title: Danger signs of neonatal illnesses: perceptions of caregivers and health workers in northern India.
abstract: OBJECTIVE
  To assess household practices that can affect neonatal health, from the perspective of caregivers and health workers; to identify signs in neonates leading either to recognition of illness or health-care seeking; and to ascertain the proportion of caregivers who recognize the individual items of the integrated management of neonatal and childhood illnesses (IMNCI) programme.
  
  
  METHODS
  The study was carried out in a rural community in Sarojininagar Block, Uttar Pradesh, India, using qualitative and quantitative research designs. Study participants were mothers, grandmothers, grandfathers, fathers or "nannies" (other female relatives) caring for infants younger than 6 months of age and recognized health-care providers serving the area. Focus group discussions (n = 7), key informant interviews (n = 35) and structured interviews (n = 210) were conducted with these participants.
  
  
  RESULTS
  Many household practices were observed which could adversely affect maternal and neonatal health. Among 200 caregivers, 70.5% reported home deliveries conducted by local untrained nurses or relatives, and most mothers initiated breastfeeding only on day 3. More than half of the caregivers recognized fever, irritability, weakness, abdominal distension/vomiting, slow breathing and diarrhoea as danger signs in neonates. Seventy-nine (39.5%) of the caregivers had seen a sick neonate in the family in the past 2 years, with 30.38% in whom illness manifested as continuous crying. Health care was sought for 46 (23%) neonates. Traditional medicines were used for treatment of bulging fontanelle, chest in-drawing and rapid breathing.
  
  
  CONCLUSIONS
  Because there is no universal recognition of danger signs in neonates, and potentially harmful antenatal and birthing practices are followed, there is a need to give priority to implementing IMNCI, and possible incorporation of continuous crying as an additional danger sign.
authors.affiliation: Department of Pediatrics, King George's Medical University, Lucknow, India. sawasthi@sancharnet.in
authors.forename: Shally
authors.initials: S
authors.lastname: Awasthi
authors.forename: Tuhina
authors.initials: T
authors.lastname: Verma
authors.forename: Monica
authors.initials: M
authors.lastname: Agarwal
mesh_terms: D000208:Acute Disease; D000328:Adult; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000193:education*; D002908:Chronic Disease; D002983:Clinical Competence; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006701:Home Nursing / Q000193:education*; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007224:Infant Care / Q000592:standards*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D007407:Interviews as Topic; D036301:Qualitative Research; D012423:Rural Health