577 - An Ethnographic Survey of Maternal Stress in a Ugandan Neonatal Hospital Unit

Poster Number: 577
Publication Number: 577.241

Delaney Barth, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Jessica Duby, McGill University Health Center, Montreal, PQ, Canada; Abner v. Tagoola, jinnja regional referral hospital, jinja, Jinja, Uganda; Olive Kabajaasi, Walimu Kampala Uganda, Kampala, Kampala, Uganda; Matthew O. Wiens, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Nancy Feeley, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada

Background: Disruption of maternal-infant bonding, the hospital environment, and the appearance of an unwell child are common triggers of maternal stress in Neonatal Intensive Care Units (NICUs) in high-income countries. However, descriptions of maternal stress in low-income countries are lacking and may vary based on cultural differences or the scarcity of healthcare workers, equipment, and other resources.

Objective: We aimed to evaluate maternal stress and its contributing factors in a Ugandan neonatal hospital unit.

Design/Methods: The study was conducted at Jinja Regional Referral Hospital with a sample from the baseline cohort of a larger interventional trial. Inclusion was restricted to full-term infants requiring hospitalization in the Special Care Neonatal Unit. Demographic data was collected by chart review and surveys. Maternal stress was evaluated with the Parental Stressor Scale: Neonatal Intensive Unit (PSS:NICU) survey 48-96 hours after admission. Responses are scored from not stressful (1) to extremely stressful (5), in 3 subscales: Baby Appearance and Behaviour, Parental Role Alteration, and Sights and Sounds (Figure 1). Hierarchical linear regression models were used to determine demographic factors associated with PSS: NICU scores.

Results: Forty-nine mother-baby dyads were included. Thirty-four mothers (69%) had received secondary or higher education, and 21 (43%) were first-time mothers (Table 1). Asphyxia was the most frequent (n=31, 62%) reason for hospitalization, and the median length of stay was seven days (IQR: 6-8 days). The mean maternal stress level on the PSS:NICU was 3.41±0.40, and subscales with the highest and lowest scores were Baby Appearance and Behaviour (3.91±0.39), and Sights and Sounds (2.66±0.75) respectively. No maternal or infant factors were associated with the overall PSS:NICU score. However, older mothers with higher education (r=1.37, p=0.018) had elevated Sights and Sounds scores. Female infants at an older gestational age (r=-0.33, p=0.024) were associated with lower Parental Role Alteration scores.Conclusion(s): The mean PSS:NICU score of 3.41 represents moderate to high maternal stress. While the mean score is comparable to that of high-income countries, Parental Role Alteration, which is typically the largest source of stress, was second to the Baby Appearance and Behaviour subscale. Interventions that reduce maternal stress in high-income countries may also be effective for Ugandan mothers. We suggest that efforts to reduce maternal stress begin at admission, as the median stay is only a week, and should include maternal education about typical baby appearance.
Delaney Barth - CV - LabsFinal.pdf
Figure 1: Examples of items in each PSS: NICU subscale.