Mothers' knowledge on essential newborn care at Juba Teaching Hospital, South Sudan

Introduction: Globally neonatal mortality remains high and in South Sudan is estimated at 52/1000 live births. Objective: To identify the gaps in the knowledge and practices of essential newborn care among postnatal mothers at Juba Teaching Hospital and to determine the socio-demographic factors that influenced these.Methodology: A hospital-based cross-sectional study among 384 postnatal mothers using consecutive sampling, a pretested questionnaire to assess knowledge and a three point Likert scale to find out to which practices mothers did, or did not, agree. Results: 45% of mothers were aged between 25-34 years; 23.9% had some secondary school education; 70% were multiparous and 82% had attended an antenatal care clinic. 90% knew about breastfeeding on demand and 74% about exclusive breastfeeding. Only 18.2% of mothers knew the cord should be cared for while uncovered; 90% used warm clothing and 33% kangaroo care for thermoregulation. Only 20.8% identified BCG and OPV as birth vaccines; 3.4% believed vaccines were harmful.Hypothermia was the danger sign least frequently identified by the mothers (41.4%). Conclusion: Adequate knowledge was found regarding breastfeeding, with knowledge gaps existing in cord care, immunization, eye care and thermoregulation. Positive practice was found about breastfeeding, cord care, eye care and immunization. Socio-demographic factors were not found to be associated with maternal knowledge on newborn care

Preventative measures taken against hypothermia in selected Durban hospitals' emergency centres and operating theatres

Introduction:Hypothermia is common in emergency general surgical patients. It is known to be associated with major complications in multiple organ systems. It is also easily preventable with the use of safe and cost-effective equipment. However, by observation, it appears that this equipment is used too infrequently thus resulting in unnecessary harm to patients.Methods:This descriptive, observational, cross-sectional study was conducted in two arms to evaluate both emergency centres and operating theatres in the major state hospitals in Durban. It was conducted as an audit as well as a questionnaire-based study, to ascertain the availability of equipment used to prevent hypothermia and also how appropriately the equipment was being used.Results:There was good availability of equipment in both the operating theatres and the emergency centres. However it was being used very poorly, particularly in emergency centres (41% of responses deemed not beneficial to patients versus 29% from operating theatres; 39% of answers beneficial versus 54% from operating theatres.Institutions with hypothermia-prevention protocols scored significantly better than those without a protocol (59% versus 25% beneficial; p = 0.01.Conclusion: In the field of hypothermia prevention, there was sufficient equipment to result in optimal patient care. However there appears to be a lack of knowledge amongst health care providers, resulting in suboptimal use of this equipment.Protocolised management may provide a solution to this problem and improve patient outcomes

Neonatal Cleft Lip Repair in Babies with Breastfeeding Difficulties at Polokwane Mankweng Hospital Complex

Background. A cleft lip (CL) is a congenital abnormality resulting from failure of union of the medial and nasal prominences with the maxillary prominence during embryonic development. CL may be classified as incomplete; complete; unilateral; bilateral or median. It may be associated with a cleft alveolus or a cleft palate. Definitive correction of a cleft lip is by surgery. In most African settings; the birth of a cleft lip and cleft palate (CLP) baby is associated with witchcraft and ancestral spirits. The parents; particularly mothers; are stigmatised.Objective. To repair CLs in neonates with difficulties in breastfeeding. Methods. Non-syndromic term neonates referred to Polokwane Mankweng Hospital Complex (PMHC) from primary and secondary hospitals with CLP and difficulties in breastfeeding were prospectively admitted to the neonatal unit. Our breastfeeding team supervised and assisted them with breastfeeding. The neonates whose breastfeeding was found to be unsatisfactory were considered for neonatal CL repair.Those who breastfed adequately were booked for later lip repair as per the rule of tens and discharged.Results. From June 2009 to March 2012; 60 children with CLP were referred to PMHC; including 36 neonates. Of these; 23 neonates were unable to breastfeed satisfactorily and were operated at a median age of 9 (range 3 - 28) days. The median weight was 2.8 (1.8 - 3.7) kg. The median haemoglobin was 13.1 (11.5 - 16) g/dL. Conclusion. Neonatal CL repair is an alternative for those with breastfeeding difficulties. Eagerness to breastfeed increased following the lip repair with subsequent improvement in maternal confidence and interaction with the baby. At follow up; weight gain was above the 50th centile on the road to health charts. Early surgery prevents exposure of CL to the public with highly positive possible outcome of decreasing the potential for stigmatisation

Neonatal Hypothermia in Sub-Saharan Africa: A Review

Background: Hypothermia is a major factor in neonatal morbidity and mortality in developing countries. High prevalence of hypothermia has been reported widely even from warmer tropical countries. In spite of the World Health Organization's recommendation of maintenance of warm chain in newborn care; hypothermia continues to be a common neonatal condition which has remained under-recognized; under-documented; and poorly-managed. Objective: This review aims at providing the incidence of and risk factors for neonatal hypothermia as well as provides a pathophysiological overview and management options for neonates with the condition in sub-Saharan Africa. Materials and Methods: All available published literature on neonatal hypothermia was searched electronically and manually. The principal electronic reference libraries and sites searched were PubMed; Embase; Ajol; Cochrane Reference Libraries and Google Scholar. The search terms used included 'neonatal hypothermia;' 'Cold stress in newborn' 'thermal care of the newborn;' 'neonatal thermogenesis;' 'neonatal cold injury;' among others. Pertinent books and monographs were accessed. Data in formats inaccessible to the reviewer were excluded. Result and Conclusion: Neonatal hypothermia is a major condition of public health importance in countries of sub- Saharan Africa. Awareness of the burden of the disease is still low in some communities. Risk factors for neonatal hypothermia in the region include poverty; home delivery; low birthweight; early bathing of babies; delayed initiation of breastfeeding and inadequate knowledge among health workers. Low-tech facilities to prevent heat losses and provide warmth are available in sub-Saharan Africa and are thus recommended as well as continuous efforts at sensitizing caregivers on the thermal needs of newborns

Keeping warm: a matter of life and death

Premature; light for dates; and low Apgar score babies have a lower tolerance to heat loss and are especially vulnerable to hypothermia. The article list simple; low cost; low technology interventions that are very effective