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. 2021 Mar;6(3):e004347.
doi: 10.1136/bmjgh-2020-004347.

Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers' voices and experiences

Suman P N Rao  1 , Nicole Minckas  2 , Melissa M Medvedev  3   4 , David Gathara  5 , Prashantha Y N  6 , Abiy Seifu Estifanos  7 , Alfrida Camelia Silitonga  8 , Arun Singh Jadaun  9 , Ebunoluwa A Adejuyigbe  10 , Helen Brotherton  4   11 , Sugandha Arya  12 , Rani Gera  12 , Chinyere V Ezeaka  13 , Abdou Gai  11 , Abebe Gebremariam Gobezayehu  14 , Queen Dube  15 , Aarti Kumar  16 , Helga Naburi  17 , Msandeni Chiume  18 , Victor Tumukunde  19 , Araya Abrha Medhanyie  20 , Gyikua Plange-Rhule  21 , Josephine Shabini  22 , Eric O Ohuma  4 , Henok Tadele  23 , Fitsum W/Gebriel  24 , Amanuel Hadgu  20 , Lamesgin Alamineh  14 , Rajesh Mehta  25 , Elizabeth Molyneux  15 , Joy E Lawn  4 ; COVID-19 Small and Sick Newborn Care Collaborative Group
Collaborators, Affiliations

Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers' voices and experiences

Suman P N Rao et al. BMJ Glob Health. 2021 Mar.

Abstract

Introduction: The COVID-19 pandemic is disrupting health systems globally. Maternity care disruptions have been surveyed, but not those related to vulnerable small newborns. We aimed to survey reported disruptions to small and sick newborn care worldwide and undertake thematic analysis of healthcare providers' experiences and proposed mitigation strategies.

Methods: Using a widely disseminated online survey in three languages, we reached out to neonatal healthcare providers. We collected data on COVID-19 preparedness, effects on health personnel and on newborn care services, including kangaroo mother care (KMC), as well as disruptors and solutions.

Results: We analysed 1120 responses from 62 countries, mainly low and middle-income countries (LMICs). Preparedness for COVID-19 was suboptimal in terms of guidelines and availability of personal protective equipment. One-third reported routine testing of all pregnant women, but 13% had no testing capacity at all. More than 85% of health personnel feared for their own health and 89% had increased stress. Newborn care practices were disrupted both due to reduced care-seeking and a compromised workforce. More than half reported that evidence-based interventions such as KMC were discontinued or discouraged. Separation of the mother-baby dyad was reported for both COVID-positive mothers (50%) and those with unknown status (16%). Follow-up care was disrupted primarily due to families' fear of visiting hospitals (~73%).

Conclusion: Newborn care providers are stressed and there is lack clarity and guidelines regarding care of small newborns during the pandemic. There is an urgent need to protect life-saving interventions, such as KMC, threatened by the pandemic, and to be ready to recover and build back better.

Keywords: SARS; cross-sectional survey; paediatrics; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Distribution of survey respondents by country, region, occupation and hospital context. NICU, neonatal intensive care unit; NSCU, neonatal special care unit; SEA, Southeast Asia.
Figure 2
Figure 2
Synthesis of disruptions and underlying challenges, and analyses of solutions and enablers according to levels of care conceptual framework. LMIC, lowand middle-income country; KMC, kangaroo mother care; SSNC, small and sick newborn care.
See this image and copyright information in PMC

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