Perceptions and experiences regarding neonatal mortality in district Thatta, Sindh, a qualitative exploratory study

According to the United Nations Inter-agency Group for Child Mortality Estimation, Pakistan has the third highest number of newborn deaths around, 245000 in year 2015 with the neonatal mortality rate of 46 per 1000 live births. In Pakistan, neonatal mortality has a minimal decline of 0.9 % per annum between 2000 and 2010 far less than the global average of 2.1%. Although the efforts made by the health system through the integrated National maternal, newborn and child health program has brought into the newborn care services at facility and community levels but still Pakistan lack behind to achieve the sustainable developmental goals. The country is currently facing the challenge in reducing the rate of neonatal mortality. The factors include unsafe delivery, birth related infections, preterm or low birth weight babies, post natal respiratory complications and barriers in utilization of timely facility based neonatal health care service. In much of Pakistan the societal norms, and cultural believes discourage facility based care seeking and many women are unable to access care for themselves and their newborn. Research Objective: 1. The study aimed to explore the perceptions and experiences of parents and healthcare providers regarding Neonatal healthcare service delivery and utilization in district Thatta. 2. The study appraised the level of health facility preparedness of District Head Quarter Hospital and a private neonatal facility in Thatta for delivering Neonatal Healthcare Services. Methodology: The study aimed to explore the perceptions and experiences of parents and health care providers regarding neonatal care and the service utiliz4ion in district Thatta. The research design was qualitative exploratory as it provided Witii the systematic subjective approach used to describe life experiences and perceptions oethe participants regarding; caring for newborn, identifying illnesses, its home management and utilization of healthcare services for neonatal care. The study was conducted in rural and urban setting of District Thatta in Pakistan, from July 2017 to September 2017. The study utilized purposive sampling technique. Study participants were purposefully included from the registered clusters of the Global network research sites in District Thatta. Multiple data sources were utilized. The focus group discussions (FGDs), In-depth interviews (ID\u27s), the key informant interviews (KIIs) using the semi structured open ended questionnaire and the observational checklist for the facility assessments were carried out. The FGDs were conducted with the women and men of reproductive age who are permanent residents of Thatta and had at least one child. The in-depth interviews were conducted with couples (mother and father) who had a live baby in last 6 months from the time of interview, and with the couples who had experienced neonatal death in last six months of the study time period. They were identified from the Maternal Newborn Health Registry (MNHR) of the Global Network for Women\u27s and Children\u27s Health, which is being maintained for last 9 years by the department of Community Health Sciences, Aga Khan University. Seven key informant interviews were carried out on a pediatrician, a staff nurse, Dispenser, Administrator of NGO, traditional birth attendant, MNCH health expert and a community midwife. The purposes of these interviews were to have a deeper insight regarding the neonatal healthcare services and it\u27s utilization in the available context. The data were transcribed in the English language and was organized and managed through NVIVO 11 software and content analysis. Results: This study explored the perceptions and experiences of parents and healthcare providers in reflecting the major challenges of the newborn care and service utilization. In Thatta the socio-cultural norms, poor transportation, limited resources, and nonfunctional primary healthcare facilities affect early referral and prevent timely care seeking for infants. Newborn in this society are highly vulnerable and less likely to get timely appropriate healthcare services. Through the study findings it was discovered that although Thatta has a District Head Quarter Hospital and other\u27private setups for neonatal health care services but they lack provision of standardize newborn care facilities such as lifesaving equipment, medicines and trained human resource. Conclusion: Pakistan has a challenging context and the most vulnerable citizens are newborns. The stagnant rates of neonatal mortality from 2010 to 2013 in District Thatta, despite of the available comprehensive policies and program indicates an urgent need to intervene at provincial and district level. The major areas that require combine efforts of community and the healthcare system is on early diagnosis, timely management and correct treatment availability in their vicinity to overcome the delays in newborn care. There is a high need to strengthen the supply side (health facility) and the demand side (community) for utilization of neonatal health services in District Thatta. The newborn cries are being heard but it requires committed partnership at facility level and advocacy of primary care givers to improve neonatal survival in District Thatta