Maternal and newborn care practices in Sierra Leone

A mixed methods study of four underserved districts

Bibliographic Data

ID11490728
AuthorsAlyssa Sharkey (0000-0001-8491-2880, United Nations Children's Fund, corresponding author), Aisha Yansaneh (0000-0002-2610-6079, Johns Hopkins University), Peter Soulaiman Bangura, Peter Bangura, Augustin Kabano (University of Sierra Leone), Eoghan Brady (0000-0003-0075-5406, Johns Hopkins University), Fatu Yumkella (Sierra Leone Agricultural Research Institute), Theresa Diaz (0000-0001-5063-8078, United Nations Children's Fund)
Year2016
Volume32
Issue2
Pagesczw104
Publication date2016-08-14
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czw104
PMID28207047
OpenAlexW2517540854
LanguageEN
Citations received7
References cited14

Despite recent progress, Sierra Leone’s lifetime risk of maternal death remains high (1 in 21), as does neonatal mortality (35 per 1000 live births). We present findings on maternal and neonatal care practices from a mixed methods study conducted in four districts during July–August 2012. We conducted a household cluster survey with data on maternal and newborn care practices collected from women ages 15–49 years who had ever given birth. We also conducted focus group discussions and in-depth interviews in two communities in each of the four districts. Participants included pregnant women, mothers of young children, older caregivers, fathers, community health volunteers, traditional birth attendants (TBAs) and health workers. We explored personal experiences and understandings of pregnancy, childbirth, the newborn period and social norms. Data analysis was conducted using STATA (quantitative) and thematic analysis using Dedoose software (qualitative). Antenatal care was high (84.2%, 95% CI: 82.0–86.3%), but not timely due to distance, transport, and social norms to delay care-seeking until a pregnancy is visible, particularly in the poorer districts of Kambia and Pujehun. Skilled delivery rates were lower (68.9%, 95% CI: 64.8–72.9%), particularly in Kambia and Tonkolili where TBAs are considered effective. Clean cord care, delaying first baths and immediate breastfeeding were inadequate across all districts. Timely postnatal checks were common among women with facility deliveries (94.1%, 95% CI: 91.9–96.6%) and their newborns (94.5%, 95% CI: 92.5–96.5%). Fewer women with home births received postnatal checks (53.6%, 95% CI: 46.2–61.3%) as did their newborns (75.8%, 95% CI: 68.9–82.8%). TBAs and practitioners are well-respected providers, and traditional beliefs impact many behaviours. Challenges remain with respect to maternal and neonatal health in Sierra Leone; these were likely exacerbated by service interruptions during the 2014–2016 Ebola Virus Disease epidemic. The reasons behind existing practices must be examined to identify appropriate strategies to improve maternal and newborn survival.

Birth attendant · Breastfeeding · Childbirth · Developing country · Environmental health · Family medicine · Focus group · Health care · Health facility · Infant mortality · Maternal health · Population · Postnatal Care · Pregnancy · Qualitative research · Sierra leone · Socioeconomics · Thematic analysis · Child Nutrition and Water Access · Demography · Global Maternal and Child Health · Maternal and Neonatal Healthcare · Medicine · Pediatrics

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