title: Maternal experiences of caring for an infant with neurological impairment after neonatal encephalopathy in Uganda: a qualitative study.
abstract: OBJECTIVE
  The study investigated maternal experiences of caring for a child affected by neurological impairment after neonatal encephalopathy (NE) ("birth asphyxia") in Uganda.
  
  
  METHODS
  Between September 2011 and October 2012 small group and one-on-one in-depths interviews were conducted with mothers recruited to the ABAaNA study examining outcomes from NE in Mulago hospital, Kampala. Data were analysed thematically with the aid of Nvivo 8 software.
  
  
  RESULTS
  Mothers reported caring for an infant with impairment was often complicated by substantial social, emotional and financial difficulties and stigma. High levels of emotional distress, feelings of social isolation and fearfulness about the future were described. Maternal health-seeking ability was exacerbated by high transport costs, lack of paternal support and poor availability of rehabilitation and counselling services. Meeting and sharing experiences with similarly affected mothers was associated with more positive maternal caring experiences.
  
  
  CONCLUSIONS
  Mothering a child with neurological impairment after NE is emotionally, physically and financially challenging but this may be partly mitigated by good social support and opportunities to share caring experiences with similarly affected mothers. A facilitated, participatory, community-based approach to rehabilitation training may have important impacts on maximising participation and improving the quality of life of affected mothers and infants. Implications for Rehabilitation Caring for an infant with neurological impairment after NE in Uganda has substantial emotional, social and financial impacts on families and is associated with high levels of emotional stress, feelings of isolation and stigma amongst mothers. Improved social support and the opportunity to share experiences with other similarly affected mothers are associated with a more positive maternal caring experience. High transport costs, lack of paternal support and poor availability of counselling and support services were barriers to maternal healthcare seeking. Studies examining the feasibility, acceptability and impact of early intervention programmes are warranted to maximise participation and improve the quality of life for affected mothers and their infants.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda .
authors.forename: Sarah
authors.initials: S
authors.lastname: Nakamanya
authors.forename: Godfrey E
authors.initials: GE
authors.lastname: Siu
authors.forename: Rachel
authors.initials: R
authors.lastname: Lassman
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
authors.forename: Cally J
authors.initials: CJ
authors.lastname: Tann
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001238:Asphyxia Neonatorum / Q000150:complications*; D001927:Brain Diseases / Q000534:rehabilitation*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D009035:Mothers / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D011788:Quality of Life; D012944:Social Support; D014454:Uganda; D055815:Young Adult
keywords: Birth asphyxia; Uganda; health-seeking; impairment; infant; maternal experience; neonatal encephalopathy