“You have to take action”: changing knowledge and attitudes towards newborn care practices during crisis in South Sudan

Samira Sami,Kate Kerber,Barbara Tomczyk,Ribka Amsalu,Debra Jackson,Elaine Scudder,Alexander Dimiti,Janet Meyers,Kemish Kenneth,Solomon Kenyi,Caitlin E Kennedy,Kweku Ackom,Luke C Mullany

doi:10.1080/09688080.2017.1405677

Abstract

Highest rates of neonatal mortality occur in countries that have recently experienced conflict. International Medical Corps implemented a package of newborn interventions in June 2016, based on the Newborn health in humanitarian settings: field guide, targeting community- and facility-based health workers in displaced person camps in South Sudan. We describe health workers’ knowledge and attitudes toward newborn health interventions, before and after receiving clinical training and supplies, and recommend dissemination strategies for improved uptake of newborn guidelines during crises. A mixed methods approach was utilised, including pre–post knowledge tests and in-depth interviews. Study participants were community- and facility-based health workers in two internally displaced person camps located in Juba and Malakal and two refugee camps in Maban from March to October 2016. Mean knowledge scores for newborn care practices and danger signs increased among 72 community health workers (pre-training: 5.8 [SD: 2.3] vs. post-training: 9.6 [SD: 2.1]) and 25 facility-based health workers (pre-training: 14.2 [SD: 2.7] vs. post-training: 17.4 [SD: 2.8]). Knowledge and attitudes toward key essential practices, such as the use of partograph to assess labour progress, early initiation of breastfeeding, skin-to-skin care and weighing the baby, improved among skilled birth attendants. Despite challenges in conflict-affected settings, conducting training has the potential to increase health workers’ knowledge on neonatal health post-training. The humanitarian community should reinforce this knowledge with key actions to shift cultural norms that expand the care provided to women and their newborns in these contexts.

Highlights

The first 28 days of life, the neonatal period, is the riskiest month in the human lifecycle
Among community health worker (CHW), knowledge increased by 40% or more on questions about normal temperature range, normal respiration rate, delayed bathing and key newborn health messages
While facility health workers experienced a similar trend with their mean number of correct responses increasing from 14.2 (SD = 2.7) pre-training to 17.4 (SD = 2.8) post-training, improvements for individual questions were lower in magnitude, largely a result of higher baseline scores, limiting the scope for large absolute gains

Summary

Introduction

The first 28 days of life, the neonatal period, is the riskiest month in the human lifecycle. In 2015, an estimated 2.7 million newborns died,[1] mainly due to complications of premature birth (36%), infections (23%) and intrapartum complications (23%).[2,3] Many of these deaths are preventable, especially in the context of weak health systems in low- and middle-income countries. There is an increasing disparity in neonatal mortality between those living in stable political settings and those experiencing conflict and violence, with 14 out of 15 of the countries with the highest neonatal mortality rate experiencing a humanitarian emergency.[4] Humanitarian crises exacerbate challenges to health service delivery by impeding access to already at-risk populations, slowing delivery of medical supplies and drugs and worsening shortages of health workers. Newly delivered women and their newborns are a vulnerable group in conflict- and disaster-affected settings and are most in need of targeted efforts for quality care.

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