Awasthi S, Srivastava N M, Pant S
The Department of Pediatrics, Chhatrapati Shahuji Maharaj Medical University, Lucknow, UP, India.
J Perinatol. 2008 Dec;28 Suppl 2:S69-75. doi: 10.1038/jp.2008.169.
To assess symptom-specific care-seeking practices for newborns and behavioral factors associated with them to inform strategies to enhance newborn care seeking in urban Lucknow, Northern India. This was a prospective follow-up study of consecutive 326 neonates delivered at an urban reproductive and child health (RCH) center. Focused Group Discussions (n=5) were also conducted in urban slums (n=3) at the RCH center (n=1) and at a district hospital (n=1). Overall, 326 neonates were recruited within 48 h of birth and 289 (88.7%) were followed up at 6 weeks (+/-15 days) at home. Parents of 51.2% (148/289) neonates reported at least one symptom of illness. Among these, 27.3% (79/289) neonates had at least one reported Integrated Management of Neonatal and Childhood Illnesses (IMNCI) danger sign, of which 15 (18.9%) did not receive any modern medical care, 5(33.3%) of which were dead by early infancy. Care seeking from unqualified providers (spiritual/traditional) was 33.3% (3/9) for persistent diarrhea and 23.5% (4/17) for pneumonia. Qualitative data from Focused Group Discussions showed that when pictures of some danger signs were shown like sunken eyes, reduced skin turgor, chest in-drawing and bulged fontanel, care seeking for these as well as fast breathing were influenced by 'local beliefs', which considered them to be untreatable by modern medicines alone. Thus, care seeking from multiple providers and use of traditional/home remedies delayed appropriate and timely medical care seeking. Almost half of the neonates had an illness symptom of which half had an IMNCI danger sign, of which one fifth did not receive medical care. Therefore, there is an urgent need to introduce a locally modified community IMNCI program here, for promoting care seeking from qualified providers for sick neonates.
为评估印度北部勒克瑙市新生儿特定症状的就医行为及与之相关的行为因素，以制定策略加强该市新生儿的就医行为。这是一项对一家城市生殖与儿童健康（RCH）中心连续分娩的326名新生儿进行的前瞻性随访研究。还在城市贫民窟（3个）、RCH中心（1个）和一家区级医院（1个）进行了焦点小组讨论（共5次）。总体而言，326名新生儿在出生后48小时内被招募，289名（88.7%）在6周（±15天）时在家中接受随访。51.2%（148/289）的新生儿家长报告至少有一种疾病症状。其中，27.3%（79/289）的新生儿至少有一种报告的新生儿和儿童疾病综合管理（IMNCI）危险体征，其中15名（18.9%）未接受任何现代医疗护理，其中5名（33.3%）在婴儿早期死亡。对于持续性腹泻，向不合格提供者（精神/传统）寻求护理的比例为33.3%（3/9），对于肺炎为23.5%（4/17）。焦点小组讨论的定性数据显示，当展示一些危险体征的图片，如眼窝凹陷、皮肤弹性降低、胸廓凹陷和囟门隆起时，对这些症状以及呼吸急促的就医行为受到“当地观念”的影响，这些观念认为仅靠现代药物无法治疗这些症状。因此，向多个提供者寻求护理以及使用传统/家庭疗法延误了适当和及时的医疗护理寻求。几乎一半新生儿有疾病症状，其中一半有IMNCI危险体征，其中五分之一未接受医疗护理。因此，迫切需要在此引入本地化改良的社区IMNCI项目，以促进患病新生儿向合格提供者寻求护理。
