Awasthi Shally, Verma Tuhina, Agarwal Monica
Department of Pediatrics, King George's Medical University, Lucknow, India.
Bull World Health Organ. 2006 Oct;84(10):819-26. doi: 10.2471/blt.05.029207.
To assess household practices that can affect neonatal health, from the perspective of caregivers and health workers; to identify signs in neonates leading either to recognition of illness or health-care seeking; and to ascertain the proportion of caregivers who recognize the individual items of the integrated management of neonatal and childhood illnesses (IMNCI) programme.
The study was carried out in a rural community in Sarojininagar Block, Uttar Pradesh, India, using qualitative and quantitative research designs. Study participants were mothers, grandmothers, grandfathers, fathers or "nannies" (other female relatives) caring for infants younger than 6 months of age and recognized health-care providers serving the area. Focus group discussions (n = 7), key informant interviews (n = 35) and structured interviews (n = 210) were conducted with these participants.
Many household practices were observed which could adversely affect maternal and neonatal health. Among 200 caregivers, 70.5% reported home deliveries conducted by local untrained nurses or relatives, and most mothers initiated breastfeeding only on day 3. More than half of the caregivers recognized fever, irritability, weakness, abdominal distension/vomiting, slow breathing and diarrhoea as danger signs in neonates. Seventy-nine (39.5%) of the caregivers had seen a sick neonate in the family in the past 2 years, with 30.38% in whom illness manifested as continuous crying. Health care was sought for 46 (23%) neonates. Traditional medicines were used for treatment of bulging fontanelle, chest in-drawing and rapid breathing.
Because there is no universal recognition of danger signs in neonates, and potentially harmful antenatal and birthing practices are followed, there is a need to give priority to implementing IMNCI, and possible incorporation of continuous crying as an additional danger sign.
从照顾者和卫生工作者的角度评估可能影响新生儿健康的家庭行为；识别新生儿中导致疾病被识别或促使寻求医疗保健的体征；并确定认识新生儿和儿童疾病综合管理（IMNCI）项目各项内容的照顾者比例。
本研究在印度北方邦萨罗吉尼纳加尔区的一个农村社区开展，采用定性和定量研究设计。研究参与者为照顾6个月以下婴儿的母亲、祖母、祖父、父亲或“保姆”（其他女性亲属）以及该地区认可的卫生保健提供者。对这些参与者进行了焦点小组讨论（n = 7）、关键 informant 访谈（n = 35）和结构化访谈（n = 210）。
观察到许多可能对孕产妇和新生儿健康产生不利影响的家庭行为。在200名照顾者中，70.5%报告由当地未经培训的护士或亲属在家接生，且大多数母亲在第3天才开始母乳喂养。超过一半的照顾者将发热、烦躁、虚弱、腹胀/呕吐、呼吸急促和腹泻识别为新生儿的危险体征。在过去2年中，79名（39.5%）照顾者家中有新生儿生病，其中30.38%的新生儿疾病表现为持续哭闹。有46名（23%）新生儿寻求了医疗保健。传统药物被用于治疗囟门隆起、胸廓凹陷和呼吸急促。
由于对新生儿危险体征缺乏普遍认识，且遵循了可能有害的产前和分娩做法，因此有必要优先实施IMNCI，并可能将持续哭闹纳入额外的危险体征。
