Background More than 2.5 million newborns die each year, accounting for 47% of children dying worldwide before their age of five years. Complications of preterm birth are the leading cause of death among newborns. Pakistan is amongst the top ten countries with highest preterm birth rate per 1000 live births. Globally, Every Newborn Action Plan (ENAP) has emphasized on Kangaroo Mother Care (KMC) as an essential component of neonatal health initiatives. Materials and methods We conducted this qualitative study with 12 in-depth interviews (IDIs) and 14 focus group discussion (FGD) sessions, in two health facilities of Sindh, Pakistan during October-December 2016, to understand the key barriers and enablers to a mother's ability to practice KMC and the feasibility of implementing and improving these practices. Results The findings revealed that community stakeholders were generally aware of health issues especially related to maternal and neonatal health. Both the health care providers and managers were supportive of implementing KMC in their respective health facilities as well as for continuous use of KMC at household level. In order to initiate KMC at facility level, study respondents emphasized on ensuring availability of equipment, supplies, water-sanitation facility, modified patient ward (e.g., curtain, separate room) and quality of services as well as training of health providers as critical prerequisites. Also in order to continue practicing KMC at household level, engaging the community and establishing functional referral linkage between community and facilities were focused issues in facility and community level FGDs and IDIs. Conclusion The study participants considered it feasible to initiate KMC practice at health facility and to continue practicing at home after returning from facility. Ensuring facility readiness to initiate KMC, improving capacity of health providers both at facility and community levels, coupled with focusing on community mobilization strategy, targeting specific audiences, may help policy makers and program planners to initiate KMC at health facility and keep KMC practice continued at household level.
Background Unsafe practices such as cutting umbilical cord with unsterilized instruments and application of harmful substances, are in practice in many rural areas of Pakistan, and associated with high risk of neonatal sepsis and mortality. Methods We conducted an implementation research in 2015 in Tharparkar district, in Sindh province of Pakistan to understand the feasibility and acceptability of community-based distribution of chlorhexidine (CHX) in rural Pakistan. For this cohort group-only study, 225 lady health workers (LHWs) enrolled 495 pregnant women. Enrolled women received 4% CHX gel and user’s instructions for newborn cord care. The LHWs also counseled women on the benefits and correct use of CHX. Study enumerators collected data from CHX receiving women 3 times: at around 2 weeks before delivery, within 24 hours after delivery, and on the 8th day after delivery. We implemented this study jointly in collaboration with Ministry of Health in Sindh province, Pakistan. Results Among enrolled participants, 399 women (81%) received only the first visit, 295 women (60%) received first two visits and 261 women (53%) received all three visits by enumerators. Among 399 women, who received CHX gel, counseling on its use and were respondent to the first round data collection, 78% remembered that the CHX gel to be applied to cord stump and surrounding areas immediately after birth; but less than a third (29%) forgot the need to keep the cord clean and dry. Among 295 respondents in the first two rounds of data collection, who delivered at home, 97% applied CHX to cord stump on the first day. Conclusions Community-based CHX distribution by LHWs, along with counseling to recipient women, resulted in a high rate of cord care with CHX among newborn delivered at home. Results from this study may help program implementers to consider expanding this intervention for improving newborn cord care on the first day of life in Pakistan. Key messages Community-based distribution of chlorhexidine for newborn cord care appears as highly acceptable and feasible in rural communities in Pakistan. Relevant program policy supporting community-based CHX distribution along with counseling by LHW may help expanding coverage of newborn cord care in rural communities in Pakistan.
Background More than 2.5 million newborns die each year, contributing to 47% of under 5 mortality worldwide. Globally, Every Newborn Action Plan has emphasized on Kangaroo Mother Care (KMC) as an essential component of neonatal health initiatives. An international joint policy statement and endorsement from health professional associations also recommended practicing KMC for newborn care. Methods We conducted a qualitative study with 12 in-depth interviews (IDIs) and 14 focus group discussion (FGD) sessions, in two health facilities of Sindh, Pakistan during October-December 2016, to understand the key barriers and enablers to a mother’s ability to practice KMC and the feasibility of implementing and improving these practices. Results Our study findings revealed that community stakeholders were generally aware of health issues especially related to maternal and neonatal health. Both the health care providers and managers were supportive of implementing KMC in their respective health facilities as well as for continuous use of KMC at household level. In order to initiate KMC at facility level, study respondents emphasized on strengthening of availability and quality of services as well as training of health providers as critical prerequisites. Also in order to continue practicing KMC at household level, engaging the community and establishing functional referral linkage between community and facilities were focused issues in facility and community level FGDs and IDIs. The study participants considered it feasible to initiate KMC practice at health facility and to continue practicing at home after returning from facility. Conclusions Ensuring facility readiness to initiate KMC, improving capacity of health providers, coupled with strengthened community mobilization, and targeting specific audiences may help policy makers and program planners to initiate KMC practice at health facility and keep KMC practice continued at household level. Key messages Introducing KMC at health facility followed by continuing practice at household level is feasible, even in a religiously conservative setting like Pakistan. Facility readiness, improved health workers’ capacity coupled with strengthened community mobilization targeting specific audiences could help scaling up this public health intervention in Pakistan.
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