Approaches at Community Level for Care of the Preterm Neonates in Low-Income Countries

The survival of preterm babies has significantly improved over the last several decades in the high-income countries because of the availability of Neonatal Intensive Care Units (NICU’s) in both large and small hospitals, presence of specially trained physicians, nurses, and other health care personnel with easy access to sophisticated equipment. However, the bigger public health advances that saw improvements in socio-economic status of the populations, improvements in education and sanitation conditions and reductions in malnutrition and rates of infectious diseases were probably the main reasons for this improved survival rates for preterm neonates. Low in-come countries are currently highest bearers of the burden of preterm morbidity and mortality. The current preventive and care interventions do not reach all the neonates and their mothers, the coverage has remained low, access is poor and the quality of care is low. The aim of this chapter is to propose ideas on how the current preterm neonatal care interventions can be adapted for community scale up through community-based health system structures like community health workers to improve survival of neonates who have been delivered from home or after they have been discharged from hospital

Mothers’ perceptions of the practice of kangaroo mother care for preterm neonates in sub-Saharan Africa : a qualitative systematic review protocol

Kangaroo mother care (KMC) has been identified as an alternative way to care for low-birthweight (LBW) and preterm neonates. It promotes parent-child bonding and breastfeeding, and stabilizes the vital signs of the neonate, particularly body temperature and heart and respiratory rates, leading to increased weight gain and improved growth. KMC reduces the need for expensive conventional medical care, improves parental involvement in care provision and offers opportunities for health education. The article proposes a systematic review of the literature to identify barriers and to facilitate uptake of KMC

Maternal and neonatal health care service utilisation in the wake of active conflict and socio-economic downturn in Torit County, Republic of South Sudan: a multimethod locally driven study

Recurrent conflicts and economic downturn hamper access to health care. We examined how renewed conflict in July 2016 in Torit County, South Sudan affected health facility utilization for pregnancy care. We analyzed key quantitative indicators before and since renewed conflict through monthly facility data covering January 2015 to December 2016 on Antenatal Care (ANC) visits, facility-based births, and major obstetric complications. A qualitative descriptive study explored perceptions on access through key informant interviews and focused group discussions. ANC visits declined by 21%; health facility births declined from 23.6% to 16.7% while the proportion of all obstetric complications treated declined from 58.9% to 43.9%. Lack of human resources, inadequate medicines supply, perceived poor quality of care and economic hardships were the main factors affecting access to care. Our multidisciplinary and multistakeholder approach and leadership by South Sudanese team members enhanced research quality and its potential impact on practice and policy.   Les conflits armés récurrents et la récession économique entravent l'accès aux services de santé. Au mois de juillet 2016, des conflits armés ont repris au Soudan du Sud. Nous avons mené une étude mixte sur l’impact de la reprise des conflits armés de 2016 sur l’utilisation des services de santé maternelle dans le comté de Torit au Soudan du Sud. La composante quantitative a évalué les consultations prénatales, les accouchements en milieu hospitalier, et les complications obstétricales majeures. Nous avons consulté les données des établissements de santé durant la période de janvier 2015 à décembre 2016. La composante qualitative a exploré les perceptions de l’accès aux services de santé. Nous avons mené des entretiens individuels et des groupes de discussion avec des informateurs clés (ministère de la Santé du comté de Torit, gestionnaires et professionnels de la santé, membres d’organisations non gouvernementales).Les résultats quantitatifs ont montré que les consultations prénatales ont diminué de 21%. Les accouchements en milieu hospitalier sont passés de 23.6% à 16.7% tandis que la proportion des complications obstétricales majeures traitées est passée de 58.9% à 43.9%. L’absence des ressources humaines en santé, les problèmes d’approvisionnement en médicaments, la qualité perçue des soins, et le manque de ressources économiques des ménages sont les principaux facteurs influençant l’accès aux services de santé maternelle. L’implication des décideurs politiques, la multidisciplinarité de l’équipe de recherche et le leadership des membres de l’équipe sud-soudanaise ont contribué à améliorer la qualité de la recherche et à son impact potentiel sur les pratiques et les politiques sanitaire

Health policy mapping and system gaps impeding the implementation of reproductive, maternal, neonatal, child, and adolescent health programs in South Sudan : a scoping review

Conflict-affected settings impact the implementation of effective reproductive, maternal, newborn, child, and adolescent health (RMNCAH) programs and policies. Pregnant women, neonates, children, and adolescents are at higher risk of dying in fragile and conflict-affected settings. The article provides health policy background and context details charting RMNCAH data. South Sudan remains one of the most volatile states in the world. Ministry of Health (MoH) leadership along with enhanced governance and accountability mechanisms are key determinants for strengthened health systems. Due to the instability of the country and multiple international partner dynamics, the policy context changes quickly.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Exploring the impact of a community participatory intervention on women’s capability : a qualitative study in Gulu Northern Uganda

Community-based women’s groups using a participatory learning and action (PLA) cycle are effective in promoting maternal and child health. The PLA women’s group intervention encouraged health promotion activities and community mobilization in Gulu district, Uganda (2017). This area has a high burden of unmet needs in family planning, neonatal mortality, teenage pregnancy, and child mortality. The women’s group enabled participants to adopt behaviours to protect their health and their children’s health at individual and community levels. Women extended their agency to control financial resources and developed strategies to stop domestic violence. As a result, there was a reduction in mistreatment of children.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

“Midwives do not appreciate pregnant women who come to the maternity with torn and dirty clothing” : institutional delivery and postnatal care in Torit County, South Sudan - a mixed method study

This detailed study examines the prevalence of factors that affect utilization of health facilities for routine delivery and postnatal care in Torit County, South Sudan. Women were more likely to plan and prepare for home delivery than for institutional delivery, and sought institutional delivery when complications arose. Perceived poor quality of care due to absence of health personnel and lack of supplies was reported as a major barrier to institutional delivery. Women emphasized fear of discrimination based on social and economic status. All categories of participants reported insecurity, distance and the lack of transport as important deterrents to access for health care services.Foreign Affairs, Trade and Development Canada (DFATD)Canadian Institutes of Health Research (CIHR

Why women die after reaching the hospital : a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda

After reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving emergency obstetrics and newborn care (EmONC). Five reasons were identified: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways. Improvement of skills, better management of meagre human resources, and availability of essential medical supplies in health facilities may help increase emergency readiness

Maternal socio-economic and neonatal medical characteristics associated with survival of preterm neonates in Torit State Hospital, South Sudan: a descriptive cross-sectional study

Introduction: One in 10 babies is born preterm globally. Preterm birth is a major cause of mortality among children under 5 years old especially in sub-Saharan Africa. The socio-economic and clinical characteristics associated with survival of preterm babies admitted in Torit State Hospital are unknown. This study describes these characteristics to inform quality-of-care initiatives to improve preterm neonatal care. Method: A retrospective study was conducted of the medical records of 67 preterm neonates admitted from 1st January to 31st December 2021. Neonatal outcome at discharge was recorded as alive, dead, or absconded while neonatal clinical and maternal socio-economic characteristics were recorded as independent variables. The data were analysed using SPSS Statistics software version 21. Descriptive statistics including frequencies and proportions were calculated. Differences in the proportions were tested using the chi-squared statistic. All significance levels were set at p ≤ 0.05. Results: Of the 67 preterm babies admitted, 47 (70.1%) were discharged alive with a significant increase in body weight, 18 (26.9%) died and the outcomes of two patients were not recorded. The ability to suckle at the time of admission (p=0.01) and having a mother educated to at least primary level (p=0.035) were significantly associated with higher preterm survival. Conclusions: Premature mortality was common among preterm babies who were not able to suckle at the time of admission and lack of formal maternal education was associated with low survival rates. Educating girls to at least primary level can contribute significantly to preterm neonatal survival

Communities and service providers address access to perinatal care in postconflict Northern Uganda: socialising evidence for participatory action

Objectives Describe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda.Study design Mixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups and a household survey identified and documented the extent of obstructions to access. Deliberative dialogue focused stakeholder discussions of this evidence to address the obstacles to access. Most significant change stories explored the participant experience of this process.Setting Three parishes in Nwoya district in the Gulu region, Northern Uganda.Participants Purposively sampled groups of women, men, female youth, male youth, community health workers, traditional midwives and service providers. Each of seven stakeholder categories included 5–8 participants in each of three parishes.Results Stakeholders identified several obstructions to accessing perinatal care: lack of savings in preparation for childbirth in facility costs, lack of male support and poor service provider attitudes. They suggested joining saving groups, practising saving money and income generation to address the short-term financial shortfall.They recommended increasing spousal awareness of perinatal care and they proposed improving service provider attitudes. Participants described their own improved care-seeking behaviour and patient–provider relationships as short-term gains of the codesign.Conclusion Participatory service improvement is feasible and acceptable in postconflict settings like Northern Uganda. Engaging communities in identifying perinatal service delivery issues and reflecting on local evidence about these issues generate workable community-led solutions and increases trust between community members and service providers