State of newborn care in South Sudan's displacement camps: a descriptive study of facility-based deliveries
Open accessAbstract
BACKGROUND: Approximately 2.7 million neonatal deaths occur annually, with highest rates of neonatal mortality in countries that have recently experienced conflict. Constant instability in South Sudan further strains a weakened health system and poses public health challenges during the neonatal period. We aimed to describe the state of newborn facility-level care in displaced person camps across Juba, Malakal, and Maban. METHODS: We conducted clinical observations of the labor and delivery period, exit interviews with recently delivered mothers, health facility assessments, and direct observations of midwife time-use. Study participants were mother-newborn pairs who sought services and birth attendants who provided delivery services between April and June 2016 in five health facilities. RESULTS: Facilities were found to be lacking the recommended medical supplies for essential newborn care. Two of the five facilities had skilled midwives working during all operating hours, with 6.2% of their time spent on postnatal care. Selected components of thermal care (62.5%), infection prevention (74.8%), and feeding support (63.6%) were commonly practiced, but postnatal monitoring (27.7%) was less consistently observed. Differences were found when comparing the primary care level to the hospital (thermal: relative risk [RR] 0.48 [95% CI] 0.40-0.58; infection: RR 1.28 [1.11-1.47]; feeding: RR 0.49 [0.40-0.58]; postnatal: RR 3.17 [2.01-5.00]). In the primary care level, relative to newborns delivered by traditional birth attendants, those delivered by skilled attendants were more likely to receive postnatal monitoring (RR 1.59 [1.09-2.32]), but other practices were not statistically different. Mothers' knowledge of danger signs was poor, with fever as the highest reported (44.8%) followed by not feeding well (41.0%), difficulty breathing (28.9%), reduced activity (27.7%), feeling cold (18.0%) and convulsions (11.2%). CONCLUSIONS: Addressing health service delivery in contexts affected by conflict is vital to reducing the global newborn mortality rate and reaching the Sustainable Development Goals. Gaps in intrapartum and postnatal care, particularly skilled care at birth, suggest a critical need to build the capacity of the existing health workforce while increasing access to skilled deliveries.
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Skin-to-skin contact was not generally reported as being practised.
“Skin-to-skin contact was not generally reported as being practised, and when practised, its frequency varied across levels of care.28 31 36 48”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [31]
When skin-to-skin contact was practised, its frequency varied across levels of care.
“Skin-to-skin contact was not generally reported as being practised, and when practised, its frequency varied across levels of care.28 31 36 48”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [31]
Four studies present high percentages of EBI being practised among women in the assessed hospitals, PHCCs and communities.
“Four studies present high percentages of EBI being practised among women in the assessed hospitals, PHCCs and communities31 50 59 60; and one from a community in Uganda reports a lower percentage.48”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [31]
In South Sudan, only 27.7% of newborns received postnatal monitoring.
“and in South Sudan only 27.7% of newborns received postnatal monitoring.31”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [31]
In South Sudan, another study reports that nearly all (95.4%) of newborns received eye care.
“and in another nearly all (95.4%) of them received it.31”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [31]
Provision of eye care with tetracycline results varied across studies.
“Provision of eye care with tetracycline was assessed at the health facility level in four studies and the results varied.31 36 47 60”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [31]
In South Sudan, maternal knowledge about newborn danger signs was generally poor.
“In South Sudan, maternal knowledge was generally poor.31 50”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [31]
A cross-sectional study assessed five health facilities in South Sudan and reports that vitamin K was not available.
“A cross-sectional study assessed five health facilities in South Sudan and reports that vitamin K was not available.31”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [31]
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Cites
A Modified Poisson Regression Approach to Prospective Studies with Binary Data
Zou, G. (2004) · American Journal of Epidemiology · doi:10.1093/aje/kwh090 · Cited by 9,760 · see citing works
4 million neonatal deaths: When? Where? Why?
Lawn, J. E., Cousens, S., & Zupan, J. (2005) · The Lancet · doi:10.1016/s0140-6736(05)71048-5 · Cited by 3,670 · see citing works
Liu, L., Oza, S., Hogan, D., Chu, Y., Perin, J., Zhu, J., Lawn, J. E., Cousens, S., Mathers, C., & Black, R. E. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31593-8 · Cited by 3,453 · see citing works
Every Newborn: progress, priorities, and potential beyond survival
Lawn, J. E., Blencowe, H., Oza, S., You, D., Lee, A. C., Waiswa, P., Lalli, M., Bhutta, Z., Barros, A. J., Christian, P., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60496-7 · Cited by 1,929 · see citing works
Evidence-based, cost-effective interventions: How many newborn babies can we save?
Darmstadt, G. L., Bhutta, Z. A., Cousens, S., Adam, T., Walker, N., & de Bernis, L. (2005) · The Lancet · doi:10.1016/s0140-6736(05)71088-6 · Cited by 1,541 · see citing works
Bhutta, Z. A., Das, J. K., Bahl, R., Lawn, J. E., Salam, R. A., Paul, V. K., Sankar, M. J., Blencowe, H., Rizvi, A., Chou, V. B., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60792-3 · Cited by 1,367 · see citing works
Rajaratnam, J. K., Marcus, J. R., Flaxman, A. D., Wang, H., Levin‐Rector, A., Dwyer‐Lindgren, L., Costa, M. E., López, A. D., & Murray, C. J. L. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60703-9 · Cited by 899 · see citing works
Oestergaard, M. Z., Inoue, M., Yoshida, S., Mahanani, W. R., Gore, F. M., Cousens, S., Lawn, J. E., Mathers, C. D., & on behalf of the United Nations Inter-agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group (2011) · PLoS Medicine · doi:10.1371/journal.pmed.1001080 · Cited by 481 · see citing works
Lessons learned from complex emergencies over past decade
Salama, P., Spiegel, P., Talley, L., & Waldman, R. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17405-9 · Cited by 346 · see citing works
Bhutta, Z. A., Soofi, S. B., Cousens, S. N., Mohammad, S., Memon, Z., Ali, I., Feroze, A. B., Raza, F., Khan, A., Wall, S. N., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(10)62274-x · Cited by 284 · see citing works
Gogia, S., & Sachdev, H. S. (2010) · Bulletin of the World Health Organization · doi:10.2471/blt.09.069369 · Cited by 210 · see citing works
Gabrysch, S., Civitelli, G., Edmond, K. M., Mathai, M., Ali, M., Bhutta, Z. A., & Campbell, O. M. R. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001340 · Cited by 126 · see citing works
Enweronu-Laryea, C. C., Dickson, K., Moxon, S. G., Simen-Kapeu, A., Nyange, C., Niermeyer, S., Bégin, F., Sobel, H. L., Lee, A. C., von Xylander, S. R., et al. (2015) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-15-s2-s4 · Cited by 120 · see citing works
Newborn care practices at home and in health facilities in 4 regions of Ethiopia
Callaghan‐Koru, J. A., Estifanos, A. S., Tholandi, M., de Graft‐Johnson, J., Daniel, E., Rawlins, B. J., Worku, B., & Baqui, A. H. (2013) · BMC Pediatrics · doi:10.1186/1471-2431-13-198 · Cited by 115 · see citing works
Sandberg, J., Pettersson, K. O., Asp, G., Kabakyenga, J. K., & Agardh, A. (2014) · PLoS ONE · doi:10.1371/journal.pone.0097253 · Cited by 100 · see citing works
Waiswa, P., Pariyo, G. W., Källander, K., Akuze, J., Namazzi, G., Kiracho, E. E., Kerber, K. J., Sengendo, H. N., Aliganyira, P., Lawn, J. E., et al. (2015) · Global Health Action · doi:10.3402/gha.v8.24584 · Cited by 99 · see citing works
Self-citationHuman resource management in post-conflict health systems: review of research and knowledge gaps
Roome, E., Raven, J., & Martineau, T. (2014) · Conflict and Health · doi:10.1186/1752-1505-8-18 · Cited by 76 · see citing works
Kibaru, E. G., & Otara, A. M. (2016) · BMC Research Notes · doi:10.1186/s13104-016-2272-3 · Cited by 73 · see citing works
Nsibande, D. F., Doherty, T., Ijumba, P., Tomlinson, M., Jackson, D. J., Sanders, D. M., & Lawn, J. E. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-47 · Cited by 60 · see citing works
Self-citationHill, P., Pavignani, E., Michael, M., et al. (2014) · Conflict and Health · doi:10.1186/1752-1505-8-20 · Cited by 56 · see citing works
Darmstadt, G. L., Bhutta, Z. A., Cousens, S. N., Adam, T., & Walker, N. (2005) · The Lancet · Cited by 51 · see citing works
Wise, P. H., & Darmstadt, G. L. (2015) · Paediatrics and International Child Health · doi:10.1179/2046905515y.0000000027 · Cited by 36 · see citing works
Berendes, S., Lako, R. L. L., Whitson, D., et al. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12363 · Cited by 35 · see citing works
Trivedi, D. P. (2016) · Primary Health Care Research & Development · doi:10.1017/s1463423616000128 · Cited by 13 · see citing works
BASIC RESEARCH and its Application in the Field of CLINICAL NUTRITION
KING, C. G. (1952) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/1.1.1 · Cited by 11 · see citing works
Health care in South Sudan at a crossroads
Green, A. R. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60661-8 · Cited by 10 · see citing works
Mapping the specialist medical workforce for Southern Sudan: Devising ways for capacity building
Achiek, M., & Lado, D. K. (2010) · South Sudan Medical Journal · Cited by 10 · see citing works
NZARA Putting the capacity into capacity building in South Sudan
Bower, H. (2000) · The Lancet · doi:10.1016/s0140-6736(05)73810-1 · Cited by 8 · see citing works
Fighting restricts access to health care in South Sudan
Green, A. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61755-4 · Cited by 7 · see citing works
Healthcare in South Sudan is jeopardised by attacks on hospitals
Moszynski, P. (2013) · BMJ · doi:10.1136/bmj.f3265 · Cited by 2 · see citing works
Aid agencies warn of mounting humanitarian crisis among refugees in South Sudan
Moszynski, P. (2012) · BMJ · doi:10.1136/bmj.e4352 · Cited by 1 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [35]Inter-Agency Working Group For Reproductive Health in Crises. Inter-agency field manual on reproductive health in humanitarian settings. 2010. http://www.who.int/reproductivehealth/publications/emergencies/field_manual/en/ 26203479
Cited by
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Munyuzangabo, M., Gaffey, M. F., Khalifa, D. S., Als, D., Ataullahjan, A., Kamali, M., Jain, R. P., Meteke, S., Radhakrishnan, A., Shah, S., et al. (2021) · BMJ Global Health · doi:10.1136/bmjgh-2020-003750 · Cited by 91 · see citing works
Komakech, H., Lubogo, D., Nabiwemba, E., & Orach, C. G. (2020) · PLoS ONE · doi:10.1371/journal.pone.0231970 · Cited by 22 · see citing works
Sustainability in refugee camps: a systematic review and Meta-analysis
Wardeh, M., & Marques, R. C. (2021) · Sustainability · doi:10.3390/su13147686 · Cited by 22 · see citing works
Lessons Learned From Helping Babies Survive in Humanitarian Settings
Amsalu, R., Schulte-Hillen, C., Garcia, D. M., Lafferty, N., Morris, C. N., Gee, S., Akseer, N., Scudder, E., Sami, S., Barasa, S. O., et al. (2020) · Pediatrics · doi:10.1542/peds.2020-016915l · Cited by 14 · see citing works
Self-citationA systematic review of newborn health interventions in humanitarian settings
Rodo, M., Duclos, D., DeJong, J., Akik, C., & Singh, N. S. (2022) · BMJ Global Health · doi:10.1136/bmjgh-2022-009082 · Cited by 11 · see citing works
- Authors
- Sami, S., Kerber, K., Kenyi, S., Amsalu, R., Tomczyk, B., Jackson, D., Dimiti, A., Scudder, E., Meyers, J., Umurungi, J. P. D. C., Kenneth, K., & Mullany, L. C.
- Affiliations
- Johns Hopkins University (US)
- Save the Children (US)
- International Medical Corps (US)
- Centers for Disease Control and Prevention (US)
- United Nations Children's Fund (US)
- Corresponding author
- Sami, Samira
- Venue
- Reproductive Health
- Published
- 2017-11-29
- Volume
- 14
- Issue
- 1
- Pages
- 161-161
- ISSN
- 1742-4755 (ISSN-L)
- PMC
- PMC5707872
- OpenAlex
- W2769893373
- Cited by
- 34
- References
- 31
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 8 · 2022: 7 · 2021: 6 · 2020: 10 · 2019: 1
- FWCI
- 3.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Reproductive Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UWC Research Repository (University of the Western Cape) (submittedVersion, cc-by)
- Funders
- Save the Children's Saving Newborn Lives
- The Elma Relief Foundation
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- neonatal care, institutional delivery, displaced persons camps, South Sudan, conflict-affected settings, skilled birth attendance, neonatal thermal care, infection control, neonatal danger signs, maternal knowledge, health facility assessment, health workforce capacity
- MeSH terms
- Infant Health, Refugee Camps, Health Services Accessibility, Humans, Infant Welfare, Infant, Newborn, Midwifery, Postnatal Care, Sudan, Delivery, Obstetric
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