Journal des maladies tropicales et de la santé publique

Abstrait

Health Care Providers and Community Health Care-worker’s Perspectives on the Factors Contributing to Continued Neonatal Deaths in Gicumbi District, Rwanda

Corneille Killy Ntihabose*, Nicholas Ngomi

Introduction: Rwanda’s neonatal mortality remains high and estimated to be 20 per 1000 live births according to the 2014-15 Rwanda Demographic and Health Survey (RDHS 2014-2015). Improving outcomes of maternal and child health outcomes in low and middle-income countries remains a major challenge. Globally, the United Nations estimated that the Maternal Mortality Ratio (MMR) was 216 per 100,000 births and the under-five mortality rate 43 per 1,000 live births in 2015 and that the majority of these deaths occurred in Sub-Saharan Africa. Factors like poor maternal health, management of pregnancy and delivery complications and poor medical and nursing care during childbirth or shortly after birth of neonate predispose to neonatal deaths and morbidities. These factors predisposing neonatal deaths and morbidities are poorly measured in developing world but some studies have revealed that neonatal asphyxia, severe neonatal sepsis, prematurity and low birth weight complications and tetanus are believed to be major components. The aim of this study is to explore health care providers and community health workers’ perspectives on the factors contributing to continued neonatal deaths.

Methods: We conducted key informant interviews with 24 health care providers (medical doctors, nurses, and midwives) and Community health workers. Interviews were recorded and analyzed thematically.

Results: We conducted a total of 24 in-depth interviews and results concluded that 91.6 % of respondents believed that the main challenges in providing care to women who are delivering or in postpartum are inadequate number of staff (medical doctors and midwives), Close to 90% reported that mother’s education is the area to be improved, Near 70% of our respondents pointed on proper labor monitoring by midwives and medical doctors as the area to improve during delivery, and finally above 50% of respondents described that mothers who are delaying to reach health facility is important factor contributing to neonatal mortality and morbidity.

Conclusion: Our findings suggest that delaying to reach health facility is a big contributor to continued deaths; therefore, this study recommends for Ministry of health to allow maternity services in health posts which are being rolled out at cell’s level in Rwanda.