Integrated review of healthcare provider postnatal newborn care recommendations in Sub‐Saharan Africa

Abstract

Aims To (1) identify formal and informal healthcare provider knowledge and counselling on newborn care recommendations; (2) identify care guidelines used; and (3) determine healthcare provider training regarding recommendations. Background In sub‐Saharan Africa, many newborn deaths occur in the community between days two to 42 of life. Introduction Formal and informal healthcare providers, including nurses and community health workers, counsel newborn caregivers but little is known about their recommendations. Methods Integrative review of studies conducted 2000–2018 after search of PubMed, CINAHL, Embase, and African healthcare journals. Study quality was assessed and findings synthesized. Findings Twelve qualitative, quantitative, or mixed‐methods studies (quality good to poor) from seven countries were included. Eleven reported on one to three recommendations; one study reported on eight recommendations. Knowledge or counselling on feeding, cord care, recognizing illness, referrals, informal treatment, home visits, immunizations, follow‐up examinations, thermal care, low birthweight, and bed net usage were reported. Formal healthcare providers gave recommendations in only two studies. Four studies documented use of guidelines. Six studies reported on training. Discussion Studies were primarily descriptive, limiting quality. Feeding and cord care recommendations were prioritized. Care guidelines were underutilized. Additional training on recommendations is needed. These findings regarding healthcare providers align with other regions with high neonatal mortality. Conclusion Research is needed to improve and sustain knowledge, counselling, and guideline usage among providers to address neonatal mortality. Implications for nursing The unique role of nurses to promote newborn health appears under‐researched. Nurse professionalization and specialization may contribute to sustained knowledge of and counselling on newborn recommendations. Implications for health policy As countries adopt universal health care, policies that enable formal providers to encourage maternal‐newborn engagement in newborn health promotion before transition to the community are needed. Collaboration between formal and informal providers may improve dissemination of recommendations and contribute to gains in newborn health.

Term Newborn Care Recommendations Provided in a Kenyan Postnatal Ward

“…Recommendations for exclusive breastfeeding and cord care were routinely delivered, consistent with the findings of other studies of sub-Saharan healthcare workers, 11 demonstrating that educational campaigns associating breastfeeding, cord care, and newborn health are effective. 36 Although poor breastfeeding was the most frequently provided newborn danger sign, inadequate instructions about preventing breastfeeding complications may cause poor breastfeeding.…”

“…However, little is known about specific recommendations provided and how they are provided. This information is key to determining next steps to improve newborn health in areas with insufficient healthcare providers and high mortality, including some areas in sub-Saharan Africa 11…”

“…In addition, mothers' reports indicate that healthcare workers are inconsistent in the antenatal and postnatal care recommendations they provide 21,22. Some recommendations, such as breastfeeding, are provided more consistently than others 11…”

“…This information is key to determining next steps to improve newborn health in areas with insufficient healthcare providers and high mortality, including some areas in sub-Saharan Africa. 11 Newborn care during the immediate postnatal period focuses on newborns' physiological needs that facilitate their rapid and dynamic transition to extrauterine life. 12 Early-to-late postnatal care includes continuation of some immediate care and prepares the newborn to thrive beyond the first 24 hours of life.…”

Baseline assessment of the WHO/UNICEF/UNFPA maternal and newborn quality-of-care standards around childbirth: Results from an intermediate hospital, northeast Namibia

“…The increase in facility deliveries in lower-and middle-income countries (LMICs) will not result in reduced maternal and newborn deaths (1-3) unless quality healthcare is improved. This includes the postnatal period (3)(4)(5). Improving quality-of-care standards during childbirth can reduce 61% of newborn deaths; however, half of the intrapartum stillbirths and maternal deaths result from poor quality care (3,5,6).…”