Mothers' experiences with neonatal care for low birth weight infants at home; A qualitative study in the Hohoe Municipality, Ghana Christina Schuler a,d, ⁎, George Edward Ntow b , Faith Agbozo a,c a Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana b Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana c Institute of Public Health, Medical Faculty, University of Heidelberg, Germany c Ghana Health and Education Initiative, Sefwi Bekwai, Ghana abstract article info Article history: Received 4 January 2018 Revised 31 December 2018 Accepted 31 December 2018 Available online xxxx Purpose: To explore knowledge and beliefs of mothers on low birth weight (LBW), examine care provision at home and societal perceptions of LBW infants. Design and methods: This qualitative study was conducted using hermeneutic phenomenological approach. Data of mothers who delivered LBW infants within 2 years preceding the study were purposively extracted from the medical records of the Hohoe Municipality Hospital in Ghana. Twenty semi-structured interviews and three focus group discussions were conducted. A thematic analysis approach was performed using Atlas.ti. Results: Mothers identified and described LBW babies based on frailty, size and activity levels. LBW recognition was easier for multiparous mothers by comparing with previous deliveries. LBW was linked to poor maternal diet, diseases during pregnancy and heavy workload. Although most mothers perceived their LBW babies as healthy irrespective of the size a few home-care practises differed. Smaller LBW infants were less likely to be so- cially accepted. In the first few weeks after birth the care of LBW infants is the core responsibility of grand- mothers. Primiparous mothers and those whose infants were smaller (b2 kg) quested for more information and support on LBW newborn care at home. Conclusion: There is a need to increase knowledge on risk factors and tackle lapses in the recognition and care of LBW infants. Counselling on recommended neonatal care should begin during antenatal care and reiterated dur- ing postnatal care. Practical implication: Tailored in-depth and culturally-adapted counselling, discharge instructions and home- based postnatal visits targeted at LBW infants and their primary caregivers could improve care. © 2019 Elsevier Inc. All rights reserved. Keywords: Low birth weight Neonatal care Beliefs Counselling Ghana Introduction Low birth weight (LBW), whether due to preterm delivery or small for gestational age or both, accounts for 80% (Lawn et al., 2014) of the 19 deaths per 1000 live births neonatal mortality rate (NMR) globally (UNICEF, 2017b). LBW remains a significant public health problem in South Asia and Sub-Saharan Africa (WHO, 2018b). In Ghana, neonatal disease burden is high with a NMR of 27 per 1000 live births (UNICEF, 2017a). LBW constitutes 11% of all deliveries nationwide (UNICEF, 2017a) and 9.7% in the study location (Agbozo, Jahn, & Abubakari, 2016). Although a high burden, it is less than the estimated 15–20% LBW deliveries recorded worldwide (WHO, 2018b). Birth weight (BW) has direct impact on child development and sur- vival, causing health and socio-economic burden for individuals, families, health systems and national budgets (Lawn et al., 2014; Liu et al., 2015). Daily, 3000 neonates die from LBW complications includ- ing respiratory problems, infections and undernutrition (Liu et al., 2015). Frequent morbidity entails extra health care, physical and finan- cial stress on families and other opportunity costs. In childhood, risk of growth failure, stunting, disability and post-neonatal death increases (Lawn et al., 2014) and complicates existing congenital conditions (Best, Tennant, & Rankin, 2017). Long-term disability from cognitive and neurodevelopmental impairments and adult-onset of non- communicable diseases is likely (Calkins & Devaskar, 2011; Lawn et al., 2014). Ghana has renewed its commitment to reduce neonatal death by fo- cusing on care of small and sick newborns as endorsed in the Sustain- able Development Goals (SDGs) which targets NMR ≤ 12/1000 live births by 2030. One measure towards this is the National Newborn Health Strategy and Action Plan (2014–2018) adopted from the global Every Newborn Action. The 5-year policy framework targets a reduction of NMR from 32 to 21/1000 live births from 2011 to 2018 (Ghana, Journal of Pediatric Nursing xxx (xxxx) xxx ⁎ Corresponding author at: Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe Campus, Ghana. E-mail address: christina.schuler@ghei.org (C. Schuler). YJPDN-01899; No of Pages 9 https://doi.org/10.1016/j.pedn.2018.12.017 0882-5963/© 2019 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Nursing journal homepage: www.pediatricnursing.org Please cite this article as: C. Schuler, G.E. Ntow and F. Agbozo, Mothers' experiences with neonatal care for low birth weight infants at home; A qualitative study in..., Journal of Pediatric Nursing, https://doi.org/10.1016/j.pedn.2018.12.017