title: Barriers to neonatal care in developing countries: parents' and providers' perceptions.
abstract: OBJECTIVE
  Hospital care and advanced medical technologies for sick neonates are increasingly available, but not always readily accessible, in many countries. We characterised parents' and providers' perceptions of barriers to neonatal care in developing countries.
  
  
  METHODS
  We interviewed parents whose infant was hospitalised within the first month of life in Cambodia, Malaysia, Laos and Vietnam, asking about perceived barriers to obtaining newborn care. We also surveyed health-care providers about perceived barriers to providing care.
  
  
  RESULTS
  We interviewed 198 parents and 212 newborn care providers (physicians, nurses, midwives, paediatric and nursing trainees). Most families paid all costs of newborn care, which they reported as a hardship. Although newborn care is accessible, 39% reported that hospitals are too distant; almost 20% did not know where to obtain care. Parents cited lack of cleanliness (46%), poor availability of medications (42%) or services (36%), staff friendliness (42%), poor infant outcome (45%), poor communications with staff (44%) and costs of care (34%) as significant problems during prior newborn care. Providers cited lack of equipment (74%), lack of staff training (61%) and poor infrastructure (51%) as barriers to providing neonatal care. Providers identified distance to hospital, lack of transportation, care costs and low parental education as barriers for families.
  
  
  CONCLUSIONS
  Improving cleanliness, staff friendliness and communication with parents may diminish some barriers to neonatal care in developing countries. Costs of newborn care, hospital infrastructure, distance to hospital, staffing shortages, limited staff training and limited access to medications pose more difficult barriers to remedy.
authors.affiliation: Departments of Pediatrics, University of California, San Francisco, California 94110, United States.
authors.forename: Alma M
authors.initials: AM
authors.lastname: Martinez
authors.forename: Dung Thi Khanh
authors.initials: DT
authors.lastname: Khu
authors.forename: Nem Yun
authors.initials: NY
authors.lastname: Boo
authors.forename: Leakhena
authors.initials: L
authors.lastname: Neou
authors.forename: Bounnack
authors.initials: B
authors.lastname: Saysanasongkham
authors.forename: John Colin
authors.initials: JC
authors.lastname: Partridge
mesh_terms: D000328:Adult; D001210:Asia, Southeastern; D002662:Child Health Services / Q000600:supply & distribution*; D003906:Developing Countries; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000523:psychology*; D036301:Qualitative Research; D011787:Quality of Health Care; D055815:Young Adult