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"We need good nutrition but we have no money to buy food": sociocultural context, care experiences, and newborn health in two UNHCR-supported camps in South Sudan.
BMC Int Health Hum Rights. 2018 11 12; 18(1):40.BI

Abstract

BACKGROUND

Determinants of newborn health and survival exist across the reproductive life cycle, with many sociocultural and contextual factors influencing outcomes beyond the availability of, and access to, quality health services. In order to better understand key needs and opportunities to improve newborn health in refugee camp settings, we conducted a multi-methods qualitative study of the status of maternal and newborn health in refugee camps in Upper Nile state, South Sudan.

METHODS

In 2016, we conducted 18 key informant interviews with health service managers and front-line providers and 13 focus group discussions in two Sudanese refugee camps in Maban County, South Sudan. Our focus group discussions comprised 147 refugee participants including groups of mothers, fathers, grandmothers, traditional birth attendants, community health workers, and midwives. We analysed our data for content and themes using inductive and deductive techniques.

RESULTS

We found both positive practices and barriers to newborn health in the camps throughout the reproductive lifecycle. Environmental and contextual factors such as poor nutrition, lack of livelihood opportunities, and insecurity presented barriers to both general health and self-care during pregnancy. We found that the receipt of material incentives is one of the leading drivers of utilization of antenatal care and facility-based childbirth services. Barriers to facility-based childbirth included poor transportation specifically during the night; insecurity; being accustomed to home delivery; and fears of an unfamiliar birth environment, caesarean section, and encountering male health care providers during childbirth. Use of potentially harmful traditional practices with the newborn are commonplace including mixed feeding, use of herbal infusions to treat newborn illnesses, and the application of ash and oil to the newborn's umbilicus.

CONCLUSIONS

Numerous sociocultural and contextual factors impact newborn health in this setting. Improving nutritional support during pregnancy, strengthening community-based transportation for women in labour, allowing a birth companion to be present during delivery, addressing harmful home-based newborn care practices such as mixed feeding and application of foreign substances to the umbilicus, and optimizing the networks of community health workers and traditional birth attendants are potential ways to improve newborn health outcomes.

Authors+Show Affiliations

United Nations High Commissioner for Refugees, Case Postale 2500, CH-1211, Genève 2, Dépôt, Switzerland. Stephie.gee@gmail.com.United Nations High Commissioner for Refugees, Case Postale 2500, CH-1211, Genève 2, Dépôt, Switzerland.University of Ottawa, 1 Stewart Street, 312-B, Ottawa, ON, K1N6N5, Canada.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30419924

Citation

Gee, Stephanie, et al. ""We Need Good Nutrition but We Have No Money to Buy Food": Sociocultural Context, Care Experiences, and Newborn Health in Two UNHCR-supported Camps in South Sudan." BMC International Health and Human Rights, vol. 18, no. 1, 2018, p. 40.
Gee S, Vargas J, Foster AM. "We need good nutrition but we have no money to buy food": sociocultural context, care experiences, and newborn health in two UNHCR-supported camps in South Sudan. BMC Int Health Hum Rights. 2018;18(1):40.
Gee, S., Vargas, J., & Foster, A. M. (2018). "We need good nutrition but we have no money to buy food": sociocultural context, care experiences, and newborn health in two UNHCR-supported camps in South Sudan. BMC International Health and Human Rights, 18(1), 40. https://doi.org/10.1186/s12914-018-0181-3
Gee S, Vargas J, Foster AM. "We Need Good Nutrition but We Have No Money to Buy Food": Sociocultural Context, Care Experiences, and Newborn Health in Two UNHCR-supported Camps in South Sudan. BMC Int Health Hum Rights. 2018 11 12;18(1):40. PubMed PMID: 30419924.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "We need good nutrition but we have no money to buy food": sociocultural context, care experiences, and newborn health in two UNHCR-supported camps in South Sudan. AU - Gee,Stephanie, AU - Vargas,Josep, AU - Foster,Angel M, Y1 - 2018/11/12/ PY - 2018/07/06/received PY - 2018/10/31/accepted PY - 2018/11/14/entrez PY - 2018/11/14/pubmed PY - 2019/6/8/medline KW - Maternal and newborn health KW - Qualitative research KW - Refugees KW - South Sudan KW - Sudan KW - Traditional practices SP - 40 EP - 40 JF - BMC international health and human rights JO - BMC Int Health Hum Rights VL - 18 IS - 1 N2 - BACKGROUND: Determinants of newborn health and survival exist across the reproductive life cycle, with many sociocultural and contextual factors influencing outcomes beyond the availability of, and access to, quality health services. In order to better understand key needs and opportunities to improve newborn health in refugee camp settings, we conducted a multi-methods qualitative study of the status of maternal and newborn health in refugee camps in Upper Nile state, South Sudan. METHODS: In 2016, we conducted 18 key informant interviews with health service managers and front-line providers and 13 focus group discussions in two Sudanese refugee camps in Maban County, South Sudan. Our focus group discussions comprised 147 refugee participants including groups of mothers, fathers, grandmothers, traditional birth attendants, community health workers, and midwives. We analysed our data for content and themes using inductive and deductive techniques. RESULTS: We found both positive practices and barriers to newborn health in the camps throughout the reproductive lifecycle. Environmental and contextual factors such as poor nutrition, lack of livelihood opportunities, and insecurity presented barriers to both general health and self-care during pregnancy. We found that the receipt of material incentives is one of the leading drivers of utilization of antenatal care and facility-based childbirth services. Barriers to facility-based childbirth included poor transportation specifically during the night; insecurity; being accustomed to home delivery; and fears of an unfamiliar birth environment, caesarean section, and encountering male health care providers during childbirth. Use of potentially harmful traditional practices with the newborn are commonplace including mixed feeding, use of herbal infusions to treat newborn illnesses, and the application of ash and oil to the newborn's umbilicus. CONCLUSIONS: Numerous sociocultural and contextual factors impact newborn health in this setting. Improving nutritional support during pregnancy, strengthening community-based transportation for women in labour, allowing a birth companion to be present during delivery, addressing harmful home-based newborn care practices such as mixed feeding and application of foreign substances to the umbilicus, and optimizing the networks of community health workers and traditional birth attendants are potential ways to improve newborn health outcomes. SN - 1472-698X UR - https://www.unboundmedicine.com/medline/citation/30419924/"We_need_good_nutrition_but_we_have_no_money_to_buy_food":_sociocultural_context_care_experiences_and_newborn_health_in_two_UNHCR_supported_camps_in_South_Sudan_ L2 - https://bmcinthealthhumrights.biomedcentral.com/articles/10.1186/s12914-018-0181-3 DB - PRIME DP - Unbound Medicine ER -