Prevention and management of neonatal hypothermia in rural Zambia.
BACKGROUND
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America; Center for Global Health & Development, Boston University, Boston, Massachusetts, United States of America; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Karsten
K
Lunze
Center for Global Health & Development, Boston University, Boston, Massachusetts, United States of America; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Kojo
K
Yeboah-Antwi
Save the Children US, Westport, Connecticut, United States of America.
David R
DR
Marsh
Tropical Disease Research Centre, Ndola, Zambia.
Sarah Ngolofwana
SN
Kafwanda
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Austen
A
Musso
Center for Global Health & Development, Boston University, Boston, Massachusetts, United States of America; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Katherine
K
Semrau
Save the Children US, Westport, Connecticut, United States of America.
Karen Z
KZ
Waltensperger
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America; Center for Global Health & Development, Boston University, Boston, Massachusetts, United States of America; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America; Zambia Center for Applied Health Research & Development, Lusaka, Zambia.
Davidson H
DH
Hamer
D001833:Body Temperature Regulation; D001942:Breast Feeding; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007035:Hypothermia / Q000453:epidemiology / Q000517:prevention & control*; D007224:Infant Care / Q000379:methods; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D012424:Rural Population; D015024:Zambia / Q000453:epidemiology