期刊论文详细信息
BMC Pediatrics
Quality of neonatal healthcare in Kilimanjaro region, northeast Tanzania: learning from mothers' experiences
Rachael Manongi2  Flavian A Masokoto5  Joshua A Melnick3  Sarah A P Ward4  Elizabeth Reddy6  Nicole L Ide7  Bernard Mbwele1 
[1] Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Center, P.O Box 2236, KCMC, Moshi, Tanzania;Kilimanjaro Christian Medical University College, P.O Box 2240, KCMC, Moshi, Tanzania;University of Georgia, Athens, GA 39602, Greece;Bowdoin College, Bowdoin College, 5000 South Street, Brunswick, ME 04011, USA;Uru Mawela Parish, Moshi Diocese at P.O Box 3011, Moshi, Kilimanjaro, Tanzania;Kilimanjaro Christian Medical Centre-Duke University Collaboration, P.O Box 3010, Moshi, Tanzania;Seattle Pacific University, 3307 3rd Ave West, Seattle, WA 98119-1997, USA
关键词: Tanzania;    Kilimanjaro;    Challenges;    Satisfaction;    Family;    Parents;    Quality of care;    Mothers;    Neonatal;   
Others  :  1144900
DOI  :  10.1186/1471-2431-13-68
 received in 2012-10-19, accepted in 2013-04-22,  发布年份 2013
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【 摘 要 】

Background

With a decline of infant mortality rates, neonatal mortality rates are striking high in development countries particularly sub Saharan Africa. The toolkit for high quality neonatal services describes the principle of patient satisfaction, which we translate as mother’s involvement in neonatal care and so better outcomes. The aim of the study was to assess mothers’ experiences, perception and satisfaction of neonatal care in the hospitals of Kilimanjaro region of Tanzania.

Methods

A cross sectional study using qualitative and quantitative approaches in 112 semi structured interviews from 14 health facilities. Open ended questions for detection of illness, care given to the baby and time spent by the health worker for care and treatment were studied. Probing of the responses was used to extract and describe findings by a mix of in-depth interview skills. Closed ended questions for the quantitative variables were used to quantify findings for statistical use. Narratives from open ended questions were coded by colours in excel sheet and themes were manually counted.

Results

80 mothers were interviewed from 13 peripheral facilities and 32 mothers were interviewed at a zonal referral hospital of Kilimanjaro region. 59 mothers (73.8%) in the peripheral hospitals of the region noted neonatal problems and they assisted for attaining diagnosis after a showing a concern for a request for further investigations. 11 mothers (13.8%) were able to identify the baby’s diagnosis directly without any assistance, followed by 7 mothers (8.7%) who were told by a relative, and 3 mothers (3.7%) who were told of the problem by the doctor that their babies needed medical attention. 24 times mothers in the peripheral hospitals reported bad language like “I don’t have time to listen to you every day and every time.” 77 mothers in the periphery (90.6%) were not satisfied with the amount of time spent by the doctors in seeing their babies.

Conclusion

Mothers of the neonates play great roles in identifying the illness of the newborn. Mother’s awareness of what might be needed during neonatal support strategies to improve neonatal care in both health facilities and the communities.

【 授权许可】

   
2013 Mbwele et al.; licensee BioMed Central Ltd.

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【 参考文献 】
  • [1]Lawn JE, Cousens S, Bhutta ZA, Darmstadt GL, Martines J, Paul V, Knippenberg R, Fogstadt H, Shetty P, Horton R: Why are 4 million newborn babies dying each year? Lancet 2004, 364(9432):399-401.
  • [2]Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M: Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012, 379(9832):2151-2161.
  • [3]Lawn JE, Kinney MV, Black RE, Pitt C, Cousens S, Kerber K, Corbett E, Moran AC, Morrissey CS, Oestergaard MZ: Newborn survival: a multi-country analysis of a decade of change. Health Policy Plan 2012, 27(Suppl 3):iii6-iii28.
  • [4]Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R: Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010, 375(9730):1969-1987.
  • [5]Duke T, Tamburlini G, Silimperi D, Paediatric Quality Care G: Improving the quality of paediatric care in peripheral hospitals in developing countries. Arch Dis Child 2003, 88(7):563-565.
  • [6]World Health Organisation: Neonatal and Perinatal Mortality: Country, Regional and Global Estimates. Geneva: World Health Organization Report; 2006.
  • [7]Ministry of Health and Social Welfare, MoHSW: The national road map strategic plan to accelerate the reduction of maternal, newborn and child deaths in Tanzania, (2008-2015). Dar es Salaam: MoHSW,The government of Tanzania & UNFPA; 2008.
  • [8]Masanja H, de Savigny D, Smithson P, Schellenberg J, John T, Mbuya C, Upunda G, Boerma T, Victora C, Smith T: Child survival gains in Tanzania: analysis of data from demographic and health surveys. Lancet 2008, 371(9620):1276-1283.
  • [9]Habib NA, Lie RT, Oneko O, Shao J, Bergsjo P, Daltveit AK: Sociodemographic characteristics and perinatal mortality among singletons in North East Tanzania: a registry-based study. J Epidemiol Community Health 2008, 62(11):960-965.
  • [10]Schmiegelow C, Minja D, Oesterholt M, Pehrson C, Suhrs HE, Bostrom S, Lemnge M, Magistrado P, Rasch V, Lusingu J: Factors associated with and causes of perinatal mortality in northeastern Tanzania.. 2012. [Acta obstetricia et gynecologica Scandinavica]
  • [11]Black RE, Morris SS, Bryce J: Where and why are 10 million children dying every year? Lancet 2003, 361(9376):2226-2234.
  • [12]Nathan R, Mwanyangala MA: Survival of neonates in rural Southern Tanzania: does place of delivery or continuum of care matter? BMC Pregnancy Childbirth 2012, 12(1):18. BioMed Central Full Text
  • [13]Haile-Mariam A, Tesfaye N, Otterness C, Bailey PE: Assessing the health system's capacity to conduct neonatal resuscitation in Ethiopia. Ethiop Med J 2012, 50(1):43-55.
  • [14]Mrisho M, Schellenberg D, Manzi F, Tanner M, Mshinda H, Shirima K, Msambichaka B, Abdulla S, Schellenberg JA: Neonatal deaths in rural southern Tanzania: care-seeking and causes of death. ISRN Pediatr 2012, 2012:953401.
  • [15]Cleveland LM: Parenting in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs: JOGNN/NAACOG 2008, 37(6):666-691.
  • [16]Beck RS, Daughtridge R, Sloane PD: Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract/Am Board Fam Pract 2002, 15(1):25-38.
  • [17]Beckman AW, Sloan BK, Moore GP, Cordell WH, Brizendine EJ, Boie ET, Knoop KJ, Goldman MJ, Geninatti MR, Group PR: Should parents be present during emergency department procedures on children, and who should make that decision? A survey of emergency physician and nurse attitudes. Acad Emerg Med: Offic J Soc Acad Emerg Med 2002, 9(2):154-158.
  • [18]Griffin T: Bringing change-of-shift report to the bedside: a patient- and family-centered approach. J Perinat Neonatal Nurs 2010, 24(4):348-353. quiz 354-345
  • [19]Sines E: The Maternal-Newborn-Child Health Continuum of Care: A Collective Effort to Save Lives. Washington, DC: Save the Children & Population Reference Bureau, PRB; 2006. [Policy Perspectives on Newborn Health]
  • [20]Mrisho M, Obrist B, Schellenberg JA, Haws RA, Mushi AK, Mshinda H, Tanner M, Schellenberg D: The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania. BMC Pregnancy Childbirth 2009, 9:10. BioMed Central Full Text
  • [21]Morey JA, Gregory K: Nurse-led education mitigates maternal stress and enhances knowledge in the NICU. MCN Am J Matern Child Nurs 2012, 37(3):182-191.
  • [22]Wigert H, Johansson R, Berg M, Hellstrom AL: Mothers' experiences of having their newborn child in a neonatal intensive care unit. Scand J Caring Sci 2006, 20(1):35-41.
  • [23]Vaskelyte A, Butkeviciene R, Klemmac D: [Assessing needs of families with premature newborns in the Neonatal Intensive Care Unit]. Medicina 2009, 45(4):320-326.
  • [24]Jones P, Harper A, Wells S, Curtis E, Carswell P, Reid P, Ameratunga S: Selection and validation of quality indicators for the Shorter Stays in Emergency Departments National Research Project. Emerg Med Austr: EMA 2012, 24(3):303-312.
  • [25]NHS & Department of Health: Toolkit for High Quality Neonatal Services. London, UK: Maternity and Newborn Team Partnerships for Children, Families and Maternity, Families and Maternity; 2009. Viewed on 13 December 2010 http://www.neonatal.org.uk/documents/5350.pdf webcite
  • [26]Griffin T, Abraham M: Transition to home from the newborn intensive care unit: applying the principles of family-centered care to the discharge process. J Perinat Neonatal Nurs 2006, 20(3):243-249. quiz 250-241
  • [27]Griffin T: Family-centered care in the NICU. J Perinat Neonatal Nurs 2006, 20(1):98-102.
  • [28]Pawar M: 5 tips for generating patient satisfaction and compliance. Fam Pract Manag 2005, 12(6):44-46.
  • [29]Chandran A, Herbert HK, Lee AC, Rudan I, Baqui AH: Assessment of the proportion of neonates and children in low and middle income countries with access to a healthcare facility: A systematic review. BMC Res Notes 2011, 4:536. BioMed Central Full Text
  • [30]Tang BG, Feldman HM, Huffman LC, Kagawa KJ, Gould JB: Missed opportunities in the referral of high-risk infants to early intervention. Pediatrics 2012, 129(6):1027-1034.
  • [31]Mbaruku G, van Roosmalen J, Kimondo I, Bilango F, Bergstrom S: Perinatal audit using the 3-delays model in western Tanzania. Int J Gynaecol Obstet: Offic Organ Intern Fed Gynaecol Obstet 2009, 106(1):85-88.
  • [32]Kahabuka CK, Moland KM, Kvale G, Hinderaker SG: Unfulfilled expectations to services offered at primary health care facilities: Experiences of caretakers of underfive children in rural Tanzania. BMC Health Serv Res 2012, 12(1):158. BioMed Central Full Text
  • [33]Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, Achadi E, Adjei S, Padmanabhan P, Marchal B: Going to scale with professional skilled care. Lancet 2006, 368(9544):1377-1386.
  • [34]Simkhada B, Teijlingen ER, Porter M, Simkhada P: Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs 2008, 61(3):244-260.
  • [35]Farina D, Rodriguez S, Erpen N, Subprograma de Referencia y C: [In-service training to improve quality of health care]. Arch Argent Pediatr 2012, 110(1):9-18.
  • [36]Meda ZC, Konate L, Ouedraogo H, Sanou M, Hercot D, Sombie I: [Leadership and vision in the improvement of universal health care coverage in low-income countries]. Sante 2011, 21(3):178-184.
  • [37]Mbwele B, Reddy E, Reyburn H: A rapid assessment of the quality of neonatal healthcare in Kilimanjaro region, northeast Tanzania. BMC Pediatr 2012, 12(1):182. BioMed Central Full Text
  • [38]Almeida CA, Tanaka OY: Women's perspective in the evaluation of the Program for the Humanization of Antenatal Care and Childbirth. Rev Saude Publica 2009, 43(1):98-104.
  • [39]Mundy CA: Assessment of family needs in neonatal intensive care units. Am J Crit Care: Offic Publ Am Assoc Crit Care Nurs 2010, 19(2):156-163.
  • [40]Pronyk PM, Muniz M, Nemser B, Somers MA, McClellan L, Palm CA, Huynh UK, Ben Amor Y, Begashaw B, McArthur JW: The effect of an integrated multisector model for achieving the Millennium Development Goals and improving child survival in rural sub-Saharan Africa: a non-randomised controlled assessment. Lancet 2012, 379(9832):2179-2188.
  • [41]Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, Dwyer-Lindgren L, Lofgren KT, Phillips D, Atkinson C: Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet 2011, 378(9797):1139-1165.
  • [42]Bryce J, Terreri N, Victora CG, Mason E, Daelmans B, Bhutta ZA, Bustreo F, Songane F, Salama P, Wardlaw T: Countdown to 2015: tracking intervention coverage for child survival. Lancet 2006, 368(9541):1067-1076.
  • [43]Salama P, Lawn J, Bryce J, Bustreo F, Fauveau V, Starrs A, Mason E: Making the Countdown count. Lancet 2008, 371(9620):1219-1221.
  • [44]Bryce J, Daelmans B, Dwivedi A, Fauveau V, Lawn JE, Mason E, Newby H, Shankar A, Countdown Coverage Writing G: Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions. Lancet 2008, 371(9620):1247-1258.
  • [45]Boerma JT, Bryce J, Kinfu Y, Axelson H, Victora CG, Countdown Equity Analysis G: Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries. Lancet 2008, 371(9620):1259-1267.
  • [46]Bhutta ZA, Chopra M, Axelson H, Berman P, Boerma T, Bryce J, Bustreo F, Cavagnero E, Cometto G, Daelmans B: Countdown to 2015 decade report (2000-10): taking stock of maternal, newborn, and child survival. Lancet 2010, 375(9730):2032-2044.
  • [47]Mbonye AK, Sentongo M, Mukasa GK, Byaruhanga R, Sentumbwe-Mugisa O, Waiswa P, Naamala Sengendo H, Aliganyira P, Nakakeeto M, Lawn JE: Newborn survival in Uganda: a decade of change and future implications. Health Policy Plan 2012, 27(Suppl 3):iii104-iii117.
  • [48]Manongi RN, Nasuwa FR, Mwangi R, Reyburn H, Poulsen A, Chandler CI: Conflicting priorities: evaluation of an intervention to improve nurse-parent relationships on a Tanzanian paediatric ward. Hum Resour Heal 2009, 7:50. BioMed Central Full Text
  • [49]Mwangi R, Chandler C, Nasuwa F, Mbakilwa H, Poulsen A, Bygbjerg IC, Reyburn H: Perceptions of mothers and hospital staff of paediatric care in 13 public hospitals in northern Tanzania. Trans R Soc Trop Med Hyg 2008, 102(8):805-810.
  • [50]Wang SF, Gau ML: [Creating baby-friendly neonatal intensive care units]. Hu Li Za Zhi J Nurs 2013, 60(1):11-16.
  • [51]Molyneux E, Ahmad S, Robertson A: Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting. Bull World Health Organ 2006, 84(4):314-319.
  • [52]Jehovaness A: Determinants of Rural Income in Tanzania: An Empirical Approach. Dar es Salaam: Research on Poverty Alleviation, REPOA; 2010. [Research Report vol 10/4]
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