Symptom-specific care-seeking behavior for sick neonates among urban poor in Lucknow, Northern India

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To assess symptom-specific care-seeking practices for newborns and behavioral factors associated with them to inform strategies to enhance newborn care seeking in urban Lucknow, Northern India. This was a prospective follow-up study of consecutive 326 neonates delivered at an urban reproductive and child health (RCH) center. Focused Group Discussions (n=5) were also conducted in urban slums (n=3) at the RCH center (n=1) and at a district hospital (n=1). Overall, 326 neonates were recruited within 48 h of birth and 289 (88.7%) were followed up at 6 weeks (+/-15 days) at home. Parents of 51.2% (148/289) neonates reported at least one symptom of illness. Among these, 27.3% (79/289) neonates had at least one reported Integrated Management of Neonatal and Childhood Illnesses (IMNCI) danger sign, of which 15 (18.9%) did not receive any modern medical care, 5(33.3%) of which were dead by early infancy. Care seeking from unqualified providers (spiritual/traditional) was 33.3% (3/9) for persistent diarrhea and 23.5% (4/17) for pneumonia. Qualitative data from Focused Group Discussions showed that when pictures of some danger signs were shown like sunken eyes, reduced skin turgor, chest in-drawing and bulged fontanel, care seeking for these as well as fast breathing were influenced by 'local beliefs', which considered them to be untreatable by modern medicines alone. Thus, care seeking from multiple providers and use of traditional/home remedies delayed appropriate and timely medical care seeking. Almost half of the neonates had an illness symptom of which half had an IMNCI danger sign, of which one fifth did not receive medical care. Therefore, there is an urgent need to introduce a locally modified community IMNCI program here, for promoting care seeking from qualified providers for sick neonates.