Exploring communities' perceptions of the etiology of illnesses in newborns and young infants 0-59 days old in 4 counties in Kenya.

George Odwe,Timothy Abuya,Charity Ndwiga,Charlotte E Warren,Pooja Sripad,Chantalle Okondo,Emma Sacks

doi:10.1371/journal.pone.0240852

Abstract

BackgroundUnderstanding communities’ beliefs about the causes of illnesses in sick young infants (SYIs) is key to strengthening interventions and improving newborn health outcomes. This study explored communities' perception of the etiology of illnesses in SYIs 0–59 days old in four counties in Kenya.MethodsWe used an exploratory qualitative study design. Data were collected between August and September 2018 and involved 23 in-depth interviews with female caregivers aged 15-24years; 25 focus group discussions with female caregivers aged 15–18 years, 19–24 years and 25–45 years; and 7 focus group discussions with fathers aged 18–34 years and 35 or more years. Participants were purposely sampled, only those with SYIs 0–59 days old were eligible to participate. Data were analyzed using inductive thematic analysis framework approach.ResultsFemale caregivers and fathers attributed illnesses in SYIs 0–59 days old to natural (biomedical) and supernatural causes which sometimes co-existed. There were commonalities in perceived natural causes of illness in SYIs across sites, age groups and gender. Perceived natural causes of illness in SYIs include unfavorable environmental and hygiene conditions, poor maternal and child nutrition, and healthcare practices. Perceived supernatural causes of illness in SYIs such as ‘evil eyes’ were common across the four counties while others were geographically unique such as the belief that owls cause illnesses.ConclusionCommunities’ understanding of the etiology of illnesses in SYIs in the study settings overlapped between natural and supernatural causes. There is need for child health programmes to take into consideration communities’ beliefs and practices regarding disease and health to improve newborn health outcomes.

Highlights

Neonatal morbidity and mortality remain serious global health concerns
Data were collected between August and September 2018 and involved 23 in-depth interviews with female caregivers aged 1524years; 25 focus group discussions with female caregivers aged 15–18 years, 19–24 years and 25–45 years; and 7 focus group discussions with fathers aged 18–34 years and 35 or more years
The worldwide neonatal mortality rate (NMR) was estimated to be about 18 deaths per 1000 live births [1] with the Sub-Saharan Africa region experiencing the highest burden of these deaths with an estimated NMR of 28 deaths per 1000 live births

Summary

Introduction

Neonatal morbidity and mortality remain serious global health concerns. In 2018 alone, approximately 2.5 million children died in their first month of life [1]. While major clinical causes of newborn morbidity and deaths are well documented such as neonatal sepsis, pneumonia, tetanus, diarrhea, birth asphyxia and prematurity [4, 5], families’ and communities’ understanding of the etiology of illnesses in newborns and young infants 0–59 days old or sick young infants (SYIs) is not well understood. Studies on this subject have noted that perceptions of causes of illnesses in SYIs may vary across socio-cultural and economic contexts [6,7,8]. This study explored communities’ perception of the etiology of illnesses in SYIs 0–59 days old in four counties in Kenya

Methods

Results

Conclusion