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Tumukunde VS, Katongole J, Namukwaya S, Medvedev MM, Nyirenda M, Tann CJ, Seeley J, Lawn JE. Kangaroo mother care prior to clinical stabilisation: Implementation barriers and facilitators reported by caregivers and healthcare providers in Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002856. [PMID: 39083500 PMCID: PMC11290675 DOI: 10.1371/journal.pgph.0002856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/11/2024] [Indexed: 08/02/2024]
Abstract
Kangaroo mother care (KMC) is an evidence-based method to improve newborn survival. However, scale-up even for stable newborns has been slow, with reported barriers to implementation. We examined facilitators and barriers to initiating KMC before stabilisation amongst neonates recruited to the OMWaNA study in Uganda. The OMWaNA study was a randomised controlled trial that examined the mortality effect of KMC prior to stabilisation amongst newborns weighing ≤2000 grams. At the four trial hospitals, we conducted focus group discussions (FGD) separately with caregivers and healthcare providers, in-depth interviews (IDI) with caregivers and key informant interviews (KII) with hospital administrators and healthcare providers. The World Health Organisation (WHO) Health Systems Building Blocks were used to guide thematic analysis. Eight FGDs (4 caregivers, 4 healthcare providers), 41 caregiver IDIs (26 mothers, 8 grandmothers, 7 fathers), and 23 KIIs were conducted. Key themes based on the building blocks were; family and community support/ involvement, health workforce, medical supplies and commodities, infrastructure and design, financing, and health facility leadership. We found that the presence of a family member in the hospital, adequate provision of healthcare workers knowledgeable in supporting KMC prior to stability, and adequate space for KMC beds where neonatal care is being delivered, can enable implementation of KMC before stability. Implementation barriers included fear of inadvertently causing harm to the newborn, inadequate space to practice KMC in the neonatal unit, and a limited number of trained healthcare workers coupled with insufficient medical supplies.
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Affiliation(s)
- Victor S. Tumukunde
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joseph Katongole
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Stella Namukwaya
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Melissa M. Medvedev
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Paediatrics, University of California San Francisco, San Francisco, California, United States of America
| | - Moffat Nyirenda
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Cally J. Tann
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Neonatal Medicine, University College London, London, United Kingdom
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joy E. Lawn
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Paediatrics, University of California San Francisco, San Francisco, California, United States of America
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Tajik F, Mahmoodi M, Azodi P, Jahanpour F. Nurse-mother communication and support: Perceptions of mothers in neonatal units. Heliyon 2024; 10:e29325. [PMID: 38644893 PMCID: PMC11033110 DOI: 10.1016/j.heliyon.2024.e29325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Having a hospitalized neonate is a stressful experience for parents, especially mothers. Thus, in recent years, a paradigm shift occurred in the neonatal units, focusing on the needs of parents and supporting them in addition to caring for neonates. The aim of this study was to evaluate the nurse-mother communication and support in neonatal units in Bushehr, Iran. Method This descriptive cross-sectional study was performed in neonatal units of 6 hospitals in Bushehr, Iran, in 2022. Using the census method, all eligible mothers who met the inclusion criteria were included in this study. Data collection tools included demographic information form, nurse-parent support tool and nurse-parent communication questionnaire. The collected data were analyzed by SPSS version 24 using descriptive statistics, independent t-test, one-way ANOVA and Pearson correlation test. Results The total mean score of nurse-parent support tool was 3.72 ± 0.72 and the total mean score of nurse-parent communication questionnaire was 59/27 ± 12/82. Caregiving support had the highest mean score (4.07 ± 73 0.73) and emotional support had the lowest (3.42 ± 91 0.91). Also, a statistically significant difference was seen between the admitted unit variable and the mean score of nurse-mother communication and support. Additionally, there was a statistically significant difference between the mechanical ventilation status of the neonate and the mean score of nurse-mother support. A significant positive correlation was seen between the neonatal gestational age and the mean score of nurse-mother communication. Conclusions The total mean score of nurse-parent support and communication was moderate. Therefore, nursing support and communication need to be improved. Planning is needed to enhance the role of neonatal nurses and strengthen their support and communication skills in line with the family-centered care approach.
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Affiliation(s)
- Farnoosh Tajik
- Department of Pediatric and Neonatal nursing, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
- MSc in Pediatric Nursing, Nursing and Midwifery Department, Member of Student Research Committee, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Marzieh Mahmoodi
- Biostatistics and Epidemiology Department, Health and Nutrition Faculty, Clinical Research Development Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Parviz Azodi
- Paramedical Sciences Department, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Faezeh Jahanpour
- Nursing and Midwifery Department, Bushehr University of Medical Sciences, Bushehr, Iran
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Oluoch D, Hinton L, English M, Irimu G, Onyango T, Jones COH. Mothers' involvement in providing care for their hospitalised sick newborns in Kenya: a focused ethnographic account. BMC Pregnancy Childbirth 2023; 23:389. [PMID: 37237328 DOI: 10.1186/s12884-023-05686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION There is growing evidence that parental participation in the care of small and sick newborns benefits both babies and parents. While studies have investigated the roles that mothers play in newborn units in high income contexts (HIC), there is little exploration of how contextual factors interplay to influence the ways in which mothers participate in the care of their small and sick newborn babies in very resource constrained settings such as those found in many countries in sub-Saharan Africa. METHODS Ethnographic methods (observations, informal conversations and formal interviews) were used to collect data during 627 h of fieldwork between March 2017 and August 2018 in the neonatal units of one government and one faith-based hospital in Kenya. Data were analysed using a modified grounded theory approach. RESULTS There were marked differences between the hospitals in the participation by mothers in the care of their sick newborn babies. The timing and types of caring task that the mothers undertook were shaped by the structural, economic and social context of the hospitals. In the resource constrained government funded hospital, the immediate informal and unplanned delegation of care to mothers was routine. In the faith-based hospital mothers were initially separated from their babies and introduced to bathing and diaper change tasks slowly under the close supervision of nurses. In both hospitals appropriate breast-feeding support was lacking, and the needs of the mothers were largely ignored. CONCLUSION In highly resource constrained hospitals with low nurse to baby ratios, mothers are required to provide primary and some specialised care to their sick newborns with little information or support on how undertake the necessary tasks. In better resourced hospital settings, most caring tasks are initially performed by nurses leaving mothers feeling powerless and worried about their capacity to care for their babies after discharge. Interventions need to focus on how to better equip hospitals and nurses to support mothers in caring for their sick newborns, promoting family centred care.
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Affiliation(s)
- Dorothy Oluoch
- Centre for Geographic Medicine (Coast), KEMRI-Wellcome Trust research programme, Nairobi, Kenya.
| | - Lisa Hinton
- THIS Institute, University of Cambridge, Cambridge, UK
| | - Mike English
- Centre for Geographic Medicine (Coast), KEMRI-Wellcome Trust research programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, NUFFIELD department of medicine, University of Oxford, Oxford, UK
| | - Grace Irimu
- Centre for Geographic Medicine (Coast), KEMRI-Wellcome Trust research programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Truphena Onyango
- Centre for Geographic Medicine (Coast), KEMRI-Wellcome Trust research programme, Nairobi, Kenya
| | - Caroline O H Jones
- Centre for Geographic Medicine (Coast), KEMRI-Wellcome Trust research programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, NUFFIELD department of medicine, University of Oxford, Oxford, UK
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