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Oluoch D, Hinton L, English M, Irimu G, Onyango T, Jones COH. Mothers' involvement in providing care for their hospitalised sick newborns in Kenya: a focused ethnographic account. BMC Pregnancy Childbirth 2023; 23:389. [PMID: 37237328 DOI: 10.1186/s12884-023-05686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION There is growing evidence that parental participation in the care of small and sick newborns benefits both babies and parents. While studies have investigated the roles that mothers play in newborn units in high income contexts (HIC), there is little exploration of how contextual factors interplay to influence the ways in which mothers participate in the care of their small and sick newborn babies in very resource constrained settings such as those found in many countries in sub-Saharan Africa. METHODS Ethnographic methods (observations, informal conversations and formal interviews) were used to collect data during 627 h of fieldwork between March 2017 and August 2018 in the neonatal units of one government and one faith-based hospital in Kenya. Data were analysed using a modified grounded theory approach. RESULTS There were marked differences between the hospitals in the participation by mothers in the care of their sick newborn babies. The timing and types of caring task that the mothers undertook were shaped by the structural, economic and social context of the hospitals. In the resource constrained government funded hospital, the immediate informal and unplanned delegation of care to mothers was routine. In the faith-based hospital mothers were initially separated from their babies and introduced to bathing and diaper change tasks slowly under the close supervision of nurses. In both hospitals appropriate breast-feeding support was lacking, and the needs of the mothers were largely ignored. CONCLUSION In highly resource constrained hospitals with low nurse to baby ratios, mothers are required to provide primary and some specialised care to their sick newborns with little information or support on how undertake the necessary tasks. In better resourced hospital settings, most caring tasks are initially performed by nurses leaving mothers feeling powerless and worried about their capacity to care for their babies after discharge. Interventions need to focus on how to better equip hospitals and nurses to support mothers in caring for their sick newborns, promoting family centred care.
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Affiliation(s)
- Dorothy Oluoch
- Centre for Geographic Medicine (Coast), KEMRI-Wellcome Trust research programme, Nairobi, Kenya.
| | - Lisa Hinton
- THIS Institute, University of Cambridge, Cambridge, UK
| | - Mike English
- Centre for Geographic Medicine (Coast), KEMRI-Wellcome Trust research programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, NUFFIELD department of medicine, University of Oxford, Oxford, UK
| | - Grace Irimu
- Centre for Geographic Medicine (Coast), KEMRI-Wellcome Trust research programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Truphena Onyango
- Centre for Geographic Medicine (Coast), KEMRI-Wellcome Trust research programme, Nairobi, Kenya
| | - Caroline O H Jones
- Centre for Geographic Medicine (Coast), KEMRI-Wellcome Trust research programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, NUFFIELD department of medicine, University of Oxford, Oxford, UK
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Haenssgen MJ, Charoenboon N, Zanello G, Mayxay M, Reed-Tsochas F, Jones COH, Kosaikanont R, Praphattong P, Manohan P, Lubell Y, Newton PN, Keomany S, Wertheim HFL, Lienert J, Xayavong T, Warapikuptanun P, Khine Zaw Y, U-Thong P, Benjaroon P, Sangkham N, Wibunjak K, Chai-In P, Chailert S, Thavethanutthanawin P, Promsutt K, Thepkhamkong A, Sithongdeng N, Keovilayvanh M, Khamsoukthavong N, Phanthasomchit P, Phanthavong C, Boualaiseng S, Vongsavang S, Greer RC, Althaus T, Nedsuwan S, Intralawan D, Wangrangsimakul T, Limmathurotsakul D, Ariana P. Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion. BMJ Glob Health 2018; 3:e000621. [PMID: 29629190 PMCID: PMC5884330 DOI: 10.1136/bmjgh-2017-000621] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/01/2018] [Accepted: 02/14/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global health priority. Leading UK and global strategy papers to fight AMR recognise its social and behavioural dimensions, but current policy responses to improve the popular use of antimicrobials (eg, antibiotics) are limited to education and awareness-raising campaigns. In response to conceptual, methodological and empirical weaknesses of this approach, we study people's antibiotic-related health behaviour through three research questions.RQ1: What are the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways?RQ2: Will people's exposure to antibiotic awareness activities entail changed behaviours that diffuse or dissipate within a network of competing healthcare practices?RQ3: Which proxy indicators facilitate the detection of problematic antibiotic behaviours across and within communities? METHODS We apply an interdisciplinary analytical framework that draws on the public health, medical anthropology, sociology and development economics literature. Our research involves social surveys of treatment-seeking behaviour among rural dwellers in northern Thailand (Chiang Rai) and southern Lao PDR (Salavan). We sample approximately 4800 adults to produce district-level representative and social network data. Additional 60 cognitive interviews facilitate survey instrument development and data interpretation. Our survey data analysis techniques include event sequence analysis (RQ1), multilevel regression (RQ1-3), social network analysis (RQ2) and latent class analysis (RQ3). DISCUSSION Social research in AMR is nascent, but our unprecedentedly detailed data on microlevel treatment-seeking behaviour can contribute an understanding of behaviour beyond awareness and free choice, highlighting, for example, decision-making constraints, problems of marginalisation and lacking access to healthcare and competing ideas about desirable behaviour. TRIAL REGISTRATION NUMBER NCT03241316; Pre-results.
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Affiliation(s)
- Marco J Haenssgen
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK
- Green Templeton College, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nutcha Charoenboon
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Giacomo Zanello
- School of Agriculture, Policy and Development, University of Reading, Reading, UK
| | - Mayfong Mayxay
- Lao Oxford Mahosot Wellcome Trust Research Unit (LOMWRU), Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Laos
| | - Felix Reed-Tsochas
- CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK
- Institute for New Economic Thinking, Oxford Martin School, University of Oxford, Oxford, UK
- Department of Sociology, University of Oxford, Oxford, UK
| | - Caroline O H Jones
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Department of Health System and Research Ethics, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Romyen Kosaikanont
- School of Social Innovation, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Pathompong Manohan
- School of Social Innovation, Mae Fah Luang University, Chiang Rai, Thailand
| | - Yoel Lubell
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul N Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Lao Oxford Mahosot Wellcome Trust Research Unit (LOMWRU), Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Heiman F L Wertheim
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Medical Microbiology Department, Radboudumc, Nijmegen, The Netherlands
| | - Jeffrey Lienert
- CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Thipphaphone Xayavong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Penporn Warapikuptanun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Yuzana Khine Zaw
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Patchapoom U-Thong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Patipat Benjaroon
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Narinnira Sangkham
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kanokporn Wibunjak
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Poowadon Chai-In
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sirirat Chailert
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Krittanon Promsutt
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Amphayvone Thepkhamkong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicksan Sithongdeng
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Maipheth Keovilayvanh
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nid Khamsoukthavong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phaengnitta Phanthasomchit
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chanthasone Phanthavong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Somsanith Boualaiseng
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Souksakhone Vongsavang
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rachel C Greer
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thomas Althaus
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Supalert Nedsuwan
- Primary Care Department, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Daranee Intralawan
- Primary Care Department, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Tri Wangrangsimakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Direk Limmathurotsakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Proochista Ariana
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Oluoch DA, Mwangome N, Kemp B, Seale AC, Koech A, Papageorghiou AT, Berkley JA, Kennedy SH, Jones COH. "You cannot know if it's a baby or not a baby": uptake, provision and perceptions of antenatal care and routine antenatal ultrasound scanning in rural Kenya. BMC Pregnancy Childbirth 2015; 15:127. [PMID: 26021564 PMCID: PMC4446960 DOI: 10.1186/s12884-015-0565-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 05/18/2015] [Indexed: 11/26/2022] Open
Abstract
Background Antenatal care early in pregnancy enables service providers to identify and manage risks to mother and fetus. In the global north, ultrasound scans are routinely offered in pregnancy to provide an accurate estimate of gestational age and identify potential problems. In sub-Saharan Africa, such services are rarely available and women often delay initiating antenatal care. This study describes the uptake and provision of antenatal care in a rural Kenyan hospital and explores how pregnant women and healthcare providers perceived the provision of ultrasound scanning, following its introduction in an international foetal growth study. Methods A descriptive study, using qualitative and quantitative methods, was conducted in Kilifi District Hospital, Kenya, between June 2011 and April 2012. In-depth interviews were conducted with 10 nurses working in the antenatal clinic (ANC) and 59 pregnant women attending ANC. Structured observations of 357 ANC consultations and 30 ultrasound scans were made. Results Women sought antenatal care for information about the health of their baby and the protection provided by the ANC services. Uncertainty about pregnancy status contributed to delay in ANC attendance; more than 78 % of women were over 20 weeks’ gestation at their first visit. Healthcare workers found it difficult to detect pregnancies below 16 weeks gestation and, accurate assessment of gestational age below 20 weeks’ gestation could be problematic. Provision of services depended on the pregnancy being detected and gestational age assessed. The “seeing”, made possible through ultrasound scanning was perceived by pregnant women and healthcare workers to be beneficial: confirming the pregnancy, and providing reassurance about the fetus’ condition. Few participants raised concerns about ultrasound scanning. Conclusions Uncertainty about pregnancy status and gestational age for women and healthcare providers is a key factor influencing timing of ANC attendance, contributing to delays and restricting early provision of ANC services. Ultrasound scanning was perceived to enhance antenatal care through confirmation of pregnancy status and enabling more accurate estimation of gestational age and the health status of the fetus. There is a need to make available more affordable means of pregnancy testing as a strategy towards encouraging early attendance, and delivery of antenatal care.
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Affiliation(s)
- Dorothy A Oluoch
- KEMRI-Wellcome Trust Research Programme, Coast Centre for Geographic Medicine and Research, Kilifi, Kenya.
| | - Nancy Mwangome
- KEMRI-Wellcome Trust Research Programme, Coast Centre for Geographic Medicine and Research, Kilifi, Kenya.
| | - Bryn Kemp
- KEMRI-Wellcome Trust Research Programme, Coast Centre for Geographic Medicine and Research, Kilifi, Kenya. .,Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK.
| | - Anna C Seale
- KEMRI-Wellcome Trust Research Programme, Coast Centre for Geographic Medicine and Research, Kilifi, Kenya. .,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Angela Koech
- KEMRI-Wellcome Trust Research Programme, Coast Centre for Geographic Medicine and Research, Kilifi, Kenya.
| | - Aris T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK. .,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Coast Centre for Geographic Medicine and Research, Kilifi, Kenya. .,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Stephen H Kennedy
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK. .,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.
| | - Caroline O H Jones
- KEMRI-Wellcome Trust Research Programme, Coast Centre for Geographic Medicine and Research, Kilifi, Kenya. .,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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