Provider Perceptions on Bereavement Following Newborn Death: A Qualitative Study from Ethiopia and Ghana

Rent, Sharla; Bakari, Ashura; Deribessa, Solomie Jebessa; Abayneh, Mahlet; Shayo, Aisa; Bockarie, Yema; Moyer, Cheryl A.; Kukora, Stephanie

doi:10.1016/j.jpeds.2022.10.011

Cited by 4 publications

(5 citation statements)

References 28 publications

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“…Globally, the literature on perinatal loss has emphasized the need for better bereavement support in LMICs [48][49][50]. Parent-focused studies in HICs highlight the importance of healthcare providers recognizing the deceased newborn as member of the family and engaging in "memory making" [26,51,52].…”

Section: Discussionmentioning

confidence: 99%

Perinatal loss in Tanzania: Perspectives of maternal-child healthcare providers

Rent,

Gaffur,

Nkini

et al. 2024

PLOS Glob Public Health

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Over 98% of stillbirths and neonatal deaths occur in Low- and Middle-Income Countries, such as Tanzania. Despite the profound burden of perinatal loss in these regions, access to facility or community-based palliative and psychosocial care is poor and understudied. In this study we explore perinatal loss through the lens of front-line healthcare providers, to better understand the knowledge and beliefs that guide their engagement with bereaved families. A Knowledge Attitudes and Practices survey addressing perinatal loss in Tanzania was developed, translated into Swahili, and administered over a 4-month period to healthcare professionals working at the Kilimanjaro Christian Medical Center (KCMC). Results were entered into REDCap and analyzed in R Studio. 74 providers completed the survey. Pediatric providers saw a yearly average of 5 stillbirths and 32.7 neonatal deaths. Obstetric providers saw an average of 11.5 stillbirths and 13.12 neonatal deaths. Most providers would provide resuscitation beginning at 28 weeks gestational age. Respondents estimated that a 50% chance of survival for a newborn occurred at 28 weeks both nationally and at KCMC. Most providers felt that stillbirth and neonatal mortality were not the mother’s fault (78.4% and 81.1%). However, nearly half (44.6%) felt that stillbirth reflects negatively on the woman and 62.2% agreed that women are at higher risk of abuse or abandonment after stillbirth. A majority perceived that women wanted hold their child after stillbirth (63.0%) or neonatal death (70.3%). Overall, this study found that providers at KCMC perceived that women are at greater risk of psychosocial or physical harm following perinatal loss. How women can best be supported by both the health system and their community remains unclear. More research on perinatal loss and bereavement in LMICs is needed to inform patient-level and health-systems interventions addressing care gaps unique to resource-limited or non-western settings.

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Section: Discussionmentioning

confidence: 99%

Perinatal loss in Tanzania: Perspectives of maternal-child healthcare providers

Rent,

Gaffur,

Nkini

et al. 2024

PLOS Glob Public Health

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“…Likewise, many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load (13). Gaps in provision of newborn intensive care and opportunities for improvement have been identified in the literature previously (13)(14)(15)(16). In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development.…”

Section: Introductionmentioning

confidence: 99%

“…Limited communication undermines parents’ trust and cause families to attribute an infant's death to poor medical care ( 14 , 51 , 58 ). Therefore, clinicians, even while providing clear and consistent messaging about the infant's condition and prognosis, must also acknowledge and explain uncertainties.…”

Section: Introductionmentioning

confidence: 99%

“…For this reason, in communities where there are cultural and societal traditions for the loss of older patients, comparatively little may be done for parents during the loss of their newborn. For example, in some cultures within Ethiopia, the death of the newborn, especially less than 3 days old, is not considered as a death of a person ( 14 , 68 ). Social gatherings, burial ceremonies and religious activities, which may be meaningful to some bereaved parents to feel supported and cope with their loss, may not be done in others.…”

Section: Introductionmentioning

confidence: 99%

“…The hidden nature of stillbirth and neonatal loss is embedded in the social construction of personhood, a phenomenon seen most commonly in regions with high NMR ( 47 , 71 – 73 ) Often, unique practices around newborn death exist to protect the woman from emotional and psychological harm ( 68 ) and protect her future fertility ( 51 , 68 ). Likewise, well-meaning family and friends may reassure parents that they will “have another baby” rather than acknowledge the loss of this child ( 14 ). While these contrast what might comfort bereaved parents in HICs, few studies of bereaved parents in these settings have explored whether parents in these cultures perceive these practices to be protective or not ( 46 , 47 ).…”

Section: Introductionmentioning

confidence: 99%

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Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development

et al. 2023

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Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development.

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