Prevention and management of neonatal hypothermia in rural Zambia

• Published in: PloS one 2014-04, Vol.9 (4), p.e92006
• Main Authors: Lunze, Karsten, Yeboah-Antwi, Kojo, Marsh, David R, Kafwanda, Sarah Ngolofwana, Musso, Austen, Semrau, Katherine, Waltensperger, Karen Z, Hamer, Davidson H
• Format: Article
• Language: English
• Subjects: Agricultural management; Agricultural practices; Babies; Bathing; Body temperature; Body Temperature Regulation; Breast Feeding; Breastfeeding & lactation; Care and treatment; Chains; Children; Community; Data processing; Drying; Fatalities; Female; Hazards; Health aspects; Health Knowledge, Attitudes, Practice; Humans; Hypothermia; Hypothermia - epidemiology; Hypothermia - prevention & control; Infant Care - methods; Infant, Newborn; Infant, Newborn, Diseases - epidemiology; Infant, Newborn, Diseases - prevention & control; Infants (Newborn); Infections; Medical personnel; Medicine; Medicine and Health Sciences; Mortality; Mothers; Neonates; Newborn babies; Postpartum; Pregnancy; Prevention; Public health; Qualitative research; R&D; Research & development; Research and Analysis Methods; Resource management; Risk Factors; Rural areas; Rural Population; Skin; Studies; Sub-Saharan Africa; Survival; Thermal protection; Workers; Zambia; Zambia - epidemiology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0092006

Neonatal hypothermia is increasingly recognized as a risk factor for newborn survival. The World Health Organization recommends maintaining a warm chain and skin-to-skin care for thermoprotection of newborn children. Since little is known about practices related to newborn hypothermia in rural Africa, this study's goal was to characterize relevant practices, attitudes, and beliefs in rural Zambia. We conducted 14 focus group discussions with mothers and grandmothers and 31 in-depth interviews with community leaders and health officers in Lufwanyama District, a rural area in the Copperbelt Province, Zambia, enrolling a total of 171 participants. We analyzed data using domain analysis. In rural Lufwanyama, community members were aware of the danger of neonatal hypothermia. Caregivers' and health workers' knowledge of thermoprotective practices included birthplace warming, drying and wrapping of the newborn, delayed bathing, and immediate and exclusive breastfeeding. However, this warm chain was not consistently maintained in the first hours postpartum, when newborns are at greatest risk. Skin-to-skin care was not practiced in the study area. Having to assume household and agricultural labor responsibilities in the immediate postnatal period was a challenge for mothers to provide continuous thermal care to their newborns. Understanding and addressing community-based practices on hypothermia prevention and management might help improve newborn survival in resource-limited settings. Possible interventions include the implementation of skin-to-skin care in rural areas and the use of appropriate, low-cost newborn warmers to prevent hypothermia and support families in their provision of newborn thermal protection. Training family members to support mothers in the provision of thermoprotection for their newborns could facilitate these practices.