“We need good nutrition but we have no money to buy food”: sociocultural context, care experiences, and newborn health in two UNHCR-supported camps in South Sudan

Abstract

BackgroundDeterminants of newborn health and survival exist across the reproductive life cycle, with many sociocultural and contextual factors influencing outcomes beyond the availability of, and access to, quality health services. In order to better understand key needs and opportunities to improve newborn health in refugee camp settings, we conducted a multi-methods qualitative study of the status of maternal and newborn health in refugee camps in Upper Nile state, South Sudan.MethodsIn 2016, we conducted 18 key informant interviews with health service managers and front-line providers and 13 focus group discussions in two Sudanese refugee camps in Maban County, South Sudan. Our focus group discussions comprised 147 refugee participants including groups of mothers, fathers, grandmothers, traditional birth attendants, community health workers, and midwives. We analysed our data for content and themes using inductive and deductive techniques.ResultsWe found both positive practices and barriers to newborn health in the camps throughout the reproductive lifecycle. Environmental and contextual factors such as poor nutrition, lack of livelihood opportunities, and insecurity presented barriers to both general health and self-care during pregnancy. We found that the receipt of material incentives is one of the leading drivers of utilization of antenatal care and facility-based childbirth services. Barriers to facility-based childbirth included poor transportation specifically during the night; insecurity; being accustomed to home delivery; and fears of an unfamiliar birth environment, caesarean section, and encountering male health care providers during childbirth. Use of potentially harmful traditional practices with the newborn are commonplace including mixed feeding, use of herbal infusions to treat newborn illnesses, and the application of ash and oil to the newborn’s umbilicus.ConclusionsNumerous sociocultural and contextual factors impact newborn health in this setting. Improving nutritional support during pregnancy, strengthening community-based transportation for women in labour, allowing a birth companion to be present during delivery, addressing harmful home-based newborn care practices such as mixed feeding and application of foreign substances to the umbilicus, and optimizing the networks of community health workers and traditional birth attendants are potential ways to improve newborn health outcomes.

The health of internally displaced children in sub-Saharan Africa: a scoping review

“…Sami et al 29 37 examined data gathered in the same setting in South Sudan but over different time periods. These two studies, along with Gee et al , 36 specifically found that both institutional and sociocultural factors contributed to the poor health of newborn and small-for-gestational-age babies born in displaced communities. These factors included lack of professional birth attendants and postnatal care services, as well as harmful traditional newborn care practices such as mixed feeding, use of herbal infusions to treat illnesses and the application of ash and oil to the newborn’s umbilicus.…”

“…A total of 25 articles met the inclusion criteria: 16 were quantitative studies, 20-30 38-42 6 were qualitative studies [31][32][33][34][35][36] and 3 were mixed method studies. 37 43 44 Limited data on disease prevalence were available across different age groups.…”

“…However, data were compared across the coding segments to identify relevant linkages (relationships, interactions and consequences). Using the 10-point quality scale resulting from the CASP tool, 19 studies achieved a score of 9 to 10 (ie, rated as strong) [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] and six scored 7 or 8 (ie, rated as medium). [38][39][40][41][42][43] Articles had various strengths: some justified their sample size by population, minimised social desirability bias through multiple data collection strategies and reanalysed results using multiple models and strong statistical analysis, including multivariate logistic regression analysis.…”

“…37 Overall, infant care in IDP camps was inadequate. Several factors contributed to this problem: first, poor nutrition, lack of opportunities and insecurity in IDP camps create barriers to good prenatal health 36 ; second, essential medical supplies are lacking in the camp facilities 29 and finally, insufficient healthcare providers, 36 and specifically female healthcare providers, 37 present another barrier to both prenatal and infant healthcare.…”

Neonatal Mortality Burden and Trends in UNHCR Refugee Camps, 2006-2017: A Retrospective Analysis

“…Niger and South Sudan. [27][28][29][30] Continued investment is needed in these and other refugee settings, including efforts to strengthen data availability and use as part of quality improvement efforts, as outlined in the recently launched Roadmap to Accelerate Progress for Every Newborn in Humanitarian Settings 2020-2024. 31 Our analysis has several limitations.…”