Koenraads Marianne, Phuka John, Maleta Kenneth, Theobald Sally, Gladstone Melissa
Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Department of Community Health, University of Malawi, Zomba, Malawi.
BMJ Glob Health. 2017 Aug 22;2(3):e000301. doi: 10.1136/bmjgh-2017-000301. eCollection 2017.
Low birthweight (LBW) babies account for >80% of neonatal mortality in sub-Saharan Africa and South Asia and those who survive the neonatal period are still at risk of detrimental outcomes. LBW is a major public health problem in Malawi and strongly contributes to the country's high neonatal mortality rate. We aimed to get a better understanding of the care of LBW babies in rural Malawi in order to inform action to improve their outcomes.
Qualitative methods were used to identify challenges faced by caregivers and health workers within communities and at the rural facility level. We conducted 33 in-depth interviews (18 with caregivers; 15 with health workers) and 4 focus group discussions with caregivers. Interviews were recorded, transcribed and translated. Thematic analysis was used to index the data into themes and develop a robust analytical framework.
Caregivers referred to LBW babies as weak, with poor health, stunted growth, developmental problems and lack of intelligence. Poor nutrition of the mother and illnesses during pregnancy were perceived to be important causes of LBW. Discrimination and stigma were described as a major challenge faced by carers of LBW babies. Problems related to feeding and the high burden of care were seen as another major challenge. Health workers described a lack of resources in health facilities, lack of adherence to counselling provided to carers and difficulties with continuity of care and follow-up in the community.
This study highlights that care of LBW babies in rural Malawi is compromised both at community and rural facility level with poverty and existing community perceptions constituting the main challenges. To make progress in reducing neonatal mortality and promoting better outcomes, we must develop integrated community-based care packages, improve care at facility level and strengthen the links between them.
在撒哈拉以南非洲和南亚，低体重儿占新生儿死亡人数的80%以上，而那些度过新生儿期的低体重儿仍有出现不良后果的风险。低体重是马拉维的一个主要公共卫生问题，对该国较高的新生儿死亡率有很大影响。我们旨在更好地了解马拉维农村地区低体重儿的护理情况，以便为改善其结局的行动提供依据。
采用定性方法来确定社区和农村医疗机构层面的照顾者和卫生工作者所面临的挑战。我们进行了33次深入访谈（18次访谈照顾者；15次访谈卫生工作者），并与照顾者进行了4次焦点小组讨论。访谈进行了录音、转录和翻译。采用主题分析法将数据归纳为主题，并建立一个强大的分析框架。
照顾者称低体重儿体弱、健康状况差、生长发育迟缓、有发育问题且智力不足。母亲营养不良和孕期患病被认为是低体重的重要原因。歧视和污名被描述为低体重儿照顾者面临的主要挑战。与喂养相关的问题和高护理负担被视为另一大挑战。卫生工作者表示，医疗机构缺乏资源，照顾者不遵守提供给他们的咨询建议，以及社区护理和随访存在困难。
本研究强调，马拉维农村地区低体重儿的护理在社区和农村医疗机构层面都受到损害，贫困和现有的社区观念构成了主要挑战。为了在降低新生儿死亡率和促进更好的结局方面取得进展，我们必须制定基于社区的综合护理方案，改善医疗机构层面的护理，并加强它们之间的联系。
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