Neonatal care practices in Buikwe District, Uganda: a qualitative study

Abstract Background Sub-Saharan Africa is the region with the highest neonatal mortality rate, with Uganda reporting 20 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period. The objective of the study was to identify provider and user perspectives regarding the knowledge of and adherence to the UCG recommendations in aspects of delivery and newborn care, both in cases of normal as well as complicated births. Methods The study used qualitative methods with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis. Results The study found low knowledge about the UCG among the health workers. Various discrepancies between performed hands-on-procedures and the UCG were found related to neonatal care practices, including low use of partograms, uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of skin-to-skin care. Conclusions Continued focus on systemic strategies for further implementation of the UCG is recommended.

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Neonatal care practices in Buikwe District, Uganda: A qualitative study

10.21203/rs.3.rs-70855/v2 ◽

2021 ◽

Author(s):

Marte Bodil Roed ◽

Ingunn Marie Stadkleiv Engebretsen ◽

Robert Mangeni

Keyword(s):

Health Workers ◽

Post Partum ◽

Newborn Care ◽

Neonatal Care ◽

Sub Saharan Africa ◽

Cord Clamping ◽

Care Practices ◽

Sub Saharan ◽

Skin To Skin ◽

User Perspectives

Abstract Background: Sub-Saharan Africa is the region with the highest neonatal mortality rate, with Uganda reporting 20 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period. The objective of the study was to identify provider and user perspectives regarding the knowledge of and adherence to the UCG recommendations in aspects of delivery and newborn care, both in cases of normal as well as complicated births. Methods: The study used qualitative methods with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis. Results: The study found low knowledge about the UCG among the health workers. Various discrepancies between performed hands-on-procedures and the UCG were found related to neonatal care practices, including low use of partograms, uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of skin-to-skin care. Conclusions: Continued focus on systemic strategies for further implementation of the UCG is recommended.

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Neonatal care practices in Buikwe District, Uganda: A qualitative study

10.21203/rs.3.rs-70855/v1 ◽

2020 ◽

Author(s):

Marte Bodil Roed ◽

Ingunn Marie Stadkleiv Engebretsen ◽

Robert Mangeni

Keyword(s):

Qualitative Method ◽

Post Partum ◽

Neonatal Care ◽

Sub Saharan Africa ◽

Group Discussions ◽

Kangaroo Care ◽

Cord Clamping ◽

Hands On ◽

Care Practices ◽

Sub Saharan

Abstract Background: Sub-Saharan Africa is the region with the highest neonatal mortality rate, with 27 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period, both in cases of normal as well as complicated births.Methods: The study used a qualitative method with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis.Results: The study found various discrepancies between performed hands-on-procedures and the UCG related to neonatal care practices, including uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of kangaroo care.Conclusions: Continued focus on systemic strategies for further implementation of the UCG is recommended

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The Impact of the World Health Organization Essential Newborn Package on Newborn Care Practices and Survival Rates in Sub-Saharan Africa: A Systematic Literature Review

International Journal of Childbirth ◽

10.1891/2156-5287.9.1.19 ◽

2019 ◽

Vol 9 (1) ◽

pp. 19-29

Author(s):

Andy Emmanuel ◽

Victoria Kain ◽

Elizabeth Forster

Keyword(s):

Systematic Review ◽

Health Workers ◽

Newborn Care ◽

Sub Saharan Africa ◽

World Health ◽

Essential Newborn Care ◽

The World ◽

Sub Saharan ◽

Health Organization ◽

The Impact

Sub-Saharan Africa, has the highest child mortality rate in the world (World Health Organization [WHO], 2016). However, there is a paucity of current systematic reviews on the impact of essential newborn care interventions in Africa. Therefore, the aim of this systematic review was to summarize evidence about the impact of essential newborn care interventions in Africa. Numerous databases were searched to retrieve articles that reported interventions in newborn care in Africa. The search was limited to the English language and to articles published between 2007 and 2017. Nine articles were selected for inclusion in this systematic review. Overall, these papers demonstrated an increase in performance of health workers (between 8 and 400%) following a test of knowledge, while health workers practical performance increased by 34%. Moreover, neonatal mortality was reduced by 45%, while perinatal mortality was reduced by 30%. Training healthcare workers is one of the most effective ways of improving newborn care and neonatal survival in Africa. However, there is a need for additional evidence to support this, because none of the reviewed studies assessed the impact of training by examining variables such as trainees' satisfaction with training, the knowledge and skills developed, and the health outcomes achieved.

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Reduced Incidence of Maternal Health Conditions Associated with the Home-Based Newborn Care Intervention Package in Rural Gadchiroli, India: A 13 Years Before – After Comparison

10.21203/rs.3.rs-38678/v1 ◽

2020 ◽

Author(s):

Anand A Bang ◽

Abhay T Bang ◽

Rani Bang ◽

Mahesh Deshmukh ◽

Kalindi Soni ◽

...

Keyword(s):

Maternal Health ◽

Field Trial ◽

Health Workers ◽

Post Partum ◽

Newborn Care ◽

Emergency Obstetric Care ◽

Neonatal Care ◽

Health Conditions ◽

Intervention Package ◽

Home Based

Abstract ObjectiveTo assess the association of home-based neonatal care interventions with the incidence of various maternal health conditions observed over 13 years in the intervention area of the field-trial of home-based neonatal care. MethodsThis was a retrospective analysis of a program implemented in thirty-nine villages in Gadchiroli, India. The home-based newborn care interventions were incrementally introduced during the field trial (1995 – 1998) and subsequently continued as a service program till 2008. Pregnant women were recruited over the thirteen year period (1995–2008) and followed up from the seventh month of pregnancy to 28 days postpartum by trained female community health workers who made antenatal, natal and post-natal home visits (total 10), provided health education to mothers for behavior change, managed normal and sick neonates as well as encouraged seeking medical care when necessary. They recorded maternal signs and symptoms; verified by a supervisory physician. Based on these, a computer algorithm diagnosed 20 types of maternal health conditions. The incidence of the conditions in the first year (1995-96) was compared with the last two years (2006 - 2008) of intervention.ResultThe mean coverage of home-based newborn care, assessed on eight indicators, increased from 48.5% in 1995 – 96 to 87.1% in 2006 – 08. Proportion of women with any maternal health conditions in pregnancy reduced from 40.67% to 22.47% (by 44.76%, p < 0.001), in labor reduced from 12.31% to 6.82% (by 44.59%, p <0.001) and during the post-partum from 43.91% to 9.74% (by 77.82%, p <0.001). Mean number of maternal conditions per 100 women reduced from 140 to 44 (by 69%, p < 0.001). Need for emergency obstetric care reduced from 5.83% to 1.23% (by 78.83%, p < 0.001). Proportion of condition free mothers increased from 32.9 % to 64.6 %.ConclusionHome based neonatal care interventions were associated with significant reduction in the incidence of maternal health conditions. Developing home-based maternal care in combination with neonatal care may considerably improve maternal health.

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Neonatal care practices in sub-Saharan Africa: a systematic review of quantitative and qualitative data

Journal of Health Population and Nutrition ◽

10.1186/s41043-018-0141-5 ◽

2018 ◽

Vol 37 (1) ◽

Cited By ~ 8

Author(s):

Margaret Bee ◽

Anushree Shiroor ◽

Zelee Hill

Keyword(s):

Systematic Review ◽

Qualitative Data ◽

Neonatal Care ◽

Sub Saharan Africa ◽

Care Practices ◽

Sub Saharan

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Reducing Geographical Imbalances of Health Workers in Sub-Saharan Africa

10.1596/978-0-8213-8599-9 ◽

2010 ◽

Cited By ~ 7

Author(s):

Christophe Lemiere ◽

Christopher Herbst ◽

Negda Jahanshahi ◽

Ellen Smith ◽

Agnest Souca

Keyword(s):

Health Workers ◽

Sub Saharan Africa ◽

Sub Saharan

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Protocol for a scoping review to identify and map in-service education and training materials for midwifery care in sub-Saharan Africa from 2000 to 2020

BMJ Open ◽

10.1136/bmjopen-2020-047118 ◽

2021 ◽

Vol 11 (3) ◽

pp. e047118

Author(s):

Joanne Welsh ◽

Mechthild M Gross ◽

Claudia Hanson ◽

Hashim Hounkpatin ◽

Ann-Beth Moller

Keyword(s):

Scoping Review ◽

Maternal Mortality Ratio ◽

Newborn Care ◽

Education And Training ◽

Sub Saharan Africa ◽

Midwifery Care ◽

Training Materials ◽

Service Training ◽

Sub Saharan ◽

And Training

IntroductionMaternal and neonatal mortality are disproportionally high in low-and middle-income countries. In 2017 the global maternal mortality ratio was estimated to be 211 per 100 000 live births. An estimated 66% of these deaths occurred in sub-Saharan Africa. Training programmes that aim to prepare providers of midwifery care vary considerably across sub-Saharan Africa in terms of length, content and quality. To overcome the shortfalls of pre-service training and support the provision of quality care, in-service training packages for providers of midwifery care have been developed and implemented in many countries in sub-Saharan Africa. We aim to identify what in-service education and training materials have been used for providers of midwifery care between 2000 and 2020 and map their content to the International Confederation of Midwives’ Essential Competencies for Midwifery Practice (ICM Competencies), and the Lancet Midwifery Series Quality Maternal and Newborn Care (QMNC) framework.Methods and analysisA search will be conducted for the years 2000–2020 in Cumulative Index of Nursing and Allied Health Literature, PubMed/MEDLINE, Social Sciences Citation Index, African Index Medicus and Google Scholar. A manual search of reference lists from identified studies and a hand search of literature from international partner organisations will be performed. Information retrieved will include study context, providers trained, focus of training and design of training. Original content of identified education and training materials will be obtained and mapped to the ICM Competencies and the Lancet Series QMNC.Ethics and disseminationA scoping review is a secondary analysis of published literature and does not require ethical approval. This scoping review will give an overview of the education and training materials used for in-service training for providers of midwifery care in sub-Saharan Africa. Mapping the content of these education and training materials to the ICM Competencies and The Lancet Series QMNC will allow us to assess their appropriateness. Findings from the review will be reflected to stakeholders involved in the design and implementation of such materials. Additionally, findings will be published in a peer-reviewed journal, and used to inform the design and content of an in-service training package for providers of midwifery care as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) study, (https://alert.ki.se/) a multi-country study in Benin, Malawi, Tanzania and Uganda.Trial registration numberPACTR202006793783148; Post-results.

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Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03421-w ◽

2021 ◽

Vol 21 (S1) ◽

Cited By ~ 2

Author(s):

Tazeen Tahsina ◽

◽

Aniqa Tasnim Hossain ◽

Harriet Ruysen ◽

Ahmed Ehsanur Rahman ◽

...

Keyword(s):

Newborn Care ◽

Health Indicators ◽

Newborn Health ◽

Public Hospitals ◽

Maternal And Newborn Health ◽

Delayed Cord Clamping ◽

Cord Clamping ◽

Improve Measurement ◽

Immediate Newborn Care ◽

Skin To Skin

Abstract Background Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. “Every Newborn Birth Indicators Research Tracking in Hospitals” (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF. Methods The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women’s exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording. Results Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8–21.0). Survey-reported (53.2, 95% CI 39.4–66.8) and register-recorded results (85.9, 95% CI 58.1–99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5–93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3–73.5%) and drying (7.3–29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5–3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting. Conclusions Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.

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Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in sub-Saharan Africa: a systematic review

Reproductive Health ◽

10.1186/s12978-021-01183-y ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Lesley Rose Ninsiima ◽

Isabel Kazanga Chiumia ◽

Rawlance Ndejjo

Keyword(s):

Reproductive Health ◽

Health Services ◽

Sexual And Reproductive Health ◽

Health Workers ◽

Sub Saharan Africa ◽

Inclusion Criteria ◽

Reproductive Health Services ◽

Factors Influencing ◽

Sub Saharan ◽

Youth Friendly

Abstract Background Despite the global agreements on adolescents’ sexual and reproductive health and rights, access to and utilisation of these services among the youth/adolescents remain unsatisfactory in low- and middle-income countries which are a significant barrier to progress in this area. This review established factors influencing access and utilisation of youth-friendly sexual and reproductive health services (YFSRHS) among the youth in sub-Saharan Africa to inform programmatic interventions. Methodology A systematic review of studies published between January 2009 and April 2019 using PubMed, Web of Science, EMBASE, Medline, and Cochrane Library, and Google Scholar databases was conducted. Studies were screened based on the inclusion criteria of barriers and facilitators of implementation of YFSRHS, existing national policies on provision of YFSRHS, and youth’s perspectives on these services. Findings A total of 23,400 studies were identified through database search and additional 5 studies from other sources. After the full-text screening, 20 studies from 7 countries met the inclusion criteria and were included in the final review. Structural barriers were the negative attitude of health workers and their being unskilled and individual barriers included lack of knowledge among youth regarding YFSRHS. Facilitators of utilisation of the services were mostly structural in nature which included community outreaches, health education, and policy recommendations to improve implementation of the quality of health services and clinics for adolescents/youth to fit their needs and preferences. Conclusion Stakeholder interventions focusing on implementing YFSRHS should aim at intensive training of health workers and put in place quality implementation standard guidelines in clinics to offer services according to youth’s needs and preferences. In addition, educating the youth through community outreaches and health education programs for those in schools can facilitate utilisation and scale up of the service.

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