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Background: Although evidence-based interventions to reach the Millennium Development Goals for Maternal and Neonatal mortality reduction exist, they have not yet been operationalised and scaled up in Sub-Saharan African cultural and health systems. A key concern is whether these internationally recommended practices are acceptable and will be demanded by the target community. We explored the acceptability of these interventions in two rural districts of Uganda. Methods: We conducted 10 focus group discussions consisting of mothers, fathers, grand parents and child minders (older children who take care of other children). We also did 10 key informant interviews with health workers and traditional birth attendants. Results: Most maternal and newborn recommended practices are acceptable to both the community and to health service providers. However, health system and community barriers were prevalent and will need to be overcome for better neonatal outcomes. Pregnant women did not comprehend the importance of attending antenatal care early or more than once unless they felt ill. Women prefer to deliver in health facilities but most do not do so because they cannot afford the cost of drugs and supplies which are demanded in a situation of poverty and limited male support. Postnatal care is non-existent. For the newborn, delayed bathing and putting nothing on the umbilical cord were neither acceptable to parents nor to health providers, requiring negotiation of alternative practices. Conclusion: The recommended maternal-newborn practices are generally acceptable to the community and health service providers, but often are not practiced due to health systems and community barriers. Communities associate the need for antenatal care attendance with feeling ill, and postnatal care is non-existent in this region. Health promotion programs to improve newborn care must prioritize postnatal care, and take into account the local socio-cultural situation and health systems barriers including the financial burden. Male involvement and promotion of waiting shelters at selected health units should be considered in order to increase access to supervised deliveries. Scale-up of the evidence based practices for maternal-neonatal health in Sub-Saharan Africa should follow rapid appraisal and adaptation of intervention packages to address the local health system and socio-cultural situation. © 2008 Waiswa et al; licensee BioMed Central Ltd.
This study was undertaken in two rural districts of Iganga and Mayuge during December 2006 and January 2007 in Busoga region, Eastern Uganda. The Busoga region has seven districts and about 3 million people, or 10% of Uganda’s population. Ten focus group discussions (FGDs) were conducted as follows: two with younger mothers less than 30 years; four with older mothers more than 30 years or having grandchildren; two with fathers and another two with child minders (older children who take care of other children) of up to 13 years of age. Selection of young mothers and fathers was limited to those having children less than six months of age in order to ensure that responses reflect recent/current practices. In addition, we also conducted key-informant interviews (KIs) with six health workers and four traditional birth attendants (TBAs). Villages were selected for interviews from both near and far from the hospital to represent the rural-urban divide. Using guidelines from the research team, community leaders identified participants for the FGDs, and district leaders of health services identified health workers and TBAs for the KIs. Pre-tested checklists guided discussions about the acceptability and barriers to adapting practices within the continuum of care approach [9,10,20] with special focus on ANC, intra-partum care, and postnatal care for the mother and the baby, and to home visits by a volunteer to promote improved care during pregnancy, delivery and in the postnatal period. Participants were asked to present their own experiences and actions, or otherwise to describe general attitudes. Interviews with health workers were conducted in English, tape-recorded, transcribed and compiled with field notes. Interviews with TBAs and all the FGDs were conducted in the local language, Lusoga, tape-recorded and transcribed by the moderators. Two Lusoga speakers independently translated interviews into English, leaving all local terminologies in Lusoga to keep informative words intact. Analysis of the in-depth interviews (IDIs) and FGDs used latent thematic content analysis. Transcripts were first read several times to get an overall picture and then meaningful units were coded, condensed and categorized into broad themes [21]. Barriers to care seeking were characterized according to the three delays model which includes delays in deciding to seek care, delay in reaching the health facility, and delay in receiving care once at the health facility [22,23]. The study tools were developed in consultation with national policy makers who included the Iganga and Mayuge districts, the Ministry of Health, the World Health Organization (WHO), UNICEF, and Saving Newborn Lives (SNL) Uganda field offices. An experienced social scientist and a medical doctor trained and supervised the research assistants during pilot testing and field work. All moderators were experienced and their minimum education was to diploma level. Verbal informed consent was sought and obtained from all participants. The study was approved by the Makerere University School of Public Health Institutional Review Board and the Uganda National Council for Science and Technology.
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