Term Newborn Care Recommendations Provided in a Kenyan Postnatal Ward: A Rapid, Focused Ethnographic Assessment.

BACKGROUND: Neonatal mortality (death within 0-28 d of life) in Kenya is high despite strong evidence that newborn care recommendations save lives. In public healthcare facilities, nurses counsel caregivers on term newborn care, but knowledge about the content and quality of nurses' recommendations is limited. PURPOSE: To describe the term newborn care recommendations provided at a tertiary-level, public referral hospital in Western Kenya, how they were provided, and related content taught at a university nursing school. METHODS: A rapid, focused ethnographic assessment, guided by the culture care theory, using stratified purposive sampling yielded 240 hours of participant observation, 24 interviews, 34 relevant documents, and 268 pages of field notes. Data were organized using NVivo software and key findings identified using applied thematic analysis. RESULTS: Themes reflect recommendations for exclusive breastfeeding, warmth, cord care, follow-up examinations, and immunizations, which were provided orally in Kiswahili and some on a written English discharge summary. Select danger sign recommendations were also provided orally, if needed. Some recommendations conflicted with other providers' guidance. More recommendations for maternal care were provided than for newborn care. IMPLICATIONS FOR PRACTICE: There is need for improved consistency in content and provision of recommendations before discharge. Findings should be used to inform teaching, clinical, and administrative processes to address practice competency and improve nursing care quality. IMPLICATIONS FOR RESEARCH: Larger studies are needed to determine whether evidence-based recommendations are provided consistently across facilities and other populations, such as community-born and premature newborns, who also experience high rates of neonatal mortality in Kenya.

Increasing utilisation of skilled attendants at birth in sub-Saharan Africa: A systematic review of interventions.

BACKGROUND: Maternal mortality is a critical global public health concern, especially in low- and middle-income countries in sub-Saharan Africa. Although maternal mortality rates have declined by approximately 39% in sub-Saharan Africa over the last decade, maternal deaths during pregnancy and in childbirth remain high. Interventions to improve mothers' use of skilled birth attendants may decrease maternal mortality in sub-Saharan African countries. OBJECTIVES: This systematic literature review examines components of and evaluates the effectiveness of interventions to increase use of skilled birth attendants in sub-Saharan Africa. METHODS: Guided by the PRISMA model for systematic reviews, the PubMed, Web of Science, and CIHNAL databases were searched for studies from years 2003 through June 2020. RESULTS: The 28 articles included in this review reported on interventions incorporating community health workers, phone or text messages, implementation of community-level initiatives, free health care, cash incentives, an international multi-disciplinary volunteer team, and a group home for pregnant women, which improved use of skilled birth attendants to varying degrees. Only one study reported improved outcomes with the use of community health workers. All of the interventions using text messages increased hospital utilization for births. CONCLUSIONS: Interventions implemented in sub-Saharan Africa hold promise for improving maternal health. Multi-level interventions that involve community members and local leaders can help address the multi-faceted issue of poor maternal health outcomes and mortality. Interventions should focus on capacity building and on training and mentoring of formally-trained health care providers and community health workers in order to expand access.

Integrated review of healthcare provider postnatal newborn care recommendations in Sub-Saharan Africa.

AIMS: To (1) identify formal and informal healthcare provider knowledge and counselling on newborn care recommendations; (2) identify care guidelines used; and (3) determine healthcare provider training regarding recommendations. BACKGROUND: In sub-Saharan Africa, many newborn deaths occur in the community between days two to 42 of life. INTRODUCTION: Formal and informal healthcare providers, including nurses and community health workers, counsel newborn caregivers but little is known about their recommendations. METHODS: Integrative review of studies conducted 2000-2018 after search of PubMed, CINAHL, Embase, and African healthcare journals. Study quality was assessed and findings synthesized. FINDINGS: Twelve qualitative, quantitative, or mixed-methods studies (quality good to poor) from seven countries were included. Eleven reported on one to three recommendations; one study reported on eight recommendations. Knowledge or counselling on feeding, cord care, recognizing illness, referrals, informal treatment, home visits, immunizations, follow-up examinations, thermal care, low birthweight, and bed net usage were reported. Formal healthcare providers gave recommendations in only two studies. Four studies documented use of guidelines. Six studies reported on training. DISCUSSION: Studies were primarily descriptive, limiting quality. Feeding and cord care recommendations were prioritized. Care guidelines were underutilized. Additional training on recommendations is needed. These findings regarding healthcare providers align with other regions with high neonatal mortality. CONCLUSION: Research is needed to improve and sustain knowledge, counselling, and guideline usage among providers to address neonatal mortality. IMPLICATIONS FOR NURSING: The unique role of nurses to promote newborn health appears under-researched. Nurse professionalization and specialization may contribute to sustained knowledge of and counselling on newborn recommendations. IMPLICATIONS FOR HEALTH POLICY: As countries adopt universal health care, policies that enable formal providers to encourage maternal-newborn engagement in newborn health promotion before transition to the community are needed. Collaboration between formal and informal providers may improve dissemination of recommendations and contribute to gains in newborn health.