Caregiver experiences and healthcare worker perspectives of accessing healthcare for low-birthweight

ABSTRACT

Background

Low-birthweight (LBW) infants (<2500 g) are at greatest risk of mortality in the neonatal period, particularly in low- and middle-income countries. Timely access to quality healthcare averts adverse outcomes.

Aim:

To explore caregiver experiences and healthcare provider perspectives of accessing healthcare for LBW infants in rural Kenya.

Methods

This qualitative study was undertaken in Homa Bay County of in rural western Kenya in June 2019. In-depth interviews with eleven caregivers and four healthcare providers were conducted by a trained research assistant. All interviews were transcribed verbatim, and transcripts in the local languages were translated into English. A thematic framework was used to analyse the data.

Results

At the community and individual level,community misconceptions about LBW infants, inadequate infant care practices after discharge, lack of maternal support networks, long distances from healthcare facilities and lack of financial support were key challenges. In addition, long hospital waiting times, healthcare worker strikes and the apparent inadequate knowledge and skills of healthcare providers were disincentives among caregivers. Among healthcare providers, health system deficiencies (staff shortages and inadequate resources for optimal assessment and treatment of LBW infants) and maternal illiteracy were key challenges. Education by staff during antenatal visits and community support groups were enablers.

Conclusion

Accessing healthcare for LBW infants in this community is fraught with challenges which have implications for their post-discharge outcome. There is an urgent need to develop and test strategies to address the barriers at the community and health system level to optimise outcome..

KEYWORDS:

• Low birthweight
• accessing care
• caregiver experiences
• Kenya

Abbreviations

CHW: community health worker; HCP: healthcare provider; HIV: human immunodeficiency virus; LBW: low birthweight; LMIC: low- and middle-income countries; SDG: sustainable development goal; SSA: sub-Saharan Africa; TBA: traditional birth attendant;

Acknowledgments

We would like to thank all the caregivers of LBW infants in Homa Bay county and all the healthcare providers at Homa Bay County Teaching and Referral hospital for participating in the interviews.

Contributors

HMN and SU conceived the study; all authors designed the study; SU and FW analysed the data; HMN and SU prepared the manuscript and are responsible for the final content. All authors read and approved the final manuscript.

Data availability statement:

All data relevant to the study are included in the article. Extra data is available by e-mailing [email protected]

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This project was self-funded by SU for her dissertation for the Master in International Public Health (Humanitarian Assistance) project at the Liverpool School of Tropical Medicine.

Notes on contributors

Sarah Unsworth

Dr Sarah Unsworth is a foundation year one doctor in the Royal Victoria Infirmary, Newcastle Upon Tyne and conducted this work as part of her MSc in International Public Health at the Liverpool School of Tropical Medicine.

Hellen C. Barsosio

Dr Hellen C. Barsosio is a Clinical Trials Manager, Principal Investigator and PhD Candidate  at the Kenya Medical Research Institute (KEMRI)- Center for Global Health Research, Kenya. Her research focuses on interventions to prevent and treat maternal infections in pregnancy including malaria and HIV. 

Florence Achieng

Ms Florence Achieng is a Research Officer at the KEMRI-Center for Global Health Research, Kenya. She has expertise in qualitative research exploring maternal and child health factors that influence outcomes of interventions in the context of randomised controlled trials.

Daniel Juma

Mr Daniel Juma is a Field Supervisor at KEMRI-Centre for Global Health Research with expertise in conducting maternal and child health observational and intervention studies in western Kenya. 

Linda Tindi

Ms Linda Tindi is the Lead Nurse for neonatal care at the Homa Bay County Teaching and Referral Hospital. She has a passion for skills training in neonatal care and is a mentor and trainer.

Fred Omiti

Mr Fred Omiti is a Project Coordinator at the KEMRI- Centre for Global Health Research, Kenya. He has expertise is coordinating maternal and child health observational and intervention studies in western Kenya.

Simon Kariuki

Dr Simon Kariuki is a Chief Research Officer and Principal investigator at the KEMRI- Centre for Global Health Research, Kenya. His has extensive experience in malaria research including interventions that focus on maternal and child health outcomes. 

Helen M. Nabwera

Dr Helen M. Nabwera is a Senior Clinical Lecturer at the Liverpool School of Tropical Medicine. She is also an honorary consultant in Paediatric Infectious Diseases at Alder Hey Children’s Hospital, Liverpool. Her research focusses on developing and testing interventions for improving the outcomes of low birth weight infants in sub-Saharan Africa.