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Exploring the Context, Roles and Experiences of Mothers in Caring for their Inpatient Sick Newborns in Nairobi, Kenya: An Ethnographic Approach
Little progress has been made in reducing deaths among newborns. Newborn morbidity and mortality can be prevented through the timely provision of combined health systems interventions and access to high-quality inpatient and supportive care. Additionally, recent evidence has demonstrated the importance of social factors to the survival of sick newborns. The involvement of parents through family centred care, as well as maternally delivered interventions, have been shown to have positive outcomes for mother and baby, but in debates around the quality of care for newborns the voices of mothers, particularly in low and middle-income countries, are rarely heard.
Using an ethnographic approach, this study critically examines the roles and experiences of mothers of hospitalized sick newborns in two newborn units in Nairobi, Kenya. Data collection involved non-participant observations, discharge in-depth interviews and narrative interviews with mothers 2-6 weeks post-discharge. Data were collected over 3 years and analysed iteratively using a grounded approach.
The study revealed striking differences in the structural, cultural and socio-economic context of the two newborn units and their clientele. In both hospitals, the mothers played a role in providing care for their babies but with marked differences in the timing of onset, preparation and supervision of these roles. Despite these differences, the mothers narrated similar experiences of shock, fear and confusion in coping with their sick newborn, exacerbated by inadequate communication and information sharing between staff and mothers and a lack of psychosocial support.
The inequities in care observed in the Nairobi newborn units are barely visible in the mothers’ own stories, instead they narrate a shared experience of their encounters with a biomedical model of care delivery. Advocacy for structural changes to reduce inequities in neonatal care are necessary. However, focusing on technological improvements risks further embedding a biomedical paradigm that ignores the needs of mothers
High seroprevalence of Immunoglobulin G (IgG) and IgM antibodies to SARS-CoV-2 in asymptomatic and symptomatic individuals amidst vaccination roll-out in western Kenya.
The population's antibody response is a key factor in comprehending SARS-CoV-2 epidemiology. This is especially important in African settings where COVID-19 impact, and vaccination rates are relatively low. This study aimed at characterizing the Immunoglobulin G (IgG) and Immunoglobulin M (IgM) in both SARS-CoV-2 asymptomatic and symptomatic individuals in Kisumu and Siaya counties in western Kenya using enzyme linked immunosorbent assays. The IgG and IgM overall seroprevalence in 98 symptomatic and asymptomatic individuals in western Kenya between December 2021-March 2022 was 76.5% (95% CI = 66.9-84.5) and 29.6% (95% CI = 20.8-39.7) respectively. In terms of gender, males had slightly higher IgG positivity 87.5% (35/40) than females 68.9% (40/58). Amidst the ongoing vaccination roll-out during the study period, over half of the study participants (55.1%, 95% CI = 44.7-65.2) had not received any vaccine. About one third, (31.6%, 95% CI = 22.6-41.8) of the study participants had been fully vaccinated, with close to a quarter (13.3% 95% CI = 7.26-21.6) partially vaccinated. When considering the vaccination status and seroprevalence, out of the 31 fully vaccinated individuals, IgG seropositivity was 81.1% (95% CI = 70.2-96.3) and IgM seropositivity was 35.5% (95% CI = 19.22-54.6). Out of the participants that had not been vaccinated at all, IgG seroprevalence was 70.4% (95% CI 56.4-82.0) with 20.4% (95% CI 10.6-33.5) seropositivity for IgM antibodies. On PCR testing, 33.7% were positive, with 66.3% negative. The 32 positive individuals included 12(37.5%) fully vaccinated, 8(25%) partially vaccinated and 12(37.5%) unvaccinated. SARs-CoV-2 PCR positivity did not significantly predict IgG (p = 0.469 [95% CI 0.514-4.230]) and IgM (p = 0.964 [95% CI 0.380-2.516]) positivity. These data indicate a high seroprevalence of antibodies to SARS-CoV-2 in western Kenya. This suggests that a larger fraction of the population was infected with SARS-CoV-2 within the defined period than what PCR testing could cover