Understanding the challenges to caring for low birthweight babies in rural southern Malawi: a qualitative study exploring caregiver and health worker perceptions and experiences

Abstract

BackgroundLow birthweight (LBW) babies account for >80% of neonatal mortality in sub-Saharan Africa and South Asia and those who survive the neonatal period are still at risk of detrimental outcomes. LBW is a major public health problem in Malawi and strongly contributes to the country’s high neonatal mortality rate. We aimed to get a better understanding of the care of LBW babies in rural Malawi in order to inform action to improve their outcomes.MethodsQualitative methods were used to identify challenges faced by caregivers and health workers within communities and at the rural facility level. We conducted 33 in-depth interviews (18 with caregivers; 15 with health workers) and 4 focus group discussions with caregivers. Interviews were recorded, transcribed and translated. Thematic analysis was used to index the data into themes and develop a robust analytical framework.ResultsCaregivers referred to LBW babies as weak, with poor health, stunted growth, developmental problems and lack of intelligence. Poor nutrition of the mother and illnesses during pregnancy were perceived to be important causes of LBW. Discrimination and stigma were described as a major challenge faced by carers of LBW babies. Problems related to feeding and the high burden of care were seen as another major challenge. Health workers described a lack of resources in health facilities, lack of adherence to counselling provided to carers and difficulties with continuity of care and follow-up in the community.ConclusionThis study highlights that care of LBW babies in rural Malawi is compromised both at community and rural facility level with poverty and existing community perceptions constituting the main challenges. To make progress in reducing neonatal mortality and promoting better outcomes, we must develop integrated community-based care packages, improve care at facility level and strengthen the links between them.

Perceptions and practices related to birthweight in rural Bangladesh: Implications for neonatal health programs in low- and middle-income settings

“…The commonly perceived causes of LBW included maternal inadequate diet, poor nutrition, and illness in pregnancy, premature delivery, and twin births, which are in line with the findings of previous research in similar settings [29, 36]. This suggests that most women and their families were aware of several important risk factors of the newborn’s poor birthweight, however, there were several other causes reported which may put their newborn’s health at risk by limiting the preventive practices of LBW.…”

“…This suggests that most women and their families were aware of several important risk factors of the newborn’s poor birthweight, however, there were several other causes reported which may put their newborn’s health at risk by limiting the preventive practices of LBW. For instance, the influence of supernatural spirit was sometimes cited as a cause of giving birth to a LBW newborn which is consistent with a few prior studies [29, 34]. This belief sometimes prevents pregnant women from seeking antenatal care as they remain at home and avoid travelling to the hospital to keep themselves safe from the bad spirit [37].…”

“…Darmstadt et al reported that there was little perceived need to be acquainted with the newborn’s birthweight in rural India [28]. Further, a recent study conducted in Malawi identified community perception as the major constraint of seeking care for LBW newborns in rural communities [29]. In Bangladesh, estimates of birthweight are mostly obtained based on maternal recall and perceptions of the newborn’s birth size, as approximately 62% of all births occur at home and weighing newborns immediately after birth is not feasible [30].…”

Parents as carers on a neonatal unit: Qualitative study of parental and staff perceptions in a low-income setting

“…Videos and mobile phone apps addressing parental issues in local languages may be additional aids, and some are already available (in Kinyarwanda in Rwanda 19 ). Developing close links with community health workers is likely to be advantagous 20 ; an extensive network of volunteer community health workers has been developed in Rwanda, though additional training in the care of the preterm or ill infants graduating from the neonatal unit may be beneficial.…”

Caring for the sick newborns in nurseries in a developing setting: Evaluation of the psychosocial burden on caregivers

“…[5,14] Koenraads et al in Southern Malawi reported high burden of care, feeding problems, and discrimination/stigma as burdens for caregivers, stated as: "Taking care of a small baby is a problem. [14] For instance I did not have time to do other work except concentrating on exclusive breastfeeding… though with scarcity of food in the house from morning to evening this life seems tough," "When he was born the breastmilk was not coming out, I tried forcing him to suck, but his jaws were not ready," and "When they see us they point fingers at us…." It should stand to reason that these reported burdensome experiences could worsen when dealing with a sick baby in a hospital setting.…”