Quality of Neonatal Health

Care : Learning From

Mothers’ experiences

Ukwanda Sustainable Rural Research Days 2014

B. Mbwele. MD, MSc Clin Research

KCMUCo / CSSC

Bernard Mbwele*, Nicole L. Ide, Elizabeth Reddy, Sarah A. P Ward, Joshua A Melnick,

Flavian A. Masokoto and Rachael Manongi

Background

With a decline of infant mortality rates, neonatal mortality rates are striking high in sub Saharan Africa1,2,

Studying care-seeking processes and treatment actions is important in Tanzania3.

The toolkit for high quality neonatal services describes the principle of patient satisfaction, (mother’s satisfaction)4 .

1. Lawn JE et al. Newborn survival: a multi-country analysis of a decade of change. Health Policy Plan 2012, 27 (Suppl 3):iii6–iii28.

2. Liu L, et al: Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012, 379(9832):2151–2161.

3. Mrisho M et al. Neonatal deaths in rural southern Tanzania: care-seeking and causes of death. ISRN Pediatr 2012, 2012:953401.

4. NHS & Department of Health: Toolkit for High Quality Neonatal Services. London, UK: Maternity and Newborn Team Partnerships for Children, Families and Maternity, Families and Maternity; 2009. http://www.neonatal.org.uk/documents/5350.pdf

The Objective

The aim of the study was to assess

mothers’ experiences, perception and

satisfaction of neonatal care in the

hospitals of Kilimanjaro region of

Tanzania.

Methods

A cross sectional study using qualitative and quantitative approaches in 112 semi structured interviews from 14 health facilities.

Open ended questions for detection of illness, care given to the baby and time spent

Probing of the responses

Closed ended questions for the quantitative variables

Narratives from open ended questions were coded by colours in excel sheet and themes were manually counted.

Noticing a problem

59 mothers (73.8%) in noted neonatal problems and assisted for attaining diagnosis

11 mothers (13.8%) were able to identify the baby’s diagnosis directly without any assistance,

7 mothers (8.7%) were told by a relative to seek medical advices

3 mothers (3.7%) knew nothing and were told of the problem by the doctor on the need

Qualitatively

In the peripheral hospitals, (52.4%, n=105)

commented on the performance of HCW

F6 NNM, 36 years old, whose baby was

floppy and coughing, explained that

“doctors and nurses need to be to be careful

with their work all the time, because they

keep giving me different information on the

same illness of the baby.”

Qualitatively

F1 SKY, 20 years old was not told the

diagnosis or what medications were given

to her baby. This mother commented that

“they did not explain my baby's problem, and

I was not taught how to take care of my baby

at home.”

Qualitatively

F1 EES, 33 years old CC: fever with difficulty

in sucking RX: Ampicillin, Gentamycin and

Cloxacillin

“I wished there could be more medicines for

the babies, because I felt disturbed to leave my

baby to the neighbouring mother while I move

out for buying medicines at the pharmacy

outside.”

Their feelings

43 mothers, 53.8% of the mothers felt

explanations were not sufficient

71 mothers, 88.8% needed more time

with the doctors.

10 mothers, 12.5% of the mothers in the

periphery reported that they never had

an opportunity to ask questions for

clarification,

Asking a nurse/doctor to com and

review the baby?

In the periphery, 25 mothers (30.4%) reported

to call a doctor or a nurse to review a baby

average response was 13.76 ± 11.4 minutes

77 mothers in the periphery (90.6%) were

not satisfied with the amount of time spent

by the doctors in seeing their babies.

Language..!?

24 times mothers in the peripheral

hospitals reported bad language

“I don’t have time to listen to you every

day and every time.”

Unfriendliness of HCW

0.0%

5.9%

5.9%

5.9%

5.9%

23.5%

23.5%

29.4%

50%

0.0%

16.7%

0.0%

0.0%

16.6%

0.0%

16.6%

0 10 20 30 40 50 60

Delay of medical care

Little opportunity in asking questions

Poor instructions and harsh care

Nurses were in a hurry

Nurses came to see me only when baby fellseriously sick

No enough explanations

Doctors did not make routine examinations

Bad language

At a tertiary refferal Center Among the peripheral centers

(Pearson X2(2) = 12.53 P value = 0.002).

Findings from Files

From other subset of patient files in the periphery

Neonatal septicaemia 31 (37.8%)

Pneumonia 12 (14.6%)

Prematurity 9 (10.9%)

Birth asphyxia 6 (7.3%)

Sucking problem 6 (7.3%)

Bacterial skin infection 6 (7.3%)

Referral centre

Premature delivery 11 (33.3%)

Neonatal septicaemia 7 (21.2%)

Birth asphyxia 5 (15.2%) .

What do we learn?

Mothers of the neonates play great roles

in identifying the illness of the newborn.

Mother’s awareness of what might be

needed during neonatal support

strategies to improve neonatal care in

both health facilities and the communities.

Way forward

Strategies to improve recognition of prenatal and postnatal newborn

danger signs in the communities must be prioritized.

“Mothers offer the solution”

© Dr Bernard Mbwele 2013