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<p>Malawi has the highest preterm birth rate in the world and preterm birth contribute
to more than one-third of the neonatal deaths annually. Malawi is also faced with
limited resources, both human and material. The lack of incubators led to the adoption
of Kangaroo Mother Care (KMC) as routine care for preterm infants. Families also provide
support, physical and emotional during this entire period. Evidence from developed
countries has shown that preterm birth contributes to maternal emotional distress
(depressive, anxiety, and posttraumatic stress symptoms and maternal worry about child’s
health) and fewer maternal and infant interactive behaviors. The majority of published
research globally has also focused on early-preterm infants and little research has
been done on late-preterm infants. Studies in Malawi have also largely focused on
postpartum depression and no published literature could be located on mother-infant-interactions.
The purpose of this study was to explore emotional distress and mother-infant interactions
of mothers with early-preterm, late-preterm, and full-term infants in Malawi. </p><p>This
mixed method study and three-part investigation was conducted at Queen Elizabeth Central
Hospital. The first part of the investigation was translation and validation of the
Perinatal PTSD Questionnaire and the Child Health Worry Scale as measures for posttraumatic
stress symptoms and maternal worry about child’s health, respectively. I conducted
a focus group discussion with Malawian nurse-midwives (N=8) to assess content of translations
in relation to original. I also tested the instruments on mothers in the perinatal
period (N=30; 10 mothers of early-preterm infants, 10 mothers of late-preterm infants,
and 10 mothers of full-term infants). Validated instruments from first phase were
used in the second phase of the study. The second phase of the investigation compared
emotional distress and mother infant interactions among 85 mother-infant dyads (28
mothers with their early-preterm, 29 mothers with their late-preterm, and 28 mothers
with their full-term infants). Baseline assessments were done following birth for
the three groups and follow-up assessments were conducted for mothers of the preterm
groups. I also recorded and coded videos of mothers and infants to assess mother-infant
interactions. The third phase of the investigation was qualitative (N= 19; 7 mothers
with early-preterm infants, 7 mothers with late-preterm infants, and 5 mothers of
full-term infants) and explored maternal perceptions of sources of concerns and social
support following birth of their infants. In-depth interviews were conducted at the
end of the study. </p><p>Findings showed that mothers of early-preterm infants experienced
higher levels of emotional distress than mothers of full-term infants, with mothers
of late-preterm infants being intermediate between the two. Cesarean birth was also
associated with more anxiety and depressive symptoms. Kangaroo Mother Care had minimal
effects on the change of emotional distress in mothers of the preterm groups. However,
KMC interruptions were associated with an increase in emotional distress. Minimal
differences were seen in mother-infant interactions among the mothers and infants
of the three groups. KMC had no impact on the interactive behaviors. Mothers’ concerns
during infant hospitalization were personal and family factors; prenatal and perinatal
experiences; infant illness, treatments, and appearance; concerns about the infant’s
outcome; loss of parental role; health care workers and the healthcare system; infant
care including breastfeeding concerns; and provision of KMC. Types of support received
during the hospitalization included instrumental/tangible support, emotional support
including spiritual support, and financial support. Mothers also preferred to have
their own family as their caregivers during hospitalization. </p><p>Future studies
need to focus on longitudinal methods to explore whether emotional distress experiences
change over time and also to explore maternal and infant interactive behaviors as
the babies mature. The Malawi healthcare system needs to provide support for mothers
throughout the prenatal and perinatal period in order to lower maternal distress symptoms
and promote positive mother-infant interactions.</p>
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