Care Seeking for Neonatal Morbidity in the Urban Slums of Uttar Pradesh, India

Background: Neonatal morbidities must be recognized early and treated appropriately to optimize chances for survival. Information is lacking on household recognition of neonatal illness, ‘triggers to action' and choice of provider.

Methods: We conducted a focused ethnographic study using free listing, severity ranking and in-depth interviewing with mothers (n=43) and healthcare providers (n=17); focused group discussions with fathers and grandmothers (n=14); and illness narratives with mothers of sick neonates (n=12).

Results: Respondents cited a number of important danger signals based on perceived severity and combinations of signs of illness. However, mothers failed to recognize the significance of some symptoms, like fever and umbilical stump swelling, unless accompanied with signs like difficult breathing and blood, respectively. Notions of illness causation incorporated traditional as well as bio-medical concepts. Families were usually prompt in seeking care outside the home. While modern medicine was the preferred choice of treatment, use of spiritual healers and home remedies was minimal. Care was uniformly sought from informal private practitioners who serve as the gateway to accessing care in the formal sector. Healthcare providers voiced concern over discontinuation of prescribed treatment courses, causing treatment failures, and few families complied with referrals. Providers displayed lack of knowledge of Integrated Management of Childhood Illness danger signs for urgent referral.

Conclusions: Urban slum communities in Meerut displayed positive health behaviors that can be built upon to foster appropriate care-seeking. Since informal private providers have an extensive reach into this population, programs designed to incentivize, train and supervise them should be considered.