Assessing community knowledge, practices and determinants of neonatal mortality in a persistently high burden region: a case study of Masaka District-Uganda.
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Introduction: South Central Uganda where Masaka district is found continues to register higher neonatal mortality rates as compared to other regions in the country. It is not clear why the region has persistently had a high neonatal mortality. Objective: To assess community knowledge, practices and determinants of neonatal mortality in a persistently high burden region in Uganda. Methods: A cross-sectional mixed methods study was conducted. Quantitative data were collected by face to face interviews from mothers (15-49years) whereas qualitative data were obtained by focus group discussions and in-depth Interviews. In addition, mothers who lost their new-borns were interviewed using a social autopsy tool. Six (6) focus group discussions were conducted with mothers (15-49years) whereas nine (9) in-depth interviews were conducted with traditional practitioners who included traditional birth attendants and traditional healers. Quantitative data were analysed using STATA13.0® Simple logistic regressions were run at both bivariate and multi-variable levels, logistic regressions at 95% confidence intervals to determine factors associated with neonatal mortality. Results: A total of 390 respondents were interviewed, where 22 of the mothers had lost neonates thus the neonatal mortality rate (NMR) at 56.4/1000 live births (22/390) in the study population. Overall, community knowledge and practices for newborn care among mothers were poor at 344(82.2 %) and 324(83.1%) respectively. Mothers discarded colostrum, had no knowledge on kangaroo mother care for pre-terms, applied substances on the cord stumps of their newborns. Factors that were significantly associated with newborn deaths included no complications at birth (aOR=0.02, 0.004-0.056), preterm babies (aOR =5.08, 1.36-18.93) and having fathers as immediate caretakers (aOR 4.26, 1.17-12.58). Qualitative findings indicated that traditional practitioners were more preferred for neonatal services and had good knowledge on danger sign recognition. However, the practitioners had no formal training in new born health, had poor knowledge and practices on newborn care, delivery and treatment. They applied substances on the cord, bathed newborns immediately after delivery and used unsterile instruments during newborn treatment procedures. Perceived causes of newborn deaths by mothers who lost their babies were; delays in making decisions to seek, reach and receive care, witchcraft, while some mothers were not aware of the causes of the deaths of their newborns xv Conclusion: NMR in Masaka district is higher than the regional average. Knowledge and practices on newborn care are poor in communities among mothers and traditional practitioners. The 3 delays and use of witchcraft have great contribution to neonatal mortality. Birth complications, preterm births and husbands as immediate postnatal caretakers are determinants of newborn deaths. The Ministry of Health needs to develop behavioural change strategies like community based trainings, inaugurate and support and women self- help projects and or community-based health insurance to reduce community induced delays so as to reduce newborn deaths in Masaka district.