Menu
Menu
Menu
Menu
Background: Ethiopia has made significant progress in reducing child mortality but newborn mortality has stagnated at around 29 deaths per 1000 births. The Maternal Health in Ethiopia Partnership (MaNHEP) was a 3.5-year implementation project aimed at developing a community-oriented model of maternal and newborn health in rural Ethiopia and to position it for scale up. In 2014, we conducted a case study of the project focusing on recognition of and timely biomedical care seeking for maternal and newborn complications. In this paper, we detail the main findings from one component of the case study – the narrative interviews on newborn complications. Methods: The study area, comprised of six districts in which MaNHEP had been implemented, was located in the two most populous federal regions of Ethiopia, Oromia and Amhara. The final purposive sample consisted of 16 cases in which the newborn survived to 28 days of life, and 13 cases in which the newborn died within 28 days of life, for a total sample size of 29 cases. Narrative interview were conducted with the main caregiver and several witnesses to the event. Analysis of the data included thematic content analysis and the determination of care seeking pathways and levels and timeliness of biomedical care seeking. Results: Mothers and other witnesses do recognize certain symptoms of newborn illness which they often mentioned in clusters. The majority considered the symptoms to be serious and in some case hopeless. Perceived causes were mostly natural. Forty-one percent of care seekers sought timely biomedical care in the neonatal period. Surprisingly, perceived severity did not necessarily trigger care seeking. Facilitators of biomedical care seeking included accessibility of health facilities and counseling by health workers, whereas barriers included perceived vulnerability of newborns, post-partum restrictions on movements, hopelessness, wait-and-see atttitudes, poor communication and physical inaccessibility of health facilities. Conclusions: Symptom recognition and care seeking patterns indicate the need to strengthen focused locally relevant health messages which target mothers, fathers and other community members, to further enhance access to health care and to improve referral and quality of care.
As described in our recent publication focusing on illness recognition and care seeking for maternal complications [5], the study was conducted in the two most populous federal regions of Ethiopia, Oromia and Amhara (Fig. 1). [1] The districts were largely rural and included Degem, Kuyu and Warra Jarso in Oromia Region and North Achefer, South Achefer and Mecha in Amhara Region (estimated population 350,000). Each district has an urban center and around six health centers each of which oversee five or six health posts. From each district, one health center and two health posts were randomly selected. Cases of newborn complications occurring within the previous 6 months were identified and sampled from the catchment areas of these facilities, as described below. A case was defined as a mother, her newborn and the witnesses to the newborn’s illness event. Sample design This section presents a summary of sampling and data collection procedures. For further details on sampling, the interview guide, reporting and maintainance of data quality, see our previous publication on recognition and care seeking for maternal complications [5]. In the six districts, the study aimed to involve 30 cases: for each of the six districts, 3 mothers who perceived that their newborn became ill during the first month of life and was alive at 28 days of life, 2 mothers whose newborn became ill and died within 28 days of life and several witnesses to each event . Representation of diverse views and availability of cases were considerations in sampling. The inclusion criteria for these mothers were: female, age 18–49 years, gave birth in the previous 6 months, residence in the MaNHEP project area, perceived her newborn became ill within the first month of life and willing and able to participate. The final sample consisted of 16 cases in which the newborn survived to 28 days of life, and 13 cases in which the newborn died within 28 days of life, for a total sample size of 29 cases (Fig. 1). After obtaining verbal informed consent using standard disclosure procedures, the study team used illness narrative interviews to collect data. The illness narrative is a qualitative rendering of an illness event by those who experienced the illness, along with those who were witnesses to the event. [6] The narrative interviews were conducted with a primary caregiver, usually the mother of the newborn, and several witnesses to the illness event, who varied in number from one-to-three additional persons including her husband, mother-in-law, mother, sibling or neighbor. Although the interviews prioritized the primary caregiver who was usually the mother, other witnesses participated to a greater or lesser extent depending on personality and their role in the management of the illness episode. Thus, it turned out that the main or only respondent(s) in 13 of the 29 interviews was the mother; the mother and her husband in seven interviews; the mother and another person such as her mother-in-law or mother in five interviews; and persons other than the mother in four interviews. Shortly after the interviews were conducted, “expanded field notes” on them were developed from memory, field notes, and audiotape recordings. . Coding procedures are detailed in our previous publication on illness recognition and care seeking for maternal complication. [5] A codebook, based on the illness narrative guide content and containing code definitions and inclusion and The analysis involved thematic content analysis using NVivo 10 based on the Delay Model [4]; re-coding of care-seeking pathways into: biomedical and non-biomedical or late biomedical categories; and univariate analysis to identify respondent characteristics and thematic code frequencies. Further details on these analyses are available in an earlier publication on care seeking for compications of pregnancy and child birth. [7] We also conducted a multiple correspondence analysis (MCA) to detect underlying structures in the illness recognition data. MCA is an exploratory qualitative data analysis technique. Perceived symptoms and causes (please refer below to the list of symptoms and causes) were treated as nominal variables with multiple levels, and the correlations among them were projected in a 2-dimensional visual “map.” Proximity between different levels of these variables and between groups of individuals associated with the levels in the map were examined for clusters or patterns of symptoms and causes in relation to outcomes. A clustering of symptoms and causes suggests illness recognition on the part of respondents. Grouping individuals by an external outcome variable allow one to examine whether clusters of symptoms and causes are associated with differential outcomes-e.g. babies survived or did not survive the first 28 days of life. MCA was performed using the statistical software R [8]. Before initiating the study, ethical review of and approval for the study was obtained from Emory University Institutional Review board and the Oromia and Amhara Regional State Health Bureaus.
N/A
