Symptom-specific care-seeking behavior for sick neonates among urban poor in Lucknow, Northern India
Symptom-specific care-seeking behavior for sick neonates among urban poor in Lucknow, Northern India
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DOI：
10.1038/jp.2008.169
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发表时间：
2008-12-01
影响因子：
2.9
通讯作者：
Pant, S.
中科院分区：
文献类型：
--
作者：
Awasthi, S.;Srivastava, N. M.;Pant, S.
评估针对新生儿的特定症状的护理寻求做法和与他们相关的行为因素，以便为在印度北部勒克瑙城市加强新生儿护理寻求的战略提供信息。这是一项对城市生殖和儿童健康(RCH)中心连续326名新生儿的前瞻性随访研究。还在城市贫民窟(n=3)、RCH中心(n=1)和地区医院(n=1)进行了重点小组讨论(n=5)。总体而言，326名新生儿在出生后48小时内被招募，289名(88.7%)在家中6周(+/-15天)获得随访。51.2%(148/289)的新生儿父母报告至少有一种疾病症状。其中，27.3%(79/289)的新生儿至少有一种新生儿和儿童疾病综合管理(IMNCI)危险体征，其中15例(18.9%)未接受任何现代医疗护理，其中5例(33.3%)婴儿早期死亡。向不合格提供者(精神/传统)寻求护理的33.3%(3/9)为持续性腹泻，23.5%(4/17)为肺炎。来自焦点小组讨论的定性数据显示，当出现一些危险迹象的图片时，如眼睛凹陷、皮肤肿胀减轻、胸部内陷和穹窿鼓起，寻求治疗这些症状以及呼吸急促的人会受到当地信仰的影响，他们认为这些症状是单靠现代药物无法治愈的。因此，从多个提供者寻求护理和使用传统/家庭补救办法推迟了适当和及时的医疗寻求。几乎一半的新生儿有疾病症状，其中一半有IMNCI危险迹象，其中五分之一没有接受医疗护理。因此，迫切需要在这里引入一个当地修改的社区IMNCI计划，以促进向合格的新生儿提供者寻求护理。
To assess symptom-specific care-seeking practices for newborns and behavioral factors associated with them to inform strategies to enhance newborn care seeking in urban Lucknow, Northern India. This was a prospective follow-up study of consecutive 326 neonates delivered at an urban reproductive and child health (RCH) center. Focused Group Discussions (n = 5) were also conducted in urban slums (n = 3) at the RCH center (n = 1) and at a district hospital (n = 1). Overall, 326 neonates were recruited within 48 h of birth and 289 (88.7%) were followed up at 6 weeks (+/- 15 days) at home. Parents of 51.2% (148/289) neonates reported at least one symptom of illness. Among these, 27.3% (79/289) neonates had at least one reported Integrated Management of Neonatal and Childhood Illnesses (IMNCI) danger sign, of which 15 (18.9%) did not receive any modern medical care, 5(33.3%) of which were dead by early infancy. Care seeking from unqualified providers (spiritual/traditional) was 33.3% (3/9) for persistent diarrhea and 23.5% (4/17) for pneumonia. Qualitative data from Focused Group Discussions showed that when pictures of some danger signs were shown like sunken eyes, reduced skin turgor, chest in-drawing and bulged fontanel, care seeking for these as well as fast breathing were influenced by 'local beliefs', which considered them to be untreatable by modern medicines alone. Thus, care seeking from multiple providers and use of traditional/home remedies delayed appropriate and timely medical care seeking. Almost half of the neonates had an illness symptom of which half had an IMNCI danger sign, of which one fifth did not receive medical care. Therefore, there is an urgent need to introduce a locally modified community IMNCI program here, for promoting care seeking from qualified providers for sick neonates.