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      A qualitative study to explore the experience of parents of newborns admitted to neonatal care unit in rural Rwanda

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          Abstract

          Background

          Neonatal Care Units (NCUs) provide special care to sick and small newborns and help reduce neonatal mortality. For parents, having a hospitalized newborn can be a traumatic experience. In sub-Saharan Africa, there is limited literature about the parents’ experience in NCUs.

          Objective

          Our study aimed to explore the experience of parents in the NCU of a rural district hospital in Rwanda.

          Methods

          A qualitative study was conducted with parents whose newborns were hospitalized in the Ruli District Hospital NCU from September 2018 to January 2019. Interviews were conducted using a semi-structured guide in the participants’ homes by trained data collectors. Data were transcribed, translated, and then coded using a structured code book. All data were organized using Dedoose software for analysis.

          Results

          Twenty-one interviews were conducted primarily with mothers (90.5%, n = 19) among newborns who were most often discharged home alive (90.5%, n = 19). Four themes emerged from the interviews. These were the parental adaptation to having a sick neonate in NCU, adaptation to the NCU environment, interaction with people (healthcare providers and fellow parents) in the NCU, and financial stressors.

          Conclusion

          The admission of a newborn to the NCU is a source of stress for parents and caregivers in rural Rwanda, however, there were several positive aspects which helped mothers adapt to the NCU. The experience in the NCU can be improved when healthcare providers communicate and explain the newborn’s status to the parents and actively involve them in the care of their newborn. Expanding the NCU access for families, encouraging peer support, and ensuring financial accessibility for neonatal care services could contribute to improved experiences for parents and families in general.

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          Most cited references39

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          Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?

          Progress in newborn survival has been slow, and even more so for reductions in stillbirths. To meet Every Newborn targets of ten or fewer neonatal deaths and ten or fewer stillbirths per 1000 births in every country by 2035 will necessitate accelerated scale-up of the most effective care targeting major causes of newborn deaths. We have systematically reviewed interventions across the continuum of care and various delivery platforms, and then modelled the effect and cost of scale-up in the 75 high-burden Countdown countries. Closure of the quality gap through the provision of effective care for all women and newborn babies delivering in facilities could prevent an estimated 113,000 maternal deaths, 531,000 stillbirths, and 1·325 million neonatal deaths annually by 2020 at an estimated running cost of US$4·5 billion per year (US$0·9 per person). Increased coverage and quality of preconception, antenatal, intrapartum, and postnatal interventions by 2025 could avert 71% of neonatal deaths (1·9 million [range 1·6-2·1 million]), 33% of stillbirths (0·82 million [0·60-0·93 million]), and 54% of maternal deaths (0·16 million [0·14-0·17 million]) per year. These reductions can be achieved at an annual incremental running cost of US$5·65 billion (US$1·15 per person), which amounts to US$1928 for each life saved, including stillbirths, neonatal, and maternal deaths. Most (82%) of this effect is attributable to facility-based care which, although more expensive than community-based strategies, improves the likelihood of survival. Most of the running costs are also for facility-based care (US$3·66 billion or 64%), even without the cost of new hospitals and country-specific capital inputs being factored in. The maximum effect on neonatal deaths is through interventions delivered during labour and birth, including for obstetric complications (41%), followed by care of small and ill newborn babies (30%). To meet the unmet need for family planning with modern contraceptives would be synergistic, and would contribute to around a halving of births and therefore deaths. Our analysis also indicates that available interventions can reduce the three most common cause of neonatal mortality--preterm, intrapartum, and infection-related deaths--by 58%, 79%, and 84%, respectively. Copyright © 2014 Elsevier Ltd. All rights reserved.
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            Quality of care for pregnant women and newborns-the WHO vision.

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              Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial

              Despite evidence suggesting that parent involvement was beneficial for infant and parent outcomes, the Family Integrated Care (FICare) programme was one of the first pragmatic approaches to enable parents to become primary caregivers in the neonatal intensive care unit (NICU). We aimed to analyse the effect of FICare on infant and parent outcomes, safety, and resource use.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: SoftwareRole: Writing – review & editing
                Role: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                13 August 2021
                2021
                : 16
                : 8
                : e0252776
                Affiliations
                [1 ] Maternal and Child Health Department, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
                [2 ] Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Butaro, Rwanda
                [3 ] School of Public Health, Yale University, New Haven, Connecticut, United States of America
                [4 ] Ruli District Hospital, Ministry of Health, Gakenke, Rwanda
                [5 ] Clinical and Public Health Services Division, Ministry of Health, Kigali, Rwanda
                [6 ] Maternal, Child and Community Health Division, Rwanda Biomedical Center, Kigali, Rwanda
                Universitat d’Alacante, SPAIN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                [¤a]

                Current address: Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America

                [¤b]

                Current address: Partners In Health, Boston, Massachusetts, United States of America

                Author information
                https://orcid.org/0000-0001-9165-0348
                Article
                PONE-D-20-32408
                10.1371/journal.pone.0252776
                8362984
                34388168
                c4e48ca1-401b-466c-9a6e-6a4ebb8a91c1
                © 2021 Byiringiro et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 October 2020
                : 21 May 2021
                Page count
                Figures: 0, Tables: 1, Pages: 16
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100004828, Grand Challenges Canada;
                Award Recipient :
                Funded by: University of Global Health Equity
                Award Recipient :
                CMK: Received funding from Grand Challenges Canada Saving Lives at Birth as part of the evaluation of the All Babies Count initiative. SB: University of Global Health Equity covered the cost of Dedoose software utilized in the analysis. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Developmental Biology
                Neonates
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Neonatal Care
                Medicine and Health Sciences
                Pediatrics
                Neonatology
                Neonatal Care
                Medicine and Health Sciences
                Health Care
                Neonatal Care
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Medicine and Health Sciences
                Health Care
                Caregivers
                People and Places
                Geographical Locations
                Africa
                Rwanda
                Biology and Life Sciences
                Psychology
                Emotions
                Social Sciences
                Psychology
                Emotions
                Social Sciences
                Economics
                Finance
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Respiratory Infections
                Medicine and Health Sciences
                Medical Conditions
                Respiratory Disorders
                Respiratory Infections
                Medicine and Health Sciences
                Pulmonology
                Respiratory Disorders
                Respiratory Infections
                Custom metadata
                All relevant data are within the paper and its Supporting Information files. Fully de-identified interview transcriptions are also available should they be needed.

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                Uncategorized

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