient therapy use; however, neonatal massage was treated with scepticism as mothers feared damaging the vulnerable neonate. Mothers suggested massage and emollient application be undertaken by health workers, if it becomes an intervention. CONCLUSIONS In eastern Uganda, the perceptions and beliefs of mothers/caregivers toward neonatal skincare influenced their practices of which some could potentially be beneficial, and others harmful. Emollient use would be easily accepted if adequate sensitisation is conducted and using the gatekeepers such as health workers.
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Affiliation(s)
- Daniel Wenani
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Kathy Burgoine
- Neonatal Unit, Department of Paediatrics and Child Health, Mbale Regional Referral Hospital, Mbale, Uganda.
| | | | - Milton Musaba
- Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
| | | | - Andrew Clarke
- Global Programmes Division, Save the Children UK, London, UK
| | - Keona Jh Blanks
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Ritah Nantale
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Jascenti Nawanga
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Sarah Kiguli
- Department of Pediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Peter Waiswa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph Kb Matovu
- Department of Community and Public Health, Busitema University, Mbale, Uganda
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - David Mukunya
- Department of Community and Public Health, Busitema University, Mbale, Uganda
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Musiimenta A, Tumuhimbise W, Atukunda EC, Mugaba AT, Asasira J, Katusiime J, Zender R, Pinkwart N, Mugyenyi GR, Haberer JE. A mobile health app may improve maternal and child health knowledge and practices among rural women with limited education in Uganda: a pilot randomized controlled trial. JAMIA Open 2022; 5:ooac081. [PMID: 36225894 PMCID: PMC9542753 DOI: 10.1093/jamiaopen/ooac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 08/24/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Objective This article describes the impact of a mobile health app (MatHealth App) on maternal and child health knowledge and practices among women with limited education. Materials and methods Pregnant women initiating antenatal care (ANC) were randomized (1:1) to the MatHealth App versus routine care. Participants were followed until 6 weeks after delivery. Questionnaires for assessing knowledge and practices were administered to participants from both arms at baseline and endline. Using logistic regression, we estimated the difference in odds of having maternal health knowledge. We reviewed clinic records to capture maternal health practices. Results Of the 80 enrolled participants, 69 (86%) completed the study with a median follow-up of 6 months. Women in the MatHealth arm had 8.2 (P = .19), 3.6 (P = .14), and 6.4 (P = .25), respectively higher odds of knowing (1) the recommended gestation period for starting ANC, (2) the recommended number of ANC visits, and (3) the timing and frequency of recommended human immunodeficiency virus (HIV) testing, respectively, compared to those in the routine care arm. All women in the MatHealth App arm exclusively breastfed their babies, and brought them at 6 weeks for HIV testing, compared to the routine care arm. Just over half of the women attended at least 4 prenatal visits across the 2 arms. The main reason for noncompliance to ANC appointments was a lack of transport to the clinic. Discussion and conclusion The app increased knowledge and practices although not reaching statistical significance. Future efforts can focus on addressing social and economic issues and assessing clinical outcomes.
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Affiliation(s)
- Angella Musiimenta
- Corresponding Author: Angella Musiimenta, PhD, Department of Information Technology, Mbarara University of Science and Technology, P.O. Box 653, Mbarara, Uganda;
| | - Wilson Tumuhimbise
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Esther C Atukunda
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Aaron T Mugaba
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda,Angels Compassion Research and Development Initiative, Mbarara, Uganda
| | - Justus Asasira
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jane Katusiime
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Raphael Zender
- Department of Computer Science, Humboldt Universitat zu Berlin, Berlin, Germany
| | - Niels Pinkwart
- Department of Computer Science, Humboldt Universitat zu Berlin, Berlin, Germany
| | | | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA,Medicine Department, Harvard Medical School, Boston, Massachusetts, USA
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Mukunya D, Tumwine JK, Nankabirwa V, Odongkara B, Tongun JB, Arach AA, Tumuhamye J, Napyo A, Zalwango V, Achora V, Musaba MW, Ndeezi G, Tylleskär T. Neonatal hypothermia in Northern Uganda: a community-based cross-sectional study. BMJ Open 2021; 11:e041723. [PMID: 33574146 PMCID: PMC7880091 DOI: 10.1136/bmjopen-2020-041723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To determine the prevalence, predictors and case fatality risk of hypothermia among neonates in Lira district, Northern Uganda. SETTING Three subcounties of Lira district in Northern Uganda. DESIGN This was a community-based cross-sectional study nested in a cluster randomised controlled trial. PARTICIPANTS Mother-baby pairs enrolled in a cluster randomised controlled trial. An axillary temperature was taken during a home visit using a lithium battery-operated digital thermometer. PRIMARY AND SECONDARY OUTCOMES The primary outcome measure was the prevalence of hypothermia. Hypothermia was defined as mild if the axillary temperature was 36.0°C to <36.5°C, moderate if the temperature was 32.0°C to <36.0°C and severe hypothermia if the temperature was <32.0°C. The secondary outcome measure was the case fatality risk of neonatal hypothermia. Predictors of moderate to severe hypothermia were determined using a generalised estimating equation model for the Poisson family. RESULTS We recruited 1330 neonates. The prevalence of hypothermia (<36.5°C) was 678/1330 (51.0%, 95% CI 46.9 to 55.1). Overall, 32% (429/1330), 95% CI 29.5 to 35.2 had mild hypothermia, whereas 18.7% (249/1330), 95% CI 15.8 to 22.0 had moderate hypothermia. None had severe hypothermia. At multivariable analysis, predictors of neonatal hypothermia included: home birth (adjusted prevalence ratio, aPR, 1.9, 95% CI 1.4 to 2.6); low birth weight (aPR 1.7, 95% CI 1.3 to 2.3) and delayed breastfeeding initiation (aPR 1.2, 95% CI 1.0 to 1.5). The case fatality risk ratio of hypothermic compared with normothermic neonates was 2.0 (95% CI 0.60 to 6.9). CONCLUSION The prevalence of neonatal hypothermia was very high, demonstrating that communities in tropical climates should not ignore neonatal hypothermia. Interventions designed to address neonatal hypothermia should consider ways of reaching neonates born at home and those with low birth weight. The promotion of early breastfeeding initiation and skin-to-skin care could reduce the risk of neonatal hypothermia. TRIAL REGISTRATION NUMBER ClinicalTrial.gov as NCT02605369.
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Affiliation(s)
- David Mukunya
- Department of Research, Sanyu Africa Research Institute, Mbale, Uganda
- Department of Global Public Health and Primary Care, Centrefor Intervention Science in Maternal and Child Health (CISMAC), Centre forInternational health, University of Bergen, Bergen, Norway
- Department of Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - James K Tumwine
- Departmentof Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Victoria Nankabirwa
- Department of Global Public Health and Primary Care, Centrefor Intervention Science in Maternal and Child Health (CISMAC), Centre forInternational health, University of Bergen, Bergen, Norway
- Center for Intervention Science in Maternal and Child Health, Center for International Health, Universitet i Bergen, Bergen, Norway
- Departmentof Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Beatrice Odongkara
- Department of Paediatrics and Child Health, Gulu University, Gulu, Uganda
| | - Justin B Tongun
- Department of Paediatrics and Child Health, Juba University, Juba, Uganda
| | - Agnes A Arach
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Josephine Tumuhamye
- Department of Global Public Health and Primary Care, Centrefor Intervention Science in Maternal and Child Health (CISMAC), Centre forInternational health, University of Bergen, Bergen, Norway
- Center for Intervention Science in Maternal and Child Health, Center for International Health, Universitet i Bergen, Bergen, Norway
| | - Agnes Napyo
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Vivian Zalwango
- Departmentof Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Vicentina Achora
- Department of Obstetrics and Gynaecology, Gulu University, Gulu, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Grace Ndeezi
- Departmentof Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Komakech H, Lubogo D, Nabiwemba E, Orach CG. Essential newborn care practices and determinants amongst mothers of infants aged 0-6 months in refugee settlements, Adjumani district, west Nile, Uganda. PLoS One 2020; 15:e0231970. [PMID: 32324787 PMCID: PMC7179823 DOI: 10.1371/journal.pone.0231970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite recent improvements in child survival, neonatal mortality remains high in most developing countries. Countries affected by humanitarian emergencies continue to report the highest neonatal mortality rates. OBJECTIVE To assess essential newborn care practices and its determinants amongst mothers of infants aged 0-6 months in refugee settlements in Adjumani district. METHODS A cross-sectional study was conducted among mothers of infants aged 0-6 months in refugee settlements, Adjumani district. A total of 561 mothers of infants were selected using systematic sampling technique from households. Data were collected using a semi-structured questionnaire. A composite outcome variable, Essential Newborn Care practices was created by merging different care practices (neonatal feeding, thermal care, and cord care). Multiple logistic regression analysis was used to determine predictors of Essential Newborn Care. RESULTS AND CONCLUSIONS Over half (57%) of the mothers breastfed their newborns within one hour. Half (50.1%) of mothers cleaned the umbilical cord of their newborns. Only 17% of the newborns received optimal thermal care immediately after birth. Mothers aged 20-24 years (OR 0.38, CI 0.17-0.96) and those involved in subsistence farming (OR 0.67, CI 0.38-1.45) were less likely to practice good newborn care compared to those in other occupations. Newborn care practices were sub-optimal in this refugee setting. To improve newborn care practices, there is need to educate mothers through community-based health interventions in order to promote delayed bathing, ideal infant feeding, thermal and umbilical cord care.
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Affiliation(s)
- Henry Komakech
- Department of Community Health and Behavioural Science, Makerere University School of Public Health, Kampala, Uganda
- * E-mail:
| | - David Lubogo
- Department of Community Health and Behavioural Science, Makerere University School of Public Health, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Science, Makerere University School of Public Health, Kampala, Uganda
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Science, Makerere University School of Public Health, Kampala, Uganda
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Mukunya D, Haaland MES, Tumwine JK, Tylleskar T, Nankabirwa V, Moland KM. "The cord is the child": meanings and practices related to umbilical cord care in Central Uganda. BMC Pediatr 2020; 20:105. [PMID: 32131781 PMCID: PMC7057479 DOI: 10.1186/s12887-020-2002-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 02/25/2020] [Indexed: 01/27/2023] Open
Abstract
Background Infections account for a quarter of all newborn deaths and the umbilical cord has been identified as a major route of newborn infections. Objective To explore the meanings and practices related to the umbilical cord among caretakers of newborns in central Uganda. Methods This was a qualitative study, designed to inform the design, and interpretation of a randomized controlled trial assessing the effectiveness of chlorhexidine use for the umbilical cord. We conducted 22 in-depth interviews exploring umbilical cord care practices among ten mothers, four health workers, five traditional birth attendants, and three men. We also conducted three focus group discussions with young mothers and elderly women. We used qualitative content analysis to analyze our findings and we borrow upon Mary Douglas’ concepts of dirt to present our findings. Results The umbilical cord had a symbolic position in newborn care. The way it was perceived and handled had far reaching consequences for the survival and wellbeing of the baby. The umbilical cord was a centre of anxiety, a possible gate to illness, a test of fatherhood and a signifier of parental responsibility. Hence, the umbilical cord and the way it was cared for played a part in the present and future survival of the baby, as well as the survival and wellbeing of the household. Persons other than the mother such as older female relatives were very influential in the care of the umbilical cord. Conclusions The umbilical cord carried symbolic meanings, which extended beyond the newborn and the newborn period, and in turn influenced the various practices of umbilical cord care. The important position of the cord in local newborn care practices should be recognized and taken into consideration when scaling up newborn care interventions in the country.
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Affiliation(s)
- David Mukunya
- Centre for Intervention Science in Maternal and Child Health (www.cismac.org), Center for International Health, University of Bergen, Bergen, Norway.
| | - Marte E S Haaland
- CISMAC, Center for International Health, University of Bergen, Bergen, Norway
| | - James K Tumwine
- Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Thorkild Tylleskar
- CISMAC, Center for International Health, University of Bergen, Bergen, Norway
| | - Victoria Nankabirwa
- CISMAC, Center for International Health, University of Bergen, Bergen, Norway.,Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Karen Marie Moland
- CISMAC, Center for International Health, University of Bergen, Bergen, Norway
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Key Decision Makers and Actors in Selected Newborn Care Practices: A Community-Based Survey in Northern Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101723. [PMID: 31100814 PMCID: PMC6572448 DOI: 10.3390/ijerph16101723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/17/2022]
Abstract
Knowledge of key decision makers and actors in newborn care is necessary to ensure that health interventions are targeted at the right people. This was a cross-sectional study carried out in Lira district, Northern Uganda. Multivariable logistic regression was used to determine factors associated with mothers being the key decision maker regarding where to give birth from and when to initiate breastfeeding. Fathers were the key decision makers on the place of birth (54.3%, n = 505) and on whether to seek care for a sick newborn child (47.7%, n = 92). Grandmothers most commonly bathed the baby immediately after birth (55.5%, n = 516), whereas mothers and health workers were common decision makers regarding breastfeeding initiation. Predictors for a mother being the key decision maker on the place of birth included: Mother having a secondary education (AOR 1.9: 95% C.I (1.0–3.6)) and mother being formally employed (AOR 2.0: 95% (1.5–2.9)). Mothers, fathers, grandmothers, health-workers, and traditional birth attendants were the most influential in the selected newborn care practices. Programs that aim to promote newborn care need to involve husbands, grandmothers, and health workers in addition to mothers.
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Shamba D, Tancred T, Hanson C, Wachira J, Manzi F. Delayed illness recognition and multiple referrals: a qualitative study exploring care-seeking trajectories contributing to maternal and newborn illnesses and death in southern Tanzania. BMC Health Serv Res 2019; 19:225. [PMID: 30975142 PMCID: PMC6460539 DOI: 10.1186/s12913-019-4019-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 03/18/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Maternal and neonatal mortality remain high in southern Tanzania despite an increasing number of births occurring in health facilities. In search for reasons for the persistently high mortality rates, we explored illness recognition, decision-making and care-seeking for cases of maternal and neonatal illness and death. METHODS We conducted 48 in-depth interviews (16 participants who experienced maternal illnesses, 16 mothers whose newborns experienced illness, eight mothers whose newborns died, and eight family members of a household with a maternal death), and five focus group discussions with community leaders in two districts of Mtwara region. Thematic analysis was used for interpretation of findings. RESULTS Our data indicated relatively timely illness recognition and decision-making for maternal complications. In contrast, families reported difficulties interpreting newborn illnesses. Decisions on care-seeking involved both the mother and her partner or other family members. Delays in care-seeking were therefore also reported in absence of the husband, or at night. Primary-level facilities were first consulted. Most respondents had to consult more than one facility and described difficulties accessing and receiving appropriate care. Definitive treatment for maternal and newborn complications was largely only available in hospitals. CONCLUSIONS Delays in reaching a facility that can provide appropriate care is influenced by multiple referrals from one facility to another. Referral and care-seeking advice should include direct care-seeking at hospitals in case of severe complications and primary facilities should facilitate prompt referral.
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Affiliation(s)
- Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania.
| | - Tara Tancred
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Hanson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Department of Public Health Sciences-Global Health, Karolinska Institute, Stockholm, Sweden
| | - Juddy Wachira
- School of Medicine/AMPATH, Moi University, Nairobi, Kenya
| | - Fatuma Manzi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
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10
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Mukunya D, Haaland MES, Tumwine JK, Ndeezi G, Namugga O, Tumuhamye J, Sommerfelt H, Rujumba J, Tylleskar T, Moland KM, Nankabirwa V. "We shall count it as a part of kyogero": acceptability and considerations for scale up of single dose chlorhexidine for umbilical cord care in Central Uganda. BMC Pregnancy Childbirth 2018; 18:476. [PMID: 30514237 PMCID: PMC6280360 DOI: 10.1186/s12884-018-2116-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/22/2018] [Indexed: 01/27/2023] Open
Abstract
Background Cleansing the umbilical cord with chlorhexidine reduces neonatal morbidity and mortality, particularly in communities where newborn deaths and home births are common. As a result, the World Health Organization and national authorities are advocating the scale up of this intervention. In order for such a scale up to be effective, it has to be acceptable to the targeted population. With the overall aim to clarify conditions for scale-up, this study explored the acceptability of single dose chlorhexidine solution for umbilical cord care among health workers and infant care providers in the districts of Kampala and Mukono in Central Uganda. Methods This was a qualitative study that involved mothers of neonates enrolled in a chlorhexidine trial, nurses implementing the trial, key community members and opinion leaders in childcare. We conducted 30 in depth interviews (IDIs) with mothers (18), health workers (8), traditional birth attendants (2), a father (1) and a grandmother (1) and 4 focus group discussions (FGDs), 3 with mothers and 1 with health workers. We used qualitative content analysis to analyze our findings and borrow upon Sekhon’s model when presenting our findings. Results Cognitive and emotional responses to chlorhexidine use included ease of use, and a perception that chlorhexidine reduced smell and abdominal colic. We also found that wider social and cultural factors were important to chlorhexidine use. These included cultural value put on quick separation of the umbilical cord as well as the practice of bathing the baby in a herbal mixture called kyogero. We also found that older relatives were key decision makers in umbilical cord care for newborns, but were seldom present during health workers’ counseling of mothers about hygienic care of the cord. Conclusions The application of chlorhexidine on the umbilical cord stump at birth was acceptable as an addition rather than a total replacement of traditional substances. The scale up of chlorhexidine should consider how to accommodate local beliefs and practices in a way that does not compromise the effect of the intervention; encouraging mothers to delay the bathing of babies in kyogero could be one way of doing this.
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Affiliation(s)
- David Mukunya
- Centre for Intervention Science in Maternal and Child Health, Center for International Health, University of Bergen, Bergen, Norway.
| | - Marte E S Haaland
- CISMAC, Center for International Health, University of Bergen, Bergen, Norway
| | - James K Tumwine
- Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Grace Ndeezi
- Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Olive Namugga
- CISMAC, Center for International Health, University of Bergen, Bergen, Norway
| | - Josephine Tumuhamye
- CISMAC, Center for International Health, University of Bergen, Bergen, Norway
| | - Halvor Sommerfelt
- CISMAC, Center for International Health, University of Bergen, Bergen, Norway
| | - Joseph Rujumba
- Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Thorkild Tylleskar
- CISMAC, Center for International Health, University of Bergen, Bergen, Norway
| | - Karen Marie Moland
- CISMAC, Center for International Health, University of Bergen, Bergen, Norway
| | - Victoria Nankabirwa
- CISMAC, Center for International Health, University of Bergen, Bergen, Norway.,Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
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Kayom VO, Mugalu J, Kakuru A, Kiguli S, Karamagi C. Burden and factors associated with clinical neonatal sepsis in urban Uganda: a community cohort study. BMC Pediatr 2018; 18:355. [PMID: 30424740 PMCID: PMC6234629 DOI: 10.1186/s12887-018-1323-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 10/24/2018] [Indexed: 11/13/2022] Open
Abstract
Background Neonatal sepsis is one of the most important causes of mortality in developing countries and yet the most preventable. In developing countries clinical algorithms are used to diagnose clinical neonatal sepsis because of inadequate microbiological services. Most information on incidence and risk factors of neonatal sepsis are from hospital studies which may not be generalized to communities where a significant proportion of mothers do not deliver from health facilities. This study, conducted in urban Uganda, sought to determine the community based incidence of clinical neonatal sepsis and the factors associated. Methods This was a cohort of mother-neonate pairs in Kampala, Uganda from March to May 2012. The enrolled neonates were assessed for clinical sepsis and factors associated, and followed up till the end of the neonatal period. STATA version 10 was used to analyse the data. Results The community based incidence of neonatal sepsis was 11% (95% CI: 7.6–14.4). On bivariate analysis, lack of financial support from the father (OR 4.09, 95% CI 1.60–10.39) and prolonged rupture of membranes more than 18 h prior to delivery (OR 11.7, 95% CI 4.0–31.83) were significantly associated with neonatal sepsis. Maternal hand washing prior to handling the baby was found to be protective of neonatal sepsis (OR 0.41, 95% CI 0.18–0.94). Of the 317 infants who completed the follow up period, one died within the neonatal period giving a neonatal mortality of 0.003%. Conclusion The high incidence of clinical neonatal sepsis in this urban community with high rates of antenatal care attendance and health facility delivery places a demand on the need to improve the quality of antenatal, perinatal and postnatal care in health facilities with regards to infection prevention including promoting simple practices like hand washing. The astoundingly low mortality rate is most likely because this was a low risk cohort. However it may also suggest that the neonatal mortality in developing countries may be reduced with promotion of simple low cost interventions like community follow up of neonates using village health teams or domiciliary care.
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Affiliation(s)
- Violet Okaba Kayom
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7062, Kampala, Uganda.
| | - Jamiir Mugalu
- Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, P.O.Box 7475, Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7062, Kampala, Uganda
| | - Charles Karamagi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7062, Kampala, Uganda
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Bee M, Shiroor A, Hill Z. Neonatal care practices in sub-Saharan Africa: a systematic review of quantitative and qualitative data. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:9. [PMID: 29661239 PMCID: PMC5902879 DOI: 10.1186/s41043-018-0141-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/02/2018] [Indexed: 05/23/2023]
Abstract
BACKGROUND Recommended immediate newborn care practices include thermal care (immediate drying and wrapping, skin-to-skin contact after delivery, delayed bathing), hygienic cord care and early initiation of breastfeeding. This paper systematically reviews quantitative and qualitative data from sub-Saharan Africa on the prevalence of key immediate newborn care practices and the factors that influence them. METHODS Studies were identified by searching relevant databases and websites, contacting national and international academics and implementers and hand-searching reference lists of included articles. English-language published and unpublished literature reporting primary data from sub-Saharan Africa (published between January 2001 and May 2014) were included if it met the quality criteria. Quantitative prevalence data were extracted and summarized. Qualitative data were synthesized through thematic analysis, with deductive coding used to identify emergent themes within each care practice. A framework approach was used to identify prominent and divergent themes. RESULTS Forty-two studies were included as well as DHS data - only available for early breastfeeding practices from 33 countries. Results found variation in the prevalence of immediate newborn care practices between countries, with the exception of skin-to-skin contact after delivery which was universally low. The importance of keeping newborn babies warm was well recognized, although thermal care practices were sub-optimal. Similar factors influenced practices across countries, including delayed drying and wrapping because the birth attendant focused on the mother; bathing newborns soon after delivery to remove the dirt and blood; negative beliefs about the vernix; applying substances to the cord to make it drop off quickly; and delayed breastfeeding because of a perception of a lack of milk or because the baby needs to sleep after delivery or does not showing signs of hunger. CONCLUSION The majority of studies included in this review came from five countries (Ethiopia, Ghana, Malawi, Tanzania and Uganda). There is a need for more research from a wider geographical area, more research on newborn care practices at health facilities and standardization in measuring newborn care practices. The findings of this study could inform behaviour change interventions to improve the uptake of immediate newborn care practices.
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Affiliation(s)
- Margaret Bee
- Concern Worldwide (UK), 13/14 Calico House, Clove Hitch Quay, London, SW11 3TN UK
| | | | - Zelee Hill
- Institute for Global Health, University College London, 30 Guilford St., London, WC1N 1EH UK
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Sumankuuro J, Crockett J, Wang S. Sociocultural barriers to maternity services delivery: a qualitative meta-synthesis of the literature. Public Health 2018; 157:77-85. [PMID: 29501985 DOI: 10.1016/j.puhe.2018.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Maternal and neonatal healthcare outcomes in Sub-Saharan Africa (SSA) remain poor despite decades of different health service delivery interventions and stakeholder investments. Qualitative studies have attributed these results, at least in part, to sociocultural beliefs and practices. Thus there is a need to understand, from an overarching perspective, how these sociocultural beliefs affect maternal and neonatal health (MNH) outcomes. STUDY DESIGN A qualitative meta-synthesis of primary studies on cultural beliefs and practices associated with maternal and neonatal health care was carried out, incorporating research conducted in any country within SSA, using data from men, women and health professionals gathered through focus group discussions, structured and semistructured interviews. METHODS A systematic search was carried out on seven electronic databases, Scopus, Ovid Medline, PubMed, CINAHL Plus, Humanities and Social Sciences (Informit), EMBASE and Web of Science, and on Google Scholar, using both manual and electronic methods, between 1st January 1990 and 1st January 2017. The terms 'cultural beliefs'; 'cultural beliefs AND maternal health'; 'cultural beliefs OR maternal health'; 'traditional practices' and 'maternal health' were used in the search. RESULTS Key components of cultural beliefs and practices associated with adverse health outcomes on pregnancy, labour and the postnatal period were identified in five overarching factors: (a) pregnancy secrecy; (b) labour complications attributed to infidelity; (c) mothers' autonomy and reproductive services; (d) marital status, trust in traditional medicines and traditional birth attendants; and (e) intergenerational beliefs attached to the 'ordeal' of giving birth. CONCLUSION Cultural beliefs and practices related to maternal and neonatal health care are intergenerational. Therefore, intensive community-specific education strategies to facilitate behaviour changes are required for improved MNH outcomes. Adopting practical approaches such as involving husbands/partners and communities in antenatal care services in a health facility and community settings can enhance improved MNH outcomes.
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Affiliation(s)
- J Sumankuuro
- School of Community Health, Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia.
| | - J Crockett
- School of Community Health, Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia
| | - S Wang
- School of Community Health, Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia
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Coalter WS, Patterson SL. Sociocultural factors affecting uptake of home-based neonatal thermal care practices in Africa: A qualitative review. J Child Health Care 2017; 21:132-141. [PMID: 29119805 DOI: 10.1177/1367493516686201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Neonatal hypothermia is a major contributor to neonatal mortality in sub-Saharan Africa, often as a comorbidity of severe infections, preterm births or asphyxia. Simple, cost-effective thermal care practices (TCPs) immediately at birth and in the post-natal period are recommended in the World Health Organization 'warm chain'. Current practices are suboptimal in the home in low-resource settings, where approximately half of neonatal deaths occur. Several databases (PubMed, OVID SP, Web of Science, The Cochrane Library and Google Scholar) were searched for original research on home-based TCPs. Seventeen articles were identified, and the results were analysed using a 'thermal care behavioural model'. This review of the qualitative literature on home-based practices across Africa illuminates the sociocultural factors affecting the uptake of recommended practices and strategies for behaviour change. Findings from the review confirm that potentially harmful cultural norms and traditions influence the sequence of TCPs in different contexts across Africa. Furthermore, caregiver factors and contextual barriers or facilitating factors to TCPs and behaviour change exist. Hypothermia and home-based TCPs are areas for further research. Thermal care behaviour change interventions tailored to the sociocultural context are necessary to improve neonatal outcomes in Africa.
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Coffey PS, Brown SC. Umbilical cord-care practices in low- and middle-income countries: a systematic review. BMC Pregnancy Childbirth 2017; 17:68. [PMID: 28219420 PMCID: PMC5319165 DOI: 10.1186/s12884-017-1250-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/08/2017] [Indexed: 01/23/2023] Open
Abstract
Background Neonatal sepsis is the third leading cause of deaths for infants in their first month of life. The newly cut umbilical cord can be a pathway for bacteria that can cause newborn sepsis and death. Optimal umbilical cord care practices for newborns and during the first week of life, especially in settings with poor hygiene, has the potential to avoid these preventable neonatal deaths. The purpose of this review of cord care practices is to assist in the development of behavior-change strategies to support introduction of novel cord-care regimens, particularly 7.1% chlorhexidine digluconate for umbilical cord care. Methods We searched domestic and international databases for articles that were published in English between January 1, 2000, and August 24, 2016. We found 321 articles and reviewed 65 full-text articles using standardized inclusion criteria. The primary criteria for inclusion was a description of substances applied to the umbilical cord stump in the days following birth. Results We included 46 articles in this review of umbilical cord-care practices. Articles included data from 15 low- and middle-income countries in sub-Saharan Africa (8 countries), Asia (5 countries), North Africa (1 country), and Latin America and the Caribbean (1 country). Findings from this review suggest that documentation of cord-care practices is not consistent throughout low- and middle-income countries, yet existing literature depicts a firm tradition of umbilical cord care in every culture. Cord-care practices vary by country and by regions or cultural groups within a country and employ a wide range of substances. The desire to promote healing and hasten cord separation are the underlying beliefs related to application of substances to the umbilical cord. The frequency of application of the substance (either the number of days or the number of times per day the substance was applied), and source and cost of products used is not well-characterized. Conclusions This desire to actively care for the umbilical cord of a newborn—as noted in the variety of cord care practices and beliefs identified in this review—points toward the need to contextualize any behavior change approach to align with the local culture. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1250-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Siobhan C Brown
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
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16
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Kabwijamu L, Waiswa P, Kawooya V, Nalwadda CK, Okuga M, Nabiwemba EL. Newborn Care Practices among Adolescent Mothers in Hoima District, Western Uganda. PLoS One 2016; 11:e0166405. [PMID: 27855186 PMCID: PMC5113955 DOI: 10.1371/journal.pone.0166405] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 10/30/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Adolescent childbearing remains a major challenge to improving neonatal mortality especially in Sub Saharan countries which are still struggling with high neonatal mortality rates. We explored essential newborn care practices and associated factors among adolescent mothers in Western Uganda. METHODS Data were collected among 410 adolescent mothers with children aged one to six months in Hoima district. Three composite variables (appropriate neonatal breastfeeding, cord care and thermal protection) were derived by combining related practices from a list of recommended newborn care practices. Logistic regression analysis was conducted to identify factors independently associated with practice of essential newborn care. RESULTS Appropriate newborn feeding, optimal thermal protection and dry cord care were practiced by 60.5%, 67.2% and 31% of adolescent mothers respectively. Independent predictors' of cord care were: knowledge of cord care (AOR 5.34, 95% CI (1.51-18.84) and having delivered twins (AOR 0.04, 95% CI (0.01-0.22). The only predictor of thermal care was knowledge (AOR 25.15, 95% CI (7.01-90.20). Staying in a hospital for more than one day postpartum (AOR 2.45, 95%CI (1.23-4.86), knowledge of the correct time of breastfeeding initiation (AOR 14.71, 95% CI (5.20-41.58), predicted appropriate neonatal feeding, whereas; adolescent mothers who had had a caesarean delivery (AOR 0.19, 95% CI (I 0.04-0.96) and a male caretaker in the postnatal period (AOR 0.18, 95% CI (0.07-0.49) were less likely to practice the recommended newborn feeding. CONCLUSION Sub optimal essential newborn care practice was noted especially suboptimal cord care. Adolescent mothers should be a focus of strategies to improve maternal and neonatal health.
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Affiliation(s)
- Lydia Kabwijamu
- Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Peter Waiswa
- Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda
- Centre of Excellence for Maternal and Newborn Health, Makerere University College of Health Sciences School of Public Health, Kampala, Uganda
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Vincent Kawooya
- Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Christine K. Nalwadda
- Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Monica Okuga
- Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda
- Centre of Excellence for Maternal and Newborn Health, Makerere University College of Health Sciences School of Public Health, Kampala, Uganda
| | - Elizabeth L. Nabiwemba
- Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda
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17
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Owor MO, Matovu JKB, Murokora D, Wanyenze RK, Waiswa P. Factors associated with adoption of beneficial newborn care practices in rural Eastern Uganda: a cross-sectional study. BMC Pregnancy Childbirth 2016; 16:83. [PMID: 27101821 PMCID: PMC4840909 DOI: 10.1186/s12884-016-0874-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 04/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background Beneficial newborn care practices can improve newborn survival. However, little is known about the factors that affect adoption of these practices. Methods Cross-sectional study conducted among 1,616 mothers who had delivered in the past year in two health sub-districts (Luuka and Buyende) in Eastern Uganda. Data collection took place between November and December 2011. Data were collected on socio-demographic and economic characteristics, antenatal care visits, skilled delivery attendance, parity, distance to health facility and early newborn care knowledge and practices. Descriptive statistics were computed to determine the proportion of mothers who adopted beneficial newborn care practices (optimal thermal care; good feeding practices; weighing and immunizing the baby immediately after birth; and good cord care) during the neonatal period. We conducted multivariable logistic regression to assess the covariates of adoption of all beneficial newborn care practices. Analysis was done using STATA statistical software, version 12.1. Results Of the 1,616 mothers enrolled, 622 (38.5 %) were aged 25-34; 1,472 (91.1 %) were married; 1,096 (67.8 %) had primary education; while 1,357 (84 %) were laborers or peasants. Utilization of all beneficial newborn care practices was 11.7 %; lower in Luuka (9.4 %, n = 797) than in Buyende health sub-district (13.9 %, n = 819; p = 0.005). Good cord care (83.6 % in Luuka; 95 % in Buyende) and immunization of newborn (80.7 % in Luuka; 82.5 % in Buyende) were the most prevalent newborn care practices reported by mothers. At the multivariable analysis, number of ANC visits (3-4 vs. 1-2: Adjusted (Adj.) Odds Ratio (OR) = 1.69, 95 % CI = 1.13, 2.52), skilled delivery (Adj. OR = 2.66, 95 % CI = 1.92, 3.69), socio-economic status (middle vs. low: Adj. OR = 1.57, 95 % CI = 1.09, 2.26) were positively associated with adoption of all beneficial newborn care practices among mothers. Conclusion Adoption of all beneficial newborn care practices was low, although associated with higher ANC visits; middle-level socio-economic status and skilled delivery attendance. These findings suggest a need for interventions to improve quality ANC and skilled delivery attendance as well as targeting of women with low and high socio-economic status with newborn care health educational messages, improved work conditions for breastfeeding, and supportive policies at national level for uptake of newborn care practices.
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Affiliation(s)
- Michael O Owor
- Makerere University School of Public Health-CDC Fellowship Program, P.O. Box 7072, Kampala, Uganda. .,Baylor Uganda Children's Foundation, P.O. Box 72052, Kampala, Uganda.
| | - Joseph K B Matovu
- Makerere University School of Public Health-CDC Fellowship Program, P.O. Box 7072, Kampala, Uganda
| | - Daniel Murokora
- Baylor Uganda Children's Foundation, P.O. Box 72052, Kampala, Uganda
| | - Rhoda K Wanyenze
- Makerere University School of Public Health-CDC Fellowship Program, P.O. Box 7072, Kampala, Uganda
| | - Peter Waiswa
- Makerere University School of Public Health-CDC Fellowship Program, P.O. Box 7072, Kampala, Uganda.,Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
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Newborn Care Practices among Mother-Infant Dyads in Urban Uganda. Int J Pediatr 2015; 2015:815938. [PMID: 26713096 PMCID: PMC4680047 DOI: 10.1155/2015/815938] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/15/2015] [Accepted: 11/18/2015] [Indexed: 11/25/2022] Open
Abstract
Background. Most information on newborn care practices in Uganda is from rural communities which may not be generalized to urban settings. Methods. A community based cross-sectional descriptive study was conducted in the capital city of Uganda from February to May 2012. Quantitative and qualitative data on the newborn care practices of eligible mothers were collected. Results. Over 99% of the mothers attended antenatal care at least once and the majority delivered in a health facility. Over 50% of the mothers applied various substances to the cord of their babies to quicken the healing. Although most of the mothers did not bathe their babies within the first 24 hours of birth, the majority had no knowledge of skin to skin care as a thermoprotective method. The practice of bathing babies in herbal medicine was common (65%). Most of the mothers breastfed exclusively (93.2%) but only 60.7% initiated breastfeeding within the first hour of life, while a significant number (29%) used prelacteal feeds. Conclusion. The inadequate newborn care practices in this urban community point to the need to intensify the promotion of universal coverage of the newborn care practices irrespective of rural or urban communities and irrespective of health care seeking indicators.
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Adejuyigbe EA, Bee MH, Amare Y, Omotara BA, Iganus RB, Manzi F, Shamba DD, Skordis-Worrall J, Odebiyi A, Hill ZE. "Why not bathe the baby today?": A qualitative study of thermal care beliefs and practices in four African sites. BMC Pediatr 2015; 15:156. [PMID: 26466994 PMCID: PMC4607092 DOI: 10.1186/s12887-015-0470-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 10/02/2015] [Indexed: 01/21/2023] Open
Abstract
Background Recommendations for care in the first week of a newborn’s life include thermal care practices such as drying and wrapping, skin to skin contact, immediate breastfeeding and delayed bathing. This paper examines beliefs and practices related to neonatal thermal care in three African countries. Methods Data were collected in the same way in each site and included 16–20 narrative interviews with recent mothers, eight observations of neonatal bathing, and in-depth interviews with 12–16 mothers, 9–12 grandmothers, eight health workers and 0–12 birth attendants in each site. Results We found similarities across sites in relation to understanding the importance of warmth, a lack of opportunities for skin to skin care, beliefs about the importance of several baths per day and beliefs that the Vernix caseosa was related to poor maternal behaviours. There was variation between sites in beliefs and practices around wrapping and drying after delivery, and the timing of the first bath with recent behavior change in some sites. There was near universal early bathing of babies in both Nigerian sites. This was linked to a deep-rooted belief about body odour. When asked about keeping the baby warm, respondents across the sites rarely mentioned recommended thermal care practices, suggesting that these are not perceived as salient. Conclusion More effort is needed to promote appropriate thermal care practices both in facilities and at home. Programmers should be aware that changing deep rooted practices, such as early bathing in Nigeria, may take time and should utilize the current beliefs in the importance of neonatal warmth to facilitate behaviour change.
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Affiliation(s)
| | - Margaret Helen Bee
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Yared Amare
- Consultancy for Social Development, Addis Ababa, Ethiopia.
| | | | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Saalam, Tanzania.
| | | | - Jolene Skordis-Worrall
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | | | - Zelee Elizabeth Hill
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
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Sacks E, Moss WJ, Winch PJ, Thuma P, van Dijk JH, Mullany LC. Skin, thermal and umbilical cord care practices for neonates in southern, rural Zambia: a qualitative study. BMC Pregnancy Childbirth 2015; 15:149. [PMID: 26177637 PMCID: PMC4504223 DOI: 10.1186/s12884-015-0584-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 07/03/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In Choma District, southern Zambia, the neonatal mortality rate is approximately 40 per 1000 live births and, although the rate is decreasing, many deliveries take place outside of formal facilities. Understanding local practices during the postnatal period is essential for optimizing newborn care programs. METHODS We conducted 36 in-depth interviews, five focus groups and eight observational sessions with recently-delivered women, traditional birth attendants, and clinic and hospital staff from three sites, focusing on skin, thermal and cord care practices for newborns in the home. RESULTS Newborns were generally kept warm by application of hats and layers of clothing. While thermal protection is provided for preterm and small newborns, the practice of nighttime bathing with cold water was common. The vernix was considered important for the preterm newborn but dangerous for HIV-exposed infants. Mothers applied various substances to the skin and umbilical cord, with special practices for preterm infants. Applied substances included petroleum jelly, commercial baby lotion, cooking oil and breastmilk. The most common substances applied to the umbilical cord were powders made of roots, burnt gourds or ash. To ward off malevolent spirits, similar powders were reportedly placed directly into dermal incisions, especially in ill children. CONCLUSIONS Thermal care for newborns is commonly practiced but co-exists with harmful practices. Locally appropriate behavior change interventions should aim to promote chlorhexidine in place of commonly-reported application of harmful substances to the skin and umbilical cord, reduce bathing of newborns at night, and address the immediate bathing of HIV-infected newborns.
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Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, 615 North Wolfe Street, E8011, Baltimore, MD, 21205, USA.
- USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington, DC, USA.
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E6547, Baltimore, MD, 21205, USA.
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E5533, Baltimore, MD, 21205, USA.
| | - Philip Thuma
- Macha Research Trust, PO Box 630 166, Choma, Zambia.
| | | | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E5533, Baltimore, MD, 21205, USA.
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Mangwi Ayiasi R, Kasasa S, Criel B, Garimoi Orach C, Kolsteren P. Is antenatal care preparing mothers to care for their newborns? A community-based cross-sectional study among lactating women in Masindi, Uganda. BMC Pregnancy Childbirth 2014; 14:114. [PMID: 24667001 PMCID: PMC3987096 DOI: 10.1186/1471-2393-14-114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/14/2014] [Indexed: 11/28/2022] Open
Abstract
Background Neonatal mortality has remained resistant to change in the wake of declining child mortality. Suboptimal newborn care practices are predisposing factors to neonatal mortality. Adherence to four ANC consultations is associated with improved newborn care practices. There is limited documentation of this evidence in sub-Saharan Africa where suboptimal newborn care practices has been widely reported. Methods Structured interviews were held with 928 women having children under-five months old at their homes in Masindi, Uganda, from October-December 2011. Four/more ANC consultations (sufficient ANC) was considered the exposure variable. Three composite variables (complete cord care, complete thermal care and complete newborn vaccination status) were derived by combining related practices from a list of recommended newborn care practices. Logistic regression models were used to assess for associations. Results One in five women 220(23.7%) were assessed to practice complete cord care. Less than ten percent 57(6.1%) were considered to practice complete thermal care and 611(65.8%) were assessed to have complete newborn vaccination status. Application of substance on the cord 744 (71.6%) and early bathing 816 (87.9%) were main drivers of sub-optimal newborn care practices. Multivariable logistic models did not demonstrate significant association between four/more ANC consultations and complete cord care, complete thermal care or complete newborn vaccination status. Secondary or higher education was associated with complete cord care [adjusted Odds Ratio (aOR): 2.72; 95% CI: 1.63-4.54] and complete newborn vaccination [aOR: 1.37; 95% CI: 1.04-1.82]. Women who reported health facility delivery were more likely to report complete thermal care [aOR: 3.63; 95% CI: 2.21-5.95] and newborn vaccination [aOR: 1.84; 95% CI: 1.23-2.75], but not complete cord care. Having the first baby was associated with complete thermal care [aOR: 2.00; 95% CI: 1.24-3.23]. Conclusion Results confirm suboptimal newborn care practices in Masindi. Despite being established policy, adherence to four or more ANC consultations was not associated with complete cord care, complete thermal care or complete newborn vaccination. This finding has important implications for the implementation of focused ANC to improve newborn care practices. Future ANC interventions should focus on addressing application of substance on the cord and early bathing of the baby during the immediate neonatal period.
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Affiliation(s)
- Richard Mangwi Ayiasi
- Makerere University School of Public Health, College of Health Sciences, Kampala Uganda, P, O, Box 7072, Kampala, Uganda.
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Ayiasi MR, Van Royen K, Verstraeten R, Atuyambe L, Criel B, Garimoi CO, Kolsteren P. Exploring the focus of prenatal information offered to pregnant mothers regarding newborn care in rural Uganda. BMC Pregnancy Childbirth 2013; 13:176. [PMID: 24041135 PMCID: PMC3848633 DOI: 10.1186/1471-2393-13-176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 09/13/2013] [Indexed: 11/13/2022] Open
Abstract
Background Neonatal death accounts for one fifth of all under-five mortality in Uganda. Suboptimal newborn care practices resulting from hypothermia, poor hygiene and delayed initiation of breastfeeding are leading predisposing factors. Evidence suggests focused educational prenatal care messages to mitigate these problems. However, there is a paucity of data on the interaction between the service provider and the prenatal service user. This study aims to understand the scope of educational information and current practices on newborn care from the perspectives of prenatal mothers and health workers. Methods A qualitative descriptive methodology was used. In-depth interviews were conducted with lactating mothers (n = 31) of babies younger than five months old across Masindi in western Uganda. Additional interviews with health workers (n = 17) and their employers or trainers (n = 5) were conducted to strengthen our findings. Data were audio-taped and transcribed verbatim. A thematic content analysis was performed using NVivo 8. Results Vertical programmes received more attention than education for newborn care during prenatal sessions. In addition, attitudinal and communication problems existed among health workers thereby largely ignoring the fundamental principles of patient autonomy and patient-centred care. The current newborn care practices were largely influenced by relatives’ cultural beliefs rather than by information provided during prenatal sessions. There is a variation in the training curriculum for health workers deployed to offer recommended prenatal and immediate newborn care in the different tiers of health care. Conclusions Findings revealed serious deficiencies in prenatal care organisations in Masindi. Pregnant mothers remain inadequately prepared for childbirth and newborn care, despite their initiative to follow prenatal sessions. These findings call for realignment of prenatal care by integrating education on newborn care practices into routine antenatal care services and be based on principles of patient-centred care.
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Affiliation(s)
- Mangwi Richard Ayiasi
- Mulago hospital complex, Makerere University School of Public Health, P,O Box 7072, Kampala, Uganda.
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Mbonye AK, Sentongo M, Mukasa GK, Byaruhanga R, Sentumbwe-Mugisa O, Waiswa P, Naamala Sengendo H, Aliganyira P, Nakakeeto M, Lawn JE, Kerber K. Newborn survival in Uganda: a decade of change and future implications. Health Policy Plan 2012; 27 Suppl 3:iii104-117. [PMID: 22692413 DOI: 10.1093/heapol/czs045] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Each year in Uganda 141 000 children die before reaching their fifth birthday; 26% of these children die in their first month of life. In a setting of persistently high fertility rates, a crisis in human resources for health and a recent history of civil unrest, Uganda has prioritized Millennium Development Goals 4 and 5 for child and maternal survival. As part of a multi-country analysis we examined change for newborn survival over the past decade through mortality and health system coverage indicators as well as national and donor funding for health, and policy and programme change. Between 2000 and 2010 Uganda's neonatal mortality rate reduced by 2.2% per year, which is greater than the regional average rate of decline but slower than national reductions in maternal mortality and under-five mortality after the neonatal period. While existing population-based data are insufficient to measure national changes in coverage and quality of services, national attention for maternal and child health has been clear and authorized from the highest levels. Attention and policy change for newborn health is comparatively recent. This recognized gap has led to a specific focus on newborn health through a national Newborn Steering Committee, which has been given a mandate from the Ministry of Health to advise on newborn survival issues since 2006. This multi-disciplinary and inter-agency network of stakeholders has been able to preside over a number of important policy changes at the level of facility care, education and training, community-based service delivery through Village Health Teams and changes to essential drugs and commodities. The committee's comprehensive reach has enabled rapid policy change and increased attention to newborn survival in a relatively short space of time. Translating this favourable policy environment into district-level implementation and high quality services is now the priority.
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