Maternity care spaces – arrangement, use, and quality of newborn care in Cameroon

Abstract

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 therelationship 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 thematerial 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.