Abstract:
Background To address high neonatal mortality (from birth to 28 days of life), baccalaureate-level nursing school
and continuing education curricula in western Kenya include content on most common causes of death in the first
week of life and the prevention and treatment of complications such as low birthweight, respiratory distress, and
sepsis. Yet these topics do not address early-to-late postnatal mortality in well-appearing, term newborns discharged
more than 24 h after delivery. In this study, we assessed curricula at a baccalaureate-level university nursing school
and a tertiary hospital in western Kenya for content on home care of term newborns.
Methods We analysed secondary data using a rapid, focused ethnographic study of newborn care recommendations
provided by nurse-midwives on the postnatal ward of a tertiary, publicly funded referral hospital and baccalaureate-
level nursing school in western Kenya. Participants were recruited via purposive stratified judgment sampling.
We conducted anonymous, semi-structured, open-ended interviews with nursing faculty, administrators, bedside
staff, and one obstetric resident physician. Data were analysed using thematic analysis.
Findings Between Nov 17 and Dec 17, 2018, we conducted 24 interviews and completed 240 h of participant observation,
reviewed 34 relevant documents (obstetric and paediatric syllabi and ward-specific continuing education logs), and took
268 pages of fieldnotes. The nursing school curriculum provided less than 6 h of didactic instruction on well-newborn
care recommendations, divided between obstetric and paediatric courses. In the hospital, 80% of the monthly continuing
education topics focused on maternal health and 20% focused on care of the sick newborn, despite only well-appearing
newborns being present on the ward. Workforce capacity constraints limited clinical instruction about home care
recommendations and contributed to early discharge of the well-appearing newborn before the recommended period
of observation after birth.
Interpretation The teaching of term newborn topics within the obstetric and paediatric nursing curriculum and
limited hospital continuing education programme may be disadvantageous to well-appearing newborns as the
newborns’ evolving postnatal health needs may be overshadowed by concern for mothers and sick newborns.
Our findings suggest a need for increased coverage of postnatal newborn health topics in nursing curricula within
the study settings, for larger studies to assess content endorsed by the Nursing Council of Kenya, and increased
vigilance of newborn health after discharge. Additional coverage of term newborn health topics may increase use
of evidence-based care recommendations to prevent complications during ongoing newborn physiological transition,
encourage partnership with caregivers to promote newborn health throughout the full postnatal period, and decrease
neonatal mortality. Study strengths include an adequate sample and rich narratives for thematic saturation; limitations
include secondary analysis and possible recall bias of participants.
