Exploring the Context, Roles and Experiences of Mothers in Caring for their Inpatient Sick Newborns in Nairobi, Kenya: An Ethnographic Approach

Oluoch, Dorothy Awuor (2020). Exploring the Context, Roles and Experiences of Mothers in Caring for their Inpatient Sick Newborns in Nairobi, Kenya: An Ethnographic Approach. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.0001156e

Abstract

Little progress has been made in reducing deaths among newborns. Newborn morbidity and mortality can be prevented through the timely provision of combined health systems interventions and access to high-quality inpatient and supportive care. Additionally, recent evidence has demonstrated the importance of social factors to the survival of sick newborns. The involvement of parents through family centred care, as well as maternally delivered interventions, have been shown to have positive outcomes for mother and baby, but in debates around the quality of care for newborns the voices of mothers, particularly in low and middle-income countries, are rarely heard.

Using an ethnographic approach, this study critically examines the roles and experiences of mothers of hospitalized sick newborns in two newborn units in Nairobi, Kenya. Data collection involved non-participant observations, discharge in-depth interviews and narrative interviews with mothers 2-6 weeks post-discharge. Data were collected over 3 years and analysed iteratively using a grounded approach.

The study revealed striking differences in the structural, cultural and socio-economic context of the two newborn units and their clientele. In both hospitals, the mothers played a role in providing care for their babies but with marked differences in the timing of onset, preparation and supervision of these roles. Despite these differences, the mothers narrated similar experiences of shock, fear and confusion in coping with their sick newborn, exacerbated by inadequate communication and information sharing between staff and mothers and a lack of psychosocial support.

The inequities in care observed in the Nairobi newborn units are barely visible in the mothers’ own stories, instead they narrate a shared experience of their encounters with a biomedical model of care delivery. Advocacy for structural changes to reduce inequities in neonatal care are necessary. However, focusing on technological improvements risks further embedding a biomedical paradigm that ignores the needs of mothers.

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