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

Techniques of perinatal care in ancient Egypt: wider perspective

Background : Maternity resembled an important issue in ancient Egyptian life and medicine. Ancient Egyptian papyri contained different prescriptions for care of both pregnant women, birthing moms and their fetus/infant babies. The interventions included both: 1) remedies of different origins, and, 2) incantations. Material/Methods:Different Egyptian papyri and temple representation were studied for the variable remedies for specific cases of maternal/ perinatal problems in relation to pregnancy, birth, breast milk and babycare.Incantation approach was also analyzed. We tried to define the specific material used, and the possible "psychogenic influence of the incantation. Results 1. Some of the remedies could be identified and correlated to current time agents. Practical extrapolation of some of these agents proved of value in modern obstetric practice andtherapeutics. 2. Other remedies could not be characterized, and, up-till now, it was not possible to detect whether they could be corresponding to existing material, 3. The incantation approach could be, in some way, correlated to the "deep psychoanalysis" of modern psychiatry. 4. Many of the "non-medical" ancient Egyptian approaches for maternity/baby care are still resembled in some way of use by current time Egyptian women. Conclusion Ancient Egyptian maternal/infant care is a composite approach. Some of the recognized remedies used proved of value in modern clinical application Identification of further remedies seems to open further promise of extra-benefit. Modification of the of the "non-remedy" line might provide a form of "psychotherapy" better tailored for our societies' concepts

Learning from Health Care Workers' Opinions for Improving Quality of Neonatal Health Care in Kilimanjaro Region; Northeast Tanzania

Background: There is a higher neonatal mortality rate while the adherence to the existing guidelines is rarely studied in Tanzania. Aim: The aim of this study is to assess the performance of health workers for neonatal health-care. Materials and Methods: Settings - Peripheral health facilities (regional referral; district hospitals and health centers) and a tertiary referral hospital of Kilimanjaro region; Tanzania. Fourteen hospital facilities within all seven districts of the Kilimanjaro region wer involved in this cross-sectional descriptive study. Data were collected for 5 months from 26 th November; 2010 to 25 th April; 2011. We analyzed our quantitative data by using STATA v10 (StataCorp; TX; USA) for statistical comparison using Chi-square test to test the difference between the categories and odds ratio (OR) for association between independent and dependent variables. Results: Birth asphyxia was the most recalled health problem requiring critical care; reported by 27.5 (33/120) of health-care workers (HCWs) at peripheral hospitals and at 46.4 (13/28) in a tertiary referral centers. Majority of HCWs commented on their own performance 47.5 (67/140). In the periphery (40); first comment was on management and follow-up of neonatal cases 47.5 (19/40); second on a need of skills 45 (18/40) and third on timely referrals 7.5 (18/40). Shortage of proper equipment was reported at 26.4 (37/140); shortage of staff was reported at 12.0 (17/140); lack of organization of care 11.4 (16/140) and poor hygiene at 2.9 (4/140). It was hard to judge the impact of training on the sufficiency of knowledge (OR: 2.1; 95 confidence interval: [0.9 - 4.8]; P = 0.08) although levels of knowledge for critical neonatal care were higher at the tertiary referral hospital (Pearson ?2 [2] = 53.8; P 0.001). Conclusion: Performance of HCWs in early neonatal care is suboptimal and requires frequent systematic evaluation

Risk Factors for Prenatal Mortality in Arua Regional Refferal Hospital, West Nile, Uganda

Background In low-income countries; the majority of neonatal deaths occur during the perinatal period. The fourth millennium development goal of reducing child mortality cannot therefore be met without substantial reduction in perinatal deaths. Objective To investigate the risk factors for perinatal mortality in Arua regional referral hospital; West Nile region. Methods We conducted a facility based unmatched case-control study at Arua Regional Referral hospital during January- March 2006. A total of 60 new cases of perinatal deaths and 120 controls were selected over a 3 months period. A case was defined as any baby born after 28 weeks of gestation either as a still birth or born alive but died within 7 days post delivery. A control was any baby born after 28 weeks of gestation and survived the first seven days of life. Control mothers were followed at home after one week to check if any perinatal death occurred. Logistic regression analysis was used to determine the risk factors for perinatal mortality. Results: The mean age of case mothers was similar to that of controls 24.1 years; range 15-38 years versus 24.9 years range 16-40 years (p-value = 0.52). Babies who died during the perinatal period were more likely not to have been resuscitated (OR= 24.85; 95CI 8.77-74.17). Mothers whose babies died were more likely to have travelled more than 5 kilometres to Arua hospital (OR= 3.89 CI 1.96-7.74); having had transport problem (OR= 3.35; CI 1.00-12.00); first sought help from other health facilities or TBA (OR= 8.03; CI 3.38-19.46); have been referred due to obstetric complications (OR= 11.45; CI 4.75-27.59); and had obstetric interventions i.e. C/S or vacuum extraction (OR= 3.79; CI 1.64-8.83). After controlling for confounding; significant risk factors for perinatal deaths included living more than 5 kilometres from the hospital (Adjusted OR= 0.91; CI 0.83-0.95); transport problem (Adjusted OR= 4.37; CI 1.14-39.75); baby not being resuscitated (Adjusted OR=4.87; CI 4.371-7.11) and baby being born with low Apgar score (Adjusted OR= 6.76; CI 2.75-187.38). Conclusion and Recommendations: Our study has identified several risk factors for perinatal deaths related to poor accessibility to and low quality of health care services in the setting. The study underscores the importance of improved accessibility to and quality of basic and comprehensive emergency obstetrical care. The findings suggest the need to improve the capacity of local health system at first; second and tertiary levels; accessibility to and quality health care services in the settings

Parents' Lived Experience of Providing Kangaroo Care to their Preterm Infants

Premature and low birthweight infants pose particular challenges to health services in South Africa. While there is good evidence to demonstrate the benefits of kangaroo care in low birthweight infants; limited research has been conducted locally on the experiences of parents who provide kangaroo care to their preterm infants. This phenomenological study explores the lived experience of parents who provided their preterm infants with kangaroo care at a tertiary-level maternity centre in the Western Cape. In-depth interviews were conducted with six parents: four mothers and two fathers. Data was analysed using an adaptation of the approaches described by Colaizzi (1978:48-71) and Hycner (1985:280-294). To ensure trustworthiness; the trustworthiness criteria described by Guba and Lincoln (1989:242-243) were applied. Kangaroo care is a phased process; each phase bringing a unique set of experiences. The eight themes that emerged are described: unforeseen; unprepared and uncertain - the experience of birth; anxiety and barriers; an intimate connection; adjustments; roles and responsibilities; measuring success; a network of encouragement and support; living-in challenges; and living with the infant outside of hospital. Challenges facing health care providers are described and recommendations for information about kangaroo care and support for parents are made

Parents' Lived Experience of Providing Kangaroo Care to their Preterm Infants

Premature and low birthweight infants pose particular challenges to health services in South Africa. While there is good evidence to demonstrate the benefits of kangaroo care in low birthweight infants; limited research has been conducted locally on the experiences of parents who provide kangaroo care to their preterm infants. This phenomenological study explores the lived experience of parents who provided their preterm infants with kangaroo care at a tertiary-level maternity centre in the Western Cape. In-depth interviews were conducted with six parents: four mothers and two fathers. Data was analysed using an adaptation of the approaches described by Colaizzi (1978:48-71) and Hycner (1985:280-294). To ensure trustworthiness; the trustworthiness criteria described by Guba and Lincoln (1989:242-243) were applied. Kangaroo care is a phased process; each phase bringing a unique set of experiences. The eight themes that emerged are described: unforeseen; unprepared and uncertain - the experience of birth; anxiety and barriers; an intimate connection; adjustments; roles and responsibilities; measuring success; a network of encouragement and support; living-in challenges; and living with the infant outside of hospital. Challenges facing health care providers are described and recommendations for information about kangaroo care and support for parents are made

Good Short-Term Outcome of Kangaroo Mother care in Low Birth Weight Infants in a Rural South African Hospital

Objective: The aim of the study was to determine the outcome of kangaroo mother care (KMC) in low birth weight infants at a community hospital. Methods : This descriptive study included 87 mothers and their low birth weight infants who were in a stable condition and eligible for KMC at Dr JS Moroka Hospital; Thaba Nchu. The infants were assessed four times: at birth; twice during hospitalisation; and a week after discharge. Infants received breast milk exclusively.Results : Regarding the mothers' obstetric history (n=87); gravidity ranged from 1 to 7 (median 3); with a 43 incidence of miscarriage. The median birth weight of the infants (n=87) was 1.5 kg (first assessment); the discharge weight (third assessment) was 1.8 kg; and a week after discharge (fourth assessment) it was 2.2 kg. Initially the infants lost weight significantly from birth to the second assessment (95 CI for median decrease [-0.02; -0.01]); but significantly gained weight from the second to the third (95 CI for median decrease [0.27; 0.33]) and from the third to the fourth assessment (95 CI for median decrease [0.32; 0.45]). Approximately half (49) of the infants had developed jaundice by the time of second assessment. These babies had a significantly lower birth weight [0.12;0.30]. Conclusion : Our findings confirm that infants with a low birth weight treated with KMC can have a good growth pattern; and exclusive breast milk is sufficient to guarantee such growth. Kangaroo mother care is a safe method for stable infants with a low birth weight in a community hospital

The Effect of Formal Exposure to Developmental Care Principles on the Implementation developmental Care Positioning and Handling of Preterm Infants by Neonatal Nurses

The preterm infant requires developmental care that is designed to minimise the stress that the infant experiences within the neonatal intensive care unit (NICU). The aim of the study was to determine the effect of formal exposureto developmental care principles on the implementation of developmental care positioning and handling of the preterm infant by neonatal nurses. The first objective of the study was to compile an accurate scale for measuring the implementation of these principles with respect to the handling and positioning of the infant. Secondly; the study aimed at determining changes in the implementation of developmental care principles within a selected NICU after neonatal nurses were formally exposed to developmental care training. A quasi-experimental research design and a one-group pre-test-post-test approach were followed; and the Wilcoxon matched-pair signed-rank tests were used toexamine the changes. Results were statistically significant and indicated improvement with respect to the developmental care components that were measured. The recommendation was that developmental care principles be integrated into formal neonatal courses. Follow-up studies should be conducted to determine the reliability of the instrument for possible inclusion in routine assessment of the quality of the implementation of developmental care in the NICU

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