Acceptability of evidence-based neonatal care practices in rural Uganda - implications for programming

Area of Science:

• Global Health
• Maternal and Child Health
• Public Health Interventions

Background:

• Evidence-based maternal and neonatal health interventions exist but lack operationalization in Sub-Saharan Africa.
• A critical gap is understanding community acceptability and demand for these internationally recommended practices.
• This study explored the acceptability of maternal and neonatal health interventions in rural Uganda.

Purpose of the Study:

• To assess the acceptability of evidence-based maternal and neonatal health interventions in rural Ugandan communities.
• To identify community and health system barriers to the uptake of recommended maternal and neonatal care practices.
• To inform the scale-up of effective maternal and neonatal health strategies in Sub-Saharan Africa.

Main Methods:

• Conducted 10 focus group discussions with mothers, fathers, grandparents, and child minders.
• Performed 10 key informant interviews with healthcare workers and traditional birth attendants.
• Explored community perceptions and experiences regarding maternal and neonatal healthcare practices.

Main Results:

• Most recommended maternal and newborn practices were found acceptable by the community and health providers.
• Significant health system and community barriers impede the implementation of these practices.
• Key barriers include low perceived need for antenatal care unless ill, unaffordability of delivery costs, limited male support, and non-existent postnatal care.
• Specific newborn practices like delayed bathing and umbilical cord care required negotiation.

Conclusions:

• Recommended maternal-newborn practices are generally acceptable but not consistently practiced due to systemic and community barriers.
• Antenatal care is often sought only when ill, and postnatal care is absent.
• Health promotion must prioritize postnatal care, consider socio-cultural contexts, and address financial burdens.
• Male involvement and accessible waiting shelters are recommended to improve supervised delivery rates.
• Successful scale-up requires rapid appraisal and adaptation of interventions to local realities in Sub-Saharan Africa.