Acceptability of evidence-based
maternal-neonatal care practices
in rural Uganda -implications for
programming
Peter Waiswa, Margaret
Kemigisa, Juliet Kiguli, Sarah
Naikoba,
George Pariyo, Stefan Peterson
Background-1
Globally 4 million newborn deaths/year or
40% of U5M, 98% in developing countries
Therefore achieving MDG4 requires
reducing newborn deaths
50% occur on D1 and 75% occur in week
one after birth
Trend same for maternal death
Background-2: In Uganda
44,500
newborn
deaths
and
45,100
stillbirths/year; 31,800 could be prevented; 23%
of U5M are neonates
56% excess newborn deaths in rural areas
comapred to urban
60% birth occur at home
Only 12% newborns ever get postnatal care
Iganga district: About 900 newborn deaths, 850
perinatal deaths (300 perinatal death in Iganga
hospital alone)
Background-3
Causes preventable - 86% of neonatal
deaths by 3 preventable problems:
infections
- 36%
prematurity
- 27%
asphyxia
- 23%
Recent evidence from Asia and S America:
low cost community interventions can
reduce neonatal deaths by 20% - 40%
The Evidence Based Practices
Birth preparedness and promotion of demand for care and readiness
for emergencies
Counseling and preparation of for newborn care
Clean delivery
Hygienic cord/skin care
Thermal care
Promotion of early and exclusive breastfeeding
Health home care
Extra care for low birth weight babies
Community case management for pneumonia
4 ANC visits inc. IPT, TT
Awareness and early detection and referral of danger signs
Objectives
To
explore
the
acceptability
of
recommended evidence-based maternalneonatal practices at community level
To investigate acceptability of home visits
by a CHW during pregnancy and in the
early neonatal period to promote home
care
Methods
10 FGDs consisting of mothers, fathers
and child minders-up to 13 years old
10 IDIs with health workers and traditional
birth attendants
Study done in Iganga/Mayuge Districts in
Busoga subregion, Eastern Uganda
Basoga are almost 10% of Ugandans
Findings: Acceptable Practices
Attending ANC 4 times during pregnancy
Maintenance of warmth through skin to
skin contact
Exclusive breast feeding
Skilled care seeking for danger signs
Facility/Supervised deliveries
Early referral for danger signs
Home visits by CHWs
Findings: Less acceptable
Practices
Early bathing – babies believed to be born “dirty”
“My babies are usually born dirty, so it is a must for me
to bathe the baby immediately I am discharged on
that same day of giving birth. You people are your
babies born clean”. (FGD Older mothers).
Putting nothing on cord – that substances encourage
‘early cord healing’
Care of premature babies at home – belief that this
should be in health facilities
Findings: Key challenges to
home care
Knowledge barriers, service delivery gaps;
cultural, traditional beliefs and practices
and financial constraints
Limited
community
knowledge
on:
importance of attending ANC four times
during pregnancy
Findings: Key challenges to
home care
Deep rooted beliefs in herbs
Decision making not by women
B/preparedness is hindered by poverty,
cultural beliefs, limited awareness, lack of
adequate male involvement and the fear of
preparing for the unborn
Most labour occurring at night
No community knowledge on postnatal
care except for immunisation
Key challenges to home care
ANC misconstrued as provision of medicine for sick
pregnant women (okunwa obulezi)
“Yes, I was given three Fansidars and they are at home. I
came back quarrelling. I went for ANC for assistance but
by giving me only three tablets, how were they helping?
Three tablets only! Yet I explained my condition in
detail”. (FGD Young Mothers)
“Yes, she (TBA) delivers and also changes the position of
the baby if it is not laying right. She can also change the
sex of the baby if you want. For instance if you have
been giving birth to only boys and you want a girl, she
can change the sex for you so that you deliver a girl”.
(FGD, older mothers)
Preparing for birth is a burden to
women and hinders facility deliveries
Alternative domestic services while mother is away
Stocking food and firewood
Finding other person to take care of home and children
Gathering personal effects for mother-to-be and newborn
Vaseline and soap
A jerrycan for water and a basin for bathing
Mother and Baby clothes and powder
Buying materials for use by health care providers
– Gloves and razorblade (for cutting the cord)
– Threads (to be used as cord ligatures)
– Syringes, needles and injectable ergometrine (to stop postpartum
haemorrge)
– Cotton wool
– ‘Kavera’/plastic sheet (an improvised mackintosh)
Preparation for emergencies
Asking transport money from male partners or saving from own
Conclusions
Evidence based practices for MN health may not
be universally acceptable
A “one size fits all strategy” to scale-up for all of
SubSaharan Africa is likely to fail
We suggest rapid appraisal and local adaptation
of evidence-based practices and packages to
address the local socio-cultural situation
Health systems strengthening will be needed for
community strategies to be effective
Male involvement is key and promotion of
waiting shelters at selected health units should
be considered
Acknowledgements
Funders:- Sida/SAREC, Saving Newborn
Lives initiative of Save the Children/USA
through a grant from the Bill and Melinda
Gates Foundation.
Study participants, DSS staff and research
assistants, and the Study Policy Advisory
Group.
We acknowledge the useful comments on
the manuscript made by Dr Joy Lawn.