Careseeking for illness in young infants in an urban slum in India

Zoysa, Isabelle de; Bhandari, Nita; Akhtari, Naseema; Bhan, Maharaj Kishan

doi:10.1016/s0277-9536(98)00275-5

Cited by 68 publications

(78 citation statements)

References 29 publications

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“…Healthcare-seeking behaviour for the newborn is influenced by many factors (Ahmed et al, 2001;Barnes-Josiah et al, 1998;De Zoysa et al, 1998;Lawn and Kerber, 2006;Marsh et al, 2002;Winch et al, 2005). Very few facilities in Tanzania have equipment and supplies to manage complications of labour and delivery or provide emergency support for the newborn (NBS [Tanzania] and ORC Macro, 2007).…”

Section: Discussionmentioning

confidence: 99%

Understanding home-based neonatal care practice in rural southern Tanzania

Mrisho

Schellenberg

Mushi

et al. 2008

Transactions of the Royal Society of Tropical Medicine and Hygi

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SummaryIn order to understand home-based neonatal care practices in rural Tanzania, with the aim of providing a basis for the development of strategies for improving neonatal survival, we conducted a qualitative study in southern Tanzania. In-depth interviews, focus group discussions and case studies were used through a network of female community-based informants in eight villages of Lindi Rural and Tandahimba districts. Data collection took place between March 2005 and April 2007. The results show that although women and families do make efforts to prepare for childbirth, most home births are assisted by unskilled attendants, which contributes to a lack of immediate appropriate care for both mother and baby. The umbilical cord is thought to make the baby vulnerable to witchcraft and great care is taken to shield both mother and baby from bad spirits until the cord stump falls off. Some neonates are denied colostrum, which is perceived as dirty. Behaviour-change communication efforts are needed to improve early newborn care practices.

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Section: Discussionmentioning

confidence: 99%

Understanding home-based neonatal care practice in rural southern Tanzania

Mrisho

Schellenberg

Mushi

et al. 2008

Transactions of the Royal Society of Tropical Medicine and Hygi

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“…Furthermore, the decision process is deeply affected by tradition, culture, religion, socio-economic environment and household demographic characteristics. 11,13,14 Sound behavioral research on the health care seeking patterns of the community can provide this information, and aid the development of educational messages that encourage evidence-based care practices, proven to improve newborn health and survival, while discouraging potentially harmful behaviors at the community level. The community death audit can prove to be a powerful tool that utilizes real life situations to address existing barriers through community participation, self-recognition of avoidable risks and audit and reinforcement of improved practices by the community, thus, producing sustainable and culturally acceptable changes.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of community neonatal death audits in rural Uttar Pradesh, India

et al. 2007

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Objective: Medical audit is a widely promoted strategy in hospitals, but experience within community settings is scant. Community neonatal death audit is a form of audit, which involves a systematic analysis of the quality of care provided in the home, danger sign recognition and care seeking decision making for neonatal illness. This research was conducted in Uttar Pradesh, India, to investigate the feasibility and cultural acceptability of community neonatal death audits.Study Design: During November-December 2004, we conducted three in-depth interviews with family members of deceased neonates, and six focus group discussions with family and community members. Three approaches were evaluated: in-depth interview with the family before engaging them in an audit with the community; preliminary meeting to build rapport with the family and community before conducting an audit; and audit with the family and community in a single focus group. Approaches were interactive processes, involving the community, to identify avoidable factors in a particular death and discuss solutions.Result: Carried out in a culturally sensitive and non-punitive manner, community neonatal death audit was found to be acceptable and feasible. All approaches provoked formal investigation by community members, and stimulated sharing of views, leading to the self-discovery that community perception was a cumulatively amplified effect of individual perceptions. Presence of an educated/experienced community member or health worker served as a catalyst. No one optimal approach was identified.Conclusion: Community neonatal audit is an acceptable approach that shows promise as an effective intervention for improving neonatal health outcomes.

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“…Moreover, the birth dose may be particularly difficult given various proscriptions against seeking care for newborns outside the home in the formal health sector, particularly for early postnatal care. 439,[569][570][571] Providing appropriate training to village health workers (VHWs) in The Gambia to deliver heat-stable vaccines in a Uniject device, however, was shown to be a costeffective and reliable method for hepatitis B vaccination in rural settings. 572 This alternative means of delivering the intervention may facilitate resolution of the above-mentioned problems with traditional hepatitis B vaccination and may be an effective way to improve coverage and seroconversion rates.…”

Section: Hepatitis B Vaccinationmentioning

confidence: 99%

“…16,25,649,650 In resource-poor countries, however, the majority of births and neonatal deaths take place in the home, and families are often reluctant to seek care outside the home for neonatal illness. 439,[569][570][571] In these settings, facility-based care with use of parenteral antibiotics is currently infeasible for many neonates, and alternative management strategies are needed. Insight into the role of oral antibiotic therapy as a potentially simpler and more feasible regimen for treatment of serious neonatal infections for situations in which referral to a health facility for quality care and parenteral therapy is not possible may be gained by reviewing pneumonia case management trials that included treatment of neonates.…”

Section: Tba/chw Trainingmentioning

confidence: 99%

“…Strengthening health facilities and health systems is an essential aspect of communitybased programs to improve neonatal health. However, given the barriers that exist to care seeking for neonatal illness, 439,[569][570][571] it is unlikely that utilization of facility-based services for newborn care in many communities will increase in the absence of demand creation, improved referral pathways, and quality of care. Although it is unlikely that interventions based in facility settings alone will make a major difference in situations in which the bulk of deliveries take place in domiciliary settings, they are nevertheless an essential adjunct to such care.…”

Section: Care In Peripheral Health Facilitiesmentioning

confidence: 99%

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Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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ABSTRACT. Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developingcountry communities has not been reported.Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in communitybased neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning.Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies.Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care.Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy...

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Careseeking for illness in young infants in an urban slum in India

Cited by 68 publications

References 29 publications

Understanding home-based neonatal care practice in rural southern Tanzania

Understanding home-based neonatal care practice in rural southern Tanzania

Feasibility of community neonatal death audits in rural Uttar Pradesh, India

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

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