Mother and newborn skin-to-skin contact in sub-Saharan Africa: prevalence and predictors

Sociocultural context of exclusive breastfeeding in Africa: A narrative review

Background and Aims

Although exclusive breastfeeding (EBF) has many benefits, it is not commonly practiced in several countries as a result of context-specific challenges. EBF practice is thus a global health discourse because over 200 million children suffer from malnutrition despite the abundance of human milk. The risk of starvation remains very high among African children with less than 40% of them exclusively breastfed. In Africa, the adoption or nonadherence to EBF is a sociocultural issue. Hence, this narrative review examined the sociocultural context of EBF in the region.

Methods

PubMed, Google Scholar, and Scopus were searched using keywords related to EBF and Africa. Relevant data from selected studies were synthesized narratively and reported using a structured narrative format.

Results

EBF is strongly rooted in every culture and is a culturally determined behavior. Some believe that colostrum is dirty and harmful to newborns and, thus, needs to be purified. Despite the belief that human milk is the best food for babies, mothers often complement human milk with other foods right from birth because of perceived lactation inadequacy. Most African mothers believe in prelacteal feeding to help cleanse the infant's gastrointestinal tract for digestion, quench thirst, flush the bladder and help the mother to rest after childbirth before breastfeeding (BF) is initiated. The role of significant others was equally found important in the decision and duration of BF. The availability of family support (especially from grandmothers and husbands) reportedly encouraged EBF in Africa. The duration and exclusivity of BF in Africa are negatively associated with demographic variables like young age, low level of education, being unmarried, low income, out of employment, and parity (first-time mother).

Conclusion

While there have been some efforts and policies to improve EBF, it is important to consider context-specific challenges and sociocultural factors. There is a need for more deliberate efforts to encourage mothers through the implementation of effective best practices concerning EBF in Africa.

Fetal outcomes and their correlates following caesarian section in a rural setting in Ghana

BACKGROUND

Regular evaluation of caesarean section (CS) is required due to their rising trend and outcomes. Many women recently opt for elective CS, even in resource-constrained settings. Data evaluating the outcomes of CS is however sparse. Hence, this study sought to determine the rate of fetal mortalities and their determinants following CS in the Tatale District Hospital of the Northern Region, Ghana.

METHODS

A retrospective cross-sectional study was employed to analyze the medical records of 275 women who underwent CS from 2019 to 2021. Data were collected from the hospital's record of CS cases from 2019 to 2021. Descriptive statistics were used to summarize the data and Pearson's chi-square/Fisher's exact test was used to examine the relationship between maternal and obstetric characteristics and fetal mortality. At a 95% confidence interval (95% CI), logistic regression was fitted to assess significant variables and reported the results using odds ratio.

RESULTS

Of 1667 deliveries, 16.5% of the mothers gave birth by CS. A fetal mortality rate of 76.4 per 1000 total births was recorded following CS. Babies born with low Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores (0-3) at fifth-minute had an increased risk of fetal mortality (AOR  =  523.19, 95%CI: 49.24-5559.37, p  =  <0.001). Having a history of previous CS, cephalopelvic disproportion and delayed labour were the major indications for CS.

CONCLUSION

Overall, this study found a high rate of CS based on the World Health Organization's recommended CS rate. Interventions such as reducing the waiting time for surgery and early diagnosis of the need for CS, and ensuring the availability of modern equipment to resuscitate infants with low APGAR scores can significantly improve fetal outcomes following CS.

A descriptive analysis of the coverage of newborn care services among women who delivered in health facilities in 17 sub-Saharan African countries

BACKGROUND

Sub-Saharan Africa (SSA) has seen an increase in facility-based births over the years. However, the region has the world's highest newborn mortality rate (42% in 2019). Quality care around the time of birth can avert these deaths. This study examined the newborn care interventions given to women who gave birth in health facilities in 17 countries in SSA.

METHODS

A cross-sectional population-based study was conducted. We used data from the most recent Demographic and Health Surveys (DHS) conducted in 17 sub-Saharan African countries. We analysed a weighted sample of 226,706 women aged 15-49 years who gave birth in the five years preceding the surveys. We described the coverage of nine newborn care services, namely weighing at birth, breastfeeding initiation within 1 h after birth, skin-to-skin contact, temperature measurement, cord examination, counselling on newborn danger signs, counselling on breastfeeding, breastfeeding observation, and child health assessment before discharge.

RESULTS

Overall, 72.0% (95% CI: 71.1, 72.8) of births occurred in health facilities, ranging from 40.0% (95% CI: 38.0, 42.1) in Nigeria to 96.3% (95% CI: 95.4, 97.1) in South Africa. Weighing at birth was the most common intervention (91.4%), followed by health checks before discharge (81%). The other interventions, including those given immediately at birth (breastfeeding and skin-to-skin contact), had suboptimal coverage. For instance, 66% of newborns were breastfed within 1 h after birth, and 56% had immediate skin-to-skin contact. Service coverage varied considerably by country and healthcare provider type.

CONCLUSIONS

The majority of the examined services, namely early breastfeeding, skin-to-skin contact, cord examination, temperature measurement, counselling on newborn danger signs, breastfeeding observation, and counselling on breastfeeding, were found to have suboptimal coverage. Even though many pregnant women in SSA give birth in healthcare facilities, some newborns do not always get the care they need to be healthy and live. This is a missed chance to improve newborn health and survival around the time of birth.

Effect of Family Integrated Care on maternal stress in preterm infants in the Neonatal Intensive Care Unit: A bi-center experience

AIM

To compare the effect of family integrated care (FICare) on maternal stress in preterm infants with traditional non-parent neonatal intensive care unit (NICU) care.

METHODS

We continuously enrolled mothers and their preterm infants from two NICUs between August 2014 and April 2017; while one NICU applied the FICare model (FICare group) and the other performed standard non-parent care model (control group). Maternal stress was evaluated by the Parental Stress Scale: NICU (PSS: NICU) on admission and right before the discharge. A generalized linear model to adjust for potential confounders. Subgroup analysis was also performed for comparisons between two groups.

RESULTS

A total of 215 mothers with preterm infants were included in this study, among whom 118 (54.88%) were in FICare group and 97 (45.12%) were in control group. The mean PSS: NICU score was 117.36 ± 26.27 on admission with no difference between two groups. Before being discharged home, the PSS: NICU score of parents in both groups was significantly reduced, with the score of FICare group was significantly lower than that of control group. In all sub-domains of PSS: NICU score as sights and sounds, baby looks and behavior score, and parental role, the scores of FICare group were significantly lower than control group.

CONCLUSIONS

There was a simultaneous decrease of maternal stress for NICU preterm infants. FICare further facilitates reducing the maternal stress. It shall be encouraged to apply FICare model in NICUs.

Prevalence and predictors of mother-infant skin-to-skin contact at birth: findings from a U.S. tertiary medical center

BACKGROUND

Immediate skin-to-skin contact has well-established benefits for both mother and baby. However, its implementation varies widely, with limited data on predictors.

OBJECTIVE

This study aimed to investigate prevalence, duration, and maternal and newborn predictors of immediate skin-to-skin contact following vaginal deliveries.

STUDY DESIGN

We conducted a retrospective cohort study of vaginal deliveries from May to October 2019 at Albany Medical Center. We abstracted patient demographic and clinical predictor variables from medical records. The primary outcome was prevalence of skin-to-skin contact during the first hour of life, including any and that meeting the World Health Organization standard of care (defined as initiation within 5 minutes lasting for 60 minutes without separation). The secondary outcome was skin-to-skin contact duration in minutes during the first hour of life. Data were analyzed using multivariate logistic and linear regression models as appropriate.

RESULTS

Among 635 mother-infant dyads, the prevalence of any skin-to-skin contact was 74% and the prevalence of skin-to-skin contact meeting the World Health Organization standard of care was 43%. Maternal higher education increased odds of any skin-to-skin contact [adjusted odds ratio, 2.34; 95% confidence interval, 1.07, 5.13], while maternal delivery complications were associated with decreased odds [adjusted odds ratio, 0.39; 95% confidence interval, 0.17, 0.91]. Infants with 1-minute Apgar scores of 0-3 were four times less likely to receive any skin-to-skin contact compared with infants with scores of 7-10 [adjusted odds ratio, 0.26; 95% confidence interval, 0.09, 0.75]. Other neonatal factors that decreased odds of skin-to-skin contact were multiple gestation [adjusted odds ratio, 0.06; 95% confidence interval, 0.02, 0.19], preterm delivery [adjusted odds ratio, 0.39; 95% confidence interval, 0.19, 0.78], and neonatal intensive care unit admission [adjusted odds ratio, 0.13; 95% confidence interval, 0.06, 0.29]. All significant neonatal predictors also significantly decreased skin-to-skin contact duration in minutes.

CONCLUSION

The practice of immediate skin-to-skin contact after vaginal delivery did not meet the recommended standard. Neonatal complications and lower maternal educational level further reduced prevalence and duration, indicating the need for targeted educational interventions for patients and providers.

CONDENSATION

The prevalence and duration of immediate skin-to-skin contact after vaginal delivery are lower than recommended. Staff and patient education could mitigate some barriers.HighlightsSkin-to-skin contact occurs less often and with shorter duration than recommendedNewborn health is a stronger predictor of skin-to-skin contact than maternal healthHigher maternal education increases prevalence of skin-to-skin contact.