Introduction
Methods
Study design
Study setting
Target population and sampling
Data collection procedure
Data analysis
Ethical consideration
Rigour of the study
Results
Knowledge of caregivers on danger signs of neonatal illness
Understanding of neonatal illness and danger signs
“Neonatal illness is when the baby is not feeling well and starts vomiting or has a fever and convulsing”. (P15) [30-year-old petty trader, First child mother].
“As for me, when my child is coughing and cannot breathe or is vomiting or running diarrhoea and having fever or jitteriness, especially at night, it is not normal and that my neonate is ill.” (P13) [29-year-old civil servant, second child mother].
“Neonatal illness is when a baby has high body temperature. Sometimes, the baby is over crying and refusing to feed, vomiting, and looking weak”. (P5) [25-year-old unemployed first child mother].
Early detection of danger signs
“A day after discharge, I noticed my baby’s skin colour had become very pink, which was unusual. However, on the third day, I was alarmed when I noticed that my baby’s eyes were yellow. This made me seek immediate care for my baby”. (P6). [32-year-old head dresser, second child mother].
Other participants added
“Three days after discharge from the hospital, I noticed my baby was warm to touch and began to have fast breathing, making it difficult to feed when I attach baby to breast”. (P15) [28-year-old seamstress, first child mother].
“I gave birth at the hospital and was discharged home few hours after delivery, a day after discharge, I notice my baby was inactive, had jerky movement, and refused to feed when I put to breast”. (P7) [26-year-old unemployed first child mother].
A 39-year-old farmer in her fifth time of having a child had this to say
“My current baby is the fifth born and was delivered at home. Three days after birth, my baby became irritable, which is common with my children. But on the fifth day, I noticed the base of my baby’s cord was red, and when I touched the knees, my baby would cry more. Baby’s knees were warm to touch, so I informed my husband, and we sought care for my baby”. (P14).
Another participant added
“I gave birth at home, and five days later, I noticed that the eyes and skin colour of my baby had changed, but I did not know that my baby was ill until he started having fever and high pitch cry after the naming ceremony, so my husband and I decided to visit the hospital” (P8). [31-year-old petty trader, first child mother].
Care seeking practices of caregivers for danger signs of neonatal illness
Home/traditional herbal remedies
A 25-year-old unemployed participant with her first child had this to say
“When my baby had difficulty passing stool on the fourth day after birth, his grandmother started to give him grounded herbs “musuro and kanafir“ as an enema. With this, my baby started passing stool very well. She also used warm water in an empty tin container with a hole under it and then applied it on the anus after the enema had been given”. (P2).
Another participant, 39 years old farmer with fifth son added
“Buying drugs from the drug store is a common practice that many people engage in at first hand even before they think of going to the hospital. As for the use of herbs, I learnt this from my aunty growing up and it always worked for her, so I also use them whenever my child is ill”. (P4).
Other participants had this to say
“When I noticed my babies were feeding poorly and looking lethargic, I informed my husband, and he suggested we gave some burnt herbs to the babies to help boost their appetite and clean any dirt in their stomach”. (P12) [39 years petty trader with her fourth child].
“I decided to try sunbathing my baby at home for three days when I noticed his skin was becoming yellow; I was also advised to apply breastmilk into my baby’s eyes to clear the yellowish colour from the eyes.” (P10) [28 years old, apprentice make-up artiste with second child].
Blended approach
According to some participants
“My baby had fever on the fourth day after delivery. I gave her suppository paracetamol, but the fever resurfaced the next day, so I bathed and massaged my baby with herbs to reduce the fever and prevent convulsion. I also used garlic to smear my baby’s body to reduce the fever and applied “allaigi“ (palm kennel oil) in my baby’s nostrils to prevent him from catching a cold, but when I did not see any improvement in the baby’s illness, I reported to the hospital.” (P1) [33-year-old petty trader, third child mother].
“Since I got married into this family, I have realized that anytime a child is sick in the house what we do is to buy drugs from a chemical shop or those men who roam with drugs from house to house or use local herbs, we only go to the hospital when the condition does not get better”. (P9) [27-year-old seamstress, second child mother].
Factors that influenced participants care seeking decisions
Inexperience caring for neonates
“Because I am a first-time mother, I took suggestions from relations, especially my senior husband’s wife, who witnessed similar signs in her then neonate. She told me that such signs, as my neonate experienced, are typical with neonates and that I should remain calm and never visit the hospital but rather try some home remedies. She told me to give the baby some gripe water, and all will be fine. Lo and behold, after giving the gripe water, my baby was able to feed well and be active. So, I can say she influenced my choice of treatment practice” (P8).
“Sometimes suggestions from experienced mothers influence treatment choice, especially when it comes to neonatal illness. Particularly in my case, my neonate frequently vomited, but I felt she was not hungry, but my mother-in-law, who is very educated, quickly sanctioned me to visit the hospital immediately. So, I can imagine her influence!” (P11).
“As for me, because this is my first time in childbirth, I easily get worried about any abnormality I get to witness in my neonate. So, anytime I see any changes in my child’s condition, I call a friend nurse to advise me on what to do. Therefore, I can say she usually influences the treatment choice” (P3).
Severity of danger signs
We took my baby to the hospital because I thought the baby was not getting any better using the home treatment, so the seriousness of the sickness prompted us to go to the hospital. So, I can say the severity of the illness influenced me to choose the hospital as my treatment choice (P3).
Social and cultural beliefs
See madam, if your child just shows some common ill signs like vomiting or fever and take him or her to the hospital, the hospital people will admit you and spend all your money mean while you can just treat them easily at home. (P12).
“Because of cultural belief like in my case, my father-in-law had to insist we consult to see whether the illness is for the hospital or can be treated at home or be left to go on its own, and I think that is influential in my treatment choice”. (P4).
Non-availability of finance
“The hospital is good, but it is costly to seek treatment there if you are not financially sound. See, as for me, I do not have any meaningful work doing and my husband does not like visiting the hospital, so he is not supportive in that regard. As a result, any time my neonate is ill, I just use the local home treatment methods available” (P4). [32-year-old unemployed fourth time mother].
Other participants [29-year-old unemployed first-time mother] added that
“My poor financial situation resulted in me resorting to traditional herbal treatment after I detected that my baby had a temperature and experienced difficulty passing stool since my husband did not support the idea of seeking hospital treatment.” (P14).
“On my own, I do not have any source of income. So, my husband takes care of all the family’s needs, including children’s healthcare. If he does not have money or is unwilling to cover hospital care, I am forced to try home remedies”. (P6) [31-year-old unemployed second child mother].