Background

1. BARRIERS TO NEONATAL CARE IN DEVELOPING COUNTRIES Leakhena Neou1; J. Colin Partridge2; Khu Thi Khanh Dung3; Sadath A. Sayeed4; Alma M. Martinez2 Departments of Pediatrics, 1Angkor Hospital for Children, Siem Reap, Cambodia; 2University of California San Francisco, San Francisco, CA, US; 3National Hospital of Pediatrics, Hanoi, Vietnam; and 4Harvard Medical School, Boston, MA, US Abstract Background Results Economic barriers Problems with newborn health care in region Background: Hospital care for sick neonates is increasingly available in many developing countries; however, availability of neonatal services may not improve access to life-saving medical therapies due to a variety of financial, religious, infrastructural, or social reasons. Objective: To characterize barriers to neonatal care that might be amenable to change as a first step in improving newborn outcomes in developing countries. Methods: Face-to-face half-hour interviews of parents whose infant was hospitalized within the first month of life in hospitals in Vietnam and Cambodia . Trained interpreters conducted interviews in the parents’ primary language. Results: To date, 89 parents have been interviewed (mother’s mean age 27 yrs, mean education 7.5 years). Only 20% lived in cities; 22% had delivered an infant at home, 55% in a hospital. 5% of parents had had a prior child die in the first month of life. While 83% rated their infant’s health as good or excellent, 73% reported difficulty in caring for their infant. Most (67%) parents felt that newborn care was accessible, but 26% did not know where to obtain care. Approximately 50% felt that hospitals were too far from home and 55% rated newborn care as too costly. Medical or environmental factors were cited as causes of neonatal illness by >75% of parents. Of 20-25% that cited spirits, curses, or karma as causing illness, only 15% believed that providers could circumvent resulting diseases. Overall, 49% reported prior newborn care as unsatisfactory, citing cost (55%), infant outcome (54%), poor communication (53%), hospital cleanliness (50%), availability of medications or services (51% and 38%, respectively), and staff availability or demeanor (47& and 46%, respectively) as significant barriers to obtaining health care for infants. Conclusions: Simple improvements in hospital hygiene, staff demeanor, and communication with parents may diminish some barriers to neonatal care. Serious infrastructural problems such as hospital crowding, financial constraints, limited hours of service and distance to health care sites pose more difficult barriers to improving access to medical care for sick newborns in the developing world. • Capacity for neonatal care is improving in many developing countries, and outcome statistics in some areas compare to US and European outcomes. • However, neonatal care may not easily accessed in countries where barriers limit access to heath care for sick newborns. • The effects of local economic, religious, infrastructural, and social barriers as obstacles that impede access to care are poorly understood. Study Objectives Parents’ beliefs about health care delivery Problems with hospital care in past Parent perception of child’s health status Study Methods • Interview instrument: 38 questions covering-- barriers to accessing newborn care assessment of infant’s health status attitudes on treatment of sick newborns prior experience of newborn health care demographics • Pre-implementation: Translation  Vietnamese and Khmai Interpreters experienced in newborn care trained to use interview tool • Interview: structured, face-to-face, ½-hour interview in parent’s primary language • Sample: parent of newborn hospitalized at birth or within the 1st month after birth. Inclusion criteria: Newborn in-patient OR discharged infant aged <6 months from participating hospital Exclusion criteria: Refusal to participate (nil) Health status = poor/very poor Ease of care = difficult/very difficult Limitations • Small sample with significant case mix • Hospital-based study may not reflect barriers to health care in surrounding areas • Use of medical staff from participating hospitals may have biased parents’ responses Parents’ beliefs on causation of illness Health care priorities by age group Conclusions Siem Reap Hanoi