Nalwadda Christine K, Waiswa Peter, Guwatudde David, Kerber Kate, Peterson Stefan, Kiguli Juliet
School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Health System Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;
Glob Health Action. 2015 Mar 31;8:24386. doi: 10.3402/gha.v8.24386. eCollection 2015.
The first week of life is the time of greatest risk of death and disability, and is also associated with many traditional beliefs and practices. Identifying sick newborns in the community and referring them to health facilities is a key strategy to reduce deaths. Although a growing area of interest, there remains a lack of data on the role of sociocultural norms and practices on newborn healthcare-seeking in sub-Saharan Africa and the extent to which these norms can be modified.
This study aimed to understand the community's perspective of potential sociocultural barriers and facilitators to compliance with newborn referral.
In this qualitative study, focus group discussions (n=12) were conducted with mothers and fathers of babies aged less than 3 months. In addition, in-depth interviews (n=11) were also held with traditional birth attendants and mothers who had been referred by community health workers to seek health-facility-based care. Participants were purposively selected from peri-urban and rural communities in two districts in eastern Uganda. Data were analysed using latent content analysis.
The community definition of a newborn varied, but this was most commonly defined by the period between birth and the umbilical cord stump falling off. During this period, newborns are perceived to be vulnerable to the environment and many mothers and their babies are kept in seclusion, although this practice may be changing. Sociocultural factors that influence compliance with newborn referrals to seek care emerged along three sub-themes: community understanding of the newborn period and cultural expectations; the role of community health actors; and caretaker knowledge, experience, and decision-making autonomy.
In this setting, there is discrepancy between biomedical and community definitions of the newborn period. There were a number of sociocultural factors that could potentially affect compliance to newborn referral. The widely practised cultural seclusion period, knowledge about newborn sickness, individual experiences in households, perceived health system gaps, and decision-making processes were facilitators of or barriers to compliance with newborn referral. Designers of newborn interventions need to address locally existing cultural beliefs at the same time as they strengthen facility care.
出生后的第一周是死亡和残疾风险最高的时期，且与许多传统观念和习俗相关。在社区中识别患病新生儿并将他们转诊至医疗机构是降低死亡率的关键策略。尽管这是一个日益受到关注的领域，但关于社会文化规范和习俗在撒哈拉以南非洲地区新生儿就医行为中的作用以及这些规范可被改变的程度，仍然缺乏数据。
本研究旨在了解社区对于遵守新生儿转诊潜在的社会文化障碍和促进因素的看法。
在这项定性研究中，对年龄小于3个月婴儿的父母进行了焦点小组讨论（n = 12）。此外，还对传统助产士以及被社区卫生工作者转诊至医疗机构寻求护理的母亲进行了深入访谈（n = 11）。参与者是从乌干达东部两个地区的城郊和农村社区中有意选取的。数据采用潜在内容分析法进行分析。
社区对新生儿的定义各不相同，但最常见的定义是从出生到脐带残端脱落的这段时间。在此期间，新生儿被认为易受环境影响，许多母亲及其婴儿会被隔离，不过这种做法可能正在改变。影响遵守新生儿转诊就医的社会文化因素呈现出三个子主题：社区对新生儿期的理解和文化期望；社区卫生工作者的作用；以及照顾者的知识、经验和决策自主权。
在这种情况下，生物医学对新生儿期的定义与社区的定义存在差异。有许多社会文化因素可能会影响对新生儿转诊的遵守情况。广泛实行的文化隔离期、对新生儿疾病的了解、家庭中的个人经历、感知到的卫生系统差距以及决策过程，都是遵守新生儿转诊的促进因素或障碍。新生儿干预措施的设计者在加强医疗机构护理的同时，需要应对当地现有的文化观念。
