Health Workers' Knowledge and Practice of Developmentally Supportive Care for Premature Infants in Four Ugandan Neonatal Units: A Cross-Sectional Study.

Background and Aims: Neonatal units can be stressful for pre-term infants at a time of rapid brain growth and plasticity, which may contribute to poorer developmental outcomes. Environmental modification to protect against negative sensory experiences and provide positive caregiver stimuli is the standard of care, but little is known about practices in low-income settings. We aimed to determine knowledge and practice relating to developmentally-supportive-care in Uganda. Methods: A quantitative survey on knowledge and practice of developmentally-supportive-care was conducted with 135 health workers in four neonatal units. In addition, observations of practices and sound measurements were conducted. Results: Only 36% of respondents reported that stress, and 21% that parental interaction can affect brain development, and knowledge of stress reduction was limited. 84% of respondents reported actions to protect infants from excessive light in their unit, 33% from excessive sound, and 69% from sleep disruption. The main perceived benefit of family involvement in care was to reduce parental stress levels (67%), with infection risk perceived as the main negative (71%). Workers at the largest volume facility had the lowest knowledge and practice, with wide variations across facilities. All units had sound readings over recommended levels. Conclusion: Knowledge and practice of DSC in this setting were low and needs to be improved to ensure that pre-terms in this setting both survive and thrive.