Neonatal units as physical spaces for newborn care delivery in Kenya: A qualitative study

Background: Neonatal units offer specialized environments for caring for small and sick newborns. However, inadequate consideration of layout and organization of space can hinder care delivery and the implementation of key interventions such as Kangaroo Mother Care, supportive care for exclusive breastfeeding, and respectful communication. While efforts are being made to improve the infrastructure and technical capacities of newborn units, it is important to consider human-cantered design aspects to ensure that the spaces meet the needs of healthcare providers and mothers. This study examines the impact of the layout and organization of three key spaces in Kenyan neonatal units on care delivery: the nursing station, the Kangaroo Mother Care ward, and the breast milk expression areas. We aim to contribute evidence on how the space and layout of neonatal units can influence care delivery in resource-limited settings, such as Kenya. 

Methods: We employed an ethnographic approach (non-participant observation, in-depth interviews, and informal conversations) to explore the layout and organization of neonatal units and how these influence care delivery in four county referral hospitals in Kenya. Data were collected between January 2022 and April 2023, cumulatively capturing over 600 hours of observations per hospital. We analyzed the data thematically. 

Results: We found substantial variation in the layout and organization of space in the neonatal units. Nursing stations emerged as pivotal hubs for communication, with their location and layout either facilitating or hindering the orientation of new mothers and the sharing of essential and confidential information. Kangaroo Mother Care spaces were often inadequate, limiting the number of babies who could benefit from continuous Kangaroo Mother Care. Designated breastmilk expressing areas in some hospitals provided mothers opportunities for peer support and bonding, but space limitations and overcrowding negatively impacted mothers' comfort and privacy when utilizing the spaces. Expressing areas also offered healthcare providers opportunities to support and supervise mothers collectively, which was helpful given staff shortages. 

Conclusion: The layout of neonatal units and the organization of spaces influence care delivery. Limitations in layout and space require healthcare providers to adopt practices that can inhibit the provision of respectful communication and maternal participation in care. Careful planning of the layout and organization of spaces in the neonatal units can facilitate these practices and support the needs of neonates, healthcare providers, and mothers.