Cultural Practices, Knowledge, and Beliefs of Newborn Care and Health-Seeking in Rural Zambia

Abstract

Purpose: Decreasing newborn morbidity and mortality remains a serious global health challenge. For this reason, interventions like maternity waiting homes (MWHs) and the Saving Mothers, Giving Life (SMGL) initiative may improve maternal-newborn newborn health and delivery outcomes. The overarching goal of this dissertation was to explore and describe the cultural practices, knowledge, and beliefs of essential newborn care and health-seeking in the context of MWHs and the SMGL initiative in rural Zambia. Guided by the Ecological Systems Theory, this goal was met through three studies with the following aims: (1) Describe knowledge and beliefs of newborn care and illness from the perspective of rural Zambian women, community members, and health workers, (2) Examine similarities and differences in knowledge and beliefs of newborn care and illness among rural Zambian women, community members, and health workers, (3) Explore the social and cultural factors that are associated with the ways women seek newborn care to identify traditional and professional newborn care practices in rural Zambia, (4) Compare maternal knowledge of newborn care in two groups of women in rural Zambia, and (5) Advance an understanding of maternal-newborn delivery outcomes for women referred from health facilities with and without MWHs to the district referral hospital. Methods: Study 1 used focus groups (n=646), comprised of community members (n=208), health workers (n=225), and women with babies younger than 1-year-old (n=213) collected between June and August 2016 in two rural Zambian districts. A semi-structured guide was used to collect data on cultural beliefs and health-seeking practices in communities with MWH and non-MWH facilities. Study 2 employed a quasi-experimental two-group comparison (n=250) design using a face-to-face survey approach to determine whether MWH use impacted maternal knowledge of newborn care. For Study 3 (n=234), a retrospective record review of district-level data recorded by healthcare providers for the Zambian Ministry of Health was performed to compare maternal-newborn delivery outcomes for cases referred from five health facilities (n=142) with and five without MWHs (n=92) to a single rural Zambian district referral hospital for delivery. Results: The following themes emerged independently from each of the focus groups in Study 1: from women with infants younger than 1-year-old, (1) traditional newborn protective rituals; from community members, (2) strong sense of family and community protecting the newborn, and from health workers, (3) preservation of dignity. A fourth theme, essential newborn care, was common among all groups. Study 2 found rural Zambians have an understanding of WHO guidelines whether or not they used an MWH. In Study 3, among all referrals across ten facilities in the case series, more came from facilities with a MWH than from those without MWHs (60.7% MWH vs. 39.3% non-MWH). Conclusions: This dissertation uncovered a maternal duality faced by women caring for newborns between cultural and health system responsibilities. The finding that referrals were more likely to come from facilities with MWHs is significant as we enter the post-2015 era of sustainable development with a goal to reduce the inequities of preventable death by reaching all women and newborns. The findings highlight the need for targeted health education by professional and community health workers towards younger and primigravida women. As maternal “Essential Newborn Care” knowledge improves through health education, potential long-term benefits exist for improved maternal-newborn health and delivery outcomes in rural Zambia.