State of newborn care in South Sudan’s displacement camps: a descriptive study of facility-based deliveries

Abstract

BackgroundApproximately 2.7 million neonatal deaths occur annually, with highest rates of neonatal mortality in countries that have recently experienced conflict. Constant instability in South Sudan further strains a weakened health system and poses public health challenges during the neonatal period. We aimed to describe the state of newborn facility-level care in displaced person camps across Juba, Malakal, and Maban.MethodsWe conducted clinical observations of the labor and delivery period, exit interviews with recently delivered mothers, health facility assessments, and direct observations of midwife time-use. Study participants were mother-newborn pairs who sought services and birth attendants who provided delivery services between April and June 2016 in five health facilities.ResultsFacilities were found to be lacking the recommended medical supplies for essential newborn care. Two of the five facilities had skilled midwives working during all operating hours, with 6.2% of their time spent on postnatal care. Selected components of thermal care (62.5%), infection prevention (74.8%), and feeding support (63.6%) were commonly practiced, but postnatal monitoring (27.7%) was less consistently observed. Differences were found when comparing the primary care level to the hospital (thermal: relative risk [RR] 0.48 [95% CI] 0.40–0.58; infection: RR 1.28 [1.11–1.47]; feeding: RR 0.49 [0.40–0.58]; postnatal: RR 3.17 [2.01–5.00]). In the primary care level, relative to newborns delivered by traditional birth attendants, those delivered by skilled attendants were more likely to receive postnatal monitoring (RR 1.59 [1.09-2.32]), but other practices were not statistically different. Mothers’ knowledge of danger signs was poor, with fever as the highest reported (44.8%) followed by not feeding well (41.0%), difficulty breathing (28.9%), reduced activity (27.7%), feeling cold (18.0%) and convulsions (11.2%).ConclusionsAddressing health service delivery in contexts affected by conflict is vital to reducing the global newborn mortality rate and reaching the Sustainable Development Goals. Gaps in intrapartum and postnatal care, particularly skilled care at birth, suggest a critical need to build the capacity of the existing health workforce while increasing access to skilled deliveries.

Essential healthcare services provided to conflict-affected internallydisplaced populations in low and middle-income countries: A systematicreview

“…38 Sexually transmitted diseases (STIs) and HIV/AIDS were not a major focus in the SRH interventions. 35,38,51,57,63 Most interventions lasted for longer durations (up to three years) 35,51 compared to other intervention types. Reasons given for shorter SRH intervention periods included poor sustainability and high-cost implications.…”

“…health workers and essential supplies, especially the provision of FP commodities for pregnancy risk reduction. 51,57 A study on newborn care reported lack of newborn services and wide disparities in the care provided at primary care levels compared to secondary care (hospitals). Difference in the quality of health services between the two levels of care was evident in the higher number of recommended essential drugs available at the hospitals (20/37) compared to primary care facilities (9/25).…”

“…Difference in the quality of health services between the two levels of care was evident in the higher number of recommended essential drugs available at the hospitals (20/37) compared to primary care facilities (9/25). 57 The observed service differences also influenced health outcomes. For example, compared to the hospitals, the relative risk of infection 1.28 (CI: 1.11-1.47), indicated a 28% higher risk of getting an infection at the primary care.…”

“…Observations in the same study also showed poor knowledge of newborn danger signs among new mothers, and that midwives spent more time on non-patient activities due to staff shortage. 57 Largely, the availability of MCH services at clinics created positive awareness among mothers and increased usage of health facilities.…”

An analytic perspective of a mixed methods study during humanitarian crises in South Sudan: translating facility- and community-based newborn guidelines into practice

“…Postnatal home visits in the first week of life, while new and acceptable to community health workers (CHWs), were not sustained during periods of mass displacement because of the inability to locate households and limited staff available to manage competing priorities (11). At the facility level, partograph use for fetal monitoring, skin-to-skin contact, and postnatal monitoring of danger signs were the least commonly used practices at baseline, highlighting gaps in care for small and sick newborns (9). Despite this, essential newborn practices such as thermal care (immediate drying and wrapping), infection prevention, and feeding support were high following the intervention (ranging from 79.7% to 83.2%).…”