Legrand Fosso Albert, Kane Hélène
Sante Publique. 2020;HS1(S1):69-79. doi: 10.3917/spub.200.0069.
To supply high-quality neonatal care, it is essential to provide adequate infrastructures and material. Exceeding the visible simplicity of this condition, we suggest analyzing finely the relationship between the arrangement of the care spaces in maternity, their uses, and the quality of the care delivered to the newborns.
An ethnographic investigation in ten hospitals of Cameroon, among which one by region chosen from the various levels of the sanitary pyramid, allowed us to examine how the arrangement of the sanitary spaces and the arrangement of the material could contribute to the vulnerability of the newborn in maternity wards. Two hundred observations of the care given at birth were transcribed, then used as support for interviews with healthcare professionals in the aims of explaining their actions.
The sanitary spaces, with habits and modes of organization, do not optimize the quality of the care to the newborns. The fragmentation of places used in the coverage of the newborn children engenders delays in care in case of complication at the birth. The ways in which the space and material are used in the wards reveal a lack of anticipation and coordination of care. The appropriations of places and arrangement of equipment are not favorable to recommended neonatal care practices, in particular concerning the fight against the hypothermia and the promotion of early breast-feeding. Indeed, the spatial organization in maternity wards appears to be more centered on the obstetrical care.
Reflecting on care spaces can provide a basis for local collective processes of improvement of newborn care practices. It allows to re-question the biomedical professional culture, the segmentation of the tasks and the techniques, and to durably anchor evolutions favorable to neonatal survival.
为提供高质量的新生儿护理，提供充足的基础设施和物资至关重要。除了这种情况表面上的简单性之外，我们建议仔细分析产科护理空间的布局、其用途以及提供给新生儿的护理质量之间的关系。
在喀麦隆的十家医院进行了一项人种学调查，其中从卫生金字塔的各个层面中各选一家，这使我们能够研究卫生空间的布局和物资的配置如何导致新生儿在产科病房中易受伤害。对两百例分娩时的护理观察进行了记录，然后用作与医护人员访谈的依据，以解释他们的行为。
卫生空间及其习惯和组织模式并未优化对新生儿的护理质量。用于新生儿护理区域的分散导致分娩时出现并发症时护理延迟。病房中空间和物资的使用方式显示出缺乏对护理的预先规划和协调。场所的分配和设备的布置不利于推荐的新生儿护理实践，特别是在预防体温过低和促进早期母乳喂养方面。实际上，产科病房的空间组织似乎更多地以产科护理为中心。
对护理空间进行反思可为当地改善新生儿护理实践的集体进程提供基础。它使人们能够重新审视生物医学专业文化、任务和技术的细分，并持久地推动有利于新生儿生存的变革。
