Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change

BMC Pregnancy and Childbirth

Zelee Hill⁴  Tanya Marchant¹  Marcel Tanner⁵  Suzanne Penfold¹  Irene Mashasi³  Zoe Jane-Lara Hildon²  Joanna Schellenberg¹  Donat Shamba³ 

[1] Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK;Ifakara Health Institute, P.O. Box 78373, Dar Es Salaam, Tanzania;Center for International Health and Development, Institute of Child Health, University College London, London, UK;Swiss Tropical and Public Health Institute, Basel, Switzerland

关键词: Mixed methods;    Behaviour change;    Formative research;    Newborn;    Hypothermia;    Thermal care;   

Others  :  1125687
DOI  :  10.1186/1471-2393-14-267

 received in 2013-09-14, accepted in 2014-08-06,  发布年份 2014

【 摘 要 】

Background

Hypothermia contributes to neonatal morbidity and mortality in low-income countries, yet little is known about thermal care practices in rural African settings. We assessed adoption and community acceptability of recommended thermal care practices in rural Tanzania.

Methods

A multi-method qualitative study, enhanced with survey data. For the qualitative component we triangulated birth narrative interviews with focus group discussions with mothers and traditional birth attendants. Results were then contrasted to related quantitative data. Qualitative analyses sought to identify themes linked to a) immediately drying and wrapping of the baby; b) bathing practices, including delaying for at least 6 hours and using warm water; c) day to day care such as covering the baby’s head, covering the baby; and d) keeping the baby skin-to-skin. Quantitative data (n = 22,243 women) on the thermal care practices relayed by mothers who had delivered in the last year are reported accordingly.

Results

42% of babies were dried and 27% wrapped within five minutes of birth mainly due to an awareness that this reduced cold. The main reason for delayed wrapping and drying was not attending to the baby until the placenta was delivered. 45% of babies born at a health facility and 19% born at home were bathed six or more hours after birth. The main reason for delayed bathing was health worker advice. The main reason for early bathing believed that the baby is dirty, particularly if the baby had an obvious vernix as this was believed to be sperm. On the other hand, keeping the baby warm and covered day-to-day was considered normal practice. Skin-to-skin care was not a normalised practice, and some respondents wondered if it might be harmful to fragile newborns.

Conclusion

Most thermal care behaviours needed improving. Many sub-optimal practices had cultural and symbolic origins. Drying the baby on birth was least symbolically imbued, although resisted by prioritizing of the mothers. Both practical interventions, for instance, having more than one attendant to help both mother and baby, and culturally anchored sensitization are recommended.

【 授权许可】

   
2014 Shamba et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Liu L, Johnson HJ, 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. Lancet 2012, 379(9832):2151-61.
• [2]Black RE, Cousens S, Johnson HJ, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, for the Child Health Epidemiology Reference Group of WHO and UNICEF: Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010, 375:1969-1987.
• [3]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. International scholarly research network. ISRN Pediatrics 2012, Article ID 953401:8. doi:10.5402/2012/953401
• [4]Darmstadt GL, Kumar V, Yadav R, Singh V, Singh P, Mohanty S, Baqui AH, Bharti N, Gupta S, Misra RP, Awasthi S, Singh JV, Santosham M, the Saksham study group: Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India. J Perinatol 2006, 26:597-604.
• [5]Lunze K, Bloom DE, Jamison DT, Hamer DH: The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival. BMC Med 2013, 11:24. http://www.biomedcentral.com/1741-7015/11/24 webcite BioMed Central Full Text
• [6]WHO⁄ UNICEF, WHO⁄ UNICEF Joint Statement: Home Visits for the Newborn Child: A Strategy to Improve Survival. Geneva: WHO; 2009.
• [7]Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, Bernis L: Evidence based, cost-effective interventions: how many newborn babies can we save? Lancet 2005, 365:977-988.
• [8]McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S: Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database Syst Rev 2010, 3:CD004210. doi: 10.1002/14651858.CD004210.pub4
• [9]The Partnership for Maternal, Newborn & Child Health: A Global Review of the Key Interventions Related to Reproductive, Maternal, Newborn and Child Health (Rmnch). Geneva, Switzerland: PMNCH; 2011.
• [10]Mullany LC: Neonatal hypothermia in low-resource settings. Semin Perinatol 2010, 1; 34(6):426-433. doi:10.1053/j.semperi.2010.09.007
• [11]Kumar V, Shearer JC, Kumar A, Darmstadt GL: Neonatal hypothermia in low resource settings: a review. J Perinatol 2009, 29:401-412.
• [12]Tawiah-Agyemang C, Kirkwood BR, Edmond K, Bazzano A, Hill Z: Early initiation of breast-feeding in Ghana: barriers and facilitators. J Perinatol 2008, 28:S46-S52.
• [13]Victor R, Baines SK, Agho KE, Dibley MJ: Determinants of breastfeeding indicators among children less than 24 months of age in Tanzania: a secondary analysis of the 2010 Tanzania demographic and health survey. BMJ Open 2013, 3:e001529. doi:10.1136/ bmjopen-2012-001529
• [14]Waiswa P, Kemigisa M, Kiguli J, Naikoba S, Pariyo GW, Peterson S: Acceptability of evidence-based neonatal care practices in rural Uganda – implications for programming. BMC Pregnancy Childbirth 2008, 8:21. BioMed Central Full Text
• [15]Hill Z, Tawiah-Agyemang C, Manu A, Okyere E, Kirkwood BR: Keeping newborns warm: beliefs, practices and potential for behaviour change in rural Ghana. Trop Med Int Health 2010. doi:10.1111/j.1365-3156.2010.02593
• [16]Byaruhanga R, Bergstrom A, Okong P: Neonatal hypothermia in Uganda: prevalence and risk factors. J Trop Pediatr 2005, 51:212-215.
• [17]Bergström A, Byaruhanga R, Okong P: The impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda: a randomized, controlled trial. Acta Paediatr 2005, 94:1462-1467.
• [18]Neonatal Mortality Formative Research Working Group: Developing community-based intervention strategies to save newborn lives: lessons learned from formative research in five countries. J Perinatol 2008, 28:S2-S8. 2008:0743-8346/08
• [19]Manji K: Situation analysis of newborn health in Tanzania: Current situation, existing plans and strategic next steps for newborn health. In Ministry of health and social welfare and Save the Children. Tanzania: Dar es Salaam; 2009.
• [20]Penfold S, Hill Z, Mrisho M, Manzi F, Tanner M, Mshinda H, Schellenberg D, Schellengerg AM: A large cross-sectional community-based study of newborn care practices in Southern Tanzania. PLoS One 2010, 5(12):Article ID e15593.
• [21]Allison T, Sainsbury P, Craig J: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007, 19(6):349-357. 10.1093
• [22]Creswell J, Klassen A, Plano Clark V, Smith K: Best practice for mixed methods research in the health sciences. In Office of Behavioral and Social Sciences Research. Bethesda, MD: National Institutes of Health; 2011.
• [23]Climate Africa – World climate data . http://www.climatedata.eu/continent.php?cid=2&lang=en webcite (accessed 11.05.2014)
• [24]Schellenberg JAM, Mrisho M, Manzi F, Shirima K, Mbuya C, Adiel K, Mushi AK, Ketende SC, Alonso PL, Mshinda H, Tanner T, Schellenberg D: Health and survival of young children in Southern Tanzania. BMC Public Health 2008, 8:194. doi:10.1186/1471-2458-8-194 BioMed Central Full Text
• [25]Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, Schellenberg D: Understanding home-based neonatal care practice in rural southern Tanzania. Trans R Soc Trop Med Hyg 2008, 102:669-678.
• [26]Halcomb E, Davidson P: Is verbatim transcription of interview data always necessary? Appl Nurs Res 2006, 19:38-42.
• [27]Strauss A, Corbin J, Grounded theory methodology: An overview. In Handbook of qualitative research. Edited by Denzin N, Lincoln Y. Thousand Oaks, CA: Sage; 1994:273-285.
• [28]Silverman D: Interpreting qualitative data Methods for analysing talk text and interaction. 3rd Volume. London: Sage Publications Ltd; 2006:445. ISBN: 1412922453
• [29]Tuckett AG: Qualitative research sampling: the very real complexities. Nurse Res 2004, 12:47-61.
• [30]NVivo QSR International. http://www.qsrinternational.com/products_nvivo.aspx webcite (Accessed 12.11.2013)
• [31]Parlato R, Darmstadt G, Tinker A: Qualitative Research, to Improve Newborn Care Practices. Saving Newborn Lives Tools for Newborn Health. Washington DC: Saving newborn lives initiative. Save the children; 2004.
• [32]WHO: Thermal protection of the newborn: a practical guide [online]. Geneva: WHO; 1997. Available from: http://www.who.int/making_pregnancy_safer/documents/ws42097th/en/ webcite [Accessed 12.11.13]
• [33]Khadduri R, Marsh DR, Rasmussen B, Bari A, Nazir R, Darmstadt GL: Household knowledge and practices of newborn and maternal health in Haripur district, Pakistan. J Perinatol 2008, 28:182-187.
• [34]Darmstadt GL, Syed U, Patel Z, Kabir N: Review of domiciliary newborn-care practices in Bangladesh. J Health Popul Nutr 2006, 24:380-393.
• [35]Sreeramareddy CT, Joshi HS, Sreekumaran BV, Giri S, Chuni N: Home delivery and newborn care practices among urban women in western Nepal: a questionnaire survey. BMC Pregnancy Childbirth 2006, 6:27. BioMed Central Full Text
• [36]Osrin D, Tumbahangphe KM, Shrestha D, Mesko N, Shrestha BP, Manandhar MK, Standing H, Manandhar DS, Costello AM: Cross sectional, community based study of care of newborn infants in Nepal. Br Med J 2002, 325:1063-1068.
• [37]Iyengar SD, Iyengar K, Martines JC, Dashora K, Deora KK: Childbirth practices in rural Rajasthan, India: implications for neonatal health and survival. J Perinatol 2008, 28:S23-S30.
• [38]Kesterton AJ, Cleland J: Neonatal care in rural Karnataka: healthy and harmful practices, the potential for change. BMC Pregnancy Childbirth 2009, 9:20. doi:10.1186/1471-2393-9-20 BioMed Central Full Text
• [39]Shamba D, Schellenberg J, Penfold S, Mashasi I, Mrisho M, Manzi F, Marchant T, Tanner M, Mshinda H, Schellenberg D, Hill Z: Clean home delivery in rural southern Tanzania: barriers, influencers and facilitators. J Health Popul Nutr 2013, 1:1107-1870.
• [40]Baqui AH, Williams EK, Darmstadt GL, Kiran TU, Panwar D, Sharma RK, Ahmed S, Sreevasta V, Ahuja R, Santosham M, Black RE: Newborn care in rural Uttar Pradesh. Indian J Pediatics 2007, 74:241-247.
• [41]Winch PJ, Ashraful Alam M, Akther A, Afroz D, Ashraf Ali N, Ellis AA, Baqui AH, Darmstadt GL, El Arifeen S, Habibur Rahman Seraji M, and the Bangladesh PROJAHNMO Study Group: Local understandings of vulnerability and protection during the neonatal period in Sylhet district, Bangladesh: a qualitative study. Lancet 2005, 366:478-485. doi:10.1016/S0140-6736(05) 66836–5
• [42]Kumar V, Mohanty S, Kumar A, Misra R, Santosham M, Awasthi S, Baqui AH, Singh P, Singh V, Ahuja RC, Singh JV, Malik GK, Ahmed S, Black RE, Bhandari M, Darmstadt GL: Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial. Lancet 2008, 372:1151-1162.
• [43]Kirkwood BR, Manu A, ten Asbroek AH, Soremekun S, Weobong B, Gyan T, Danso S, Amenga-Etego S, Tawiah-Agyemang C, Owusu-Agyei S, Hill Z: Effect of the Newhints home-visits intervention on neonatal mortality rate and care practices in Ghana: a cluster randomised controlled trial. Lancet 2013, 381(9884):2184-2192.
• [44]Hanson C, Ronsmans C, Penfold S, Maokola W, Manzi F, Jaribu J, Mbaruku G, Mshinda H, Tanner M, Schellenberg J: Health system support for childbirth care in Southern Tanzania: results from a health facility census. Res Notes 2013, 6:435. BioMed Central Full Text