Participants commonly described protecting newborns from heat loss by covering them with multiple layers of clothing and cotton materials. Mothers reported preparing baby clothing before delivery so the neonate could be wrapped promptly after birth. These practices were described as routine steps taken to prevent cold exposure during the immediate postnatal period.
Respondents described several approaches to maintaining a warm environment in the postpartum ward or home setting. Two subthemes emerged: maintaining indoor heating to warm the room and using indoor lighting to increase room temperature. Mothers reported purposeful actions to keep the ambient temperature elevated so that neonates remained warm and to reduce the risk of hypothermia.
Continuous physical contact between mother and baby was reported as a key strategy for warmth. Participants described keeping the newborn in direct contact with the mother — a practice aligned with kangaroo mother care principles — to preserve body heat. Timely breastfeeding was also emphasized by mothers as part of thermal protection. Participants linked early feeding with maintaining neonatal warmth and energy, noting that breastfeeding and close contact were complementary behaviors for preventing heat loss.
Mothers reported body care practices intended to maintain skin warmth. One common behavior was massaging neonates with oil, which participants believed helped retain warmth. Bathing practices were also discussed: many mothers described delaying the newborn’s first bath as a deliberate preventive step to avoid hypothermia during the early hours and days after delivery.
The research used a qualitative descriptive design grounded in an interpretivist paradigm, chosen to provide direct descriptions of participants’ experiences without imposing a heavy theoretical framework. The principal researcher has clinical midwifery experience and applied reflexive methods (including Husserlian bracketing and reflexive journaling) to mitigate preconceptions and maintain fidelity to participants’ accounts. Peer debriefing and field notes on nonverbal cues and context were used to enrich the analytic description.
The study was conducted at four public health facilities in the Kilimanjaro region: Hai district hospital, Pasua health centre, Longoi health centre, and Majengo health centre. Facilities were selected to reflect variation in delivery volume and services, including sites that provide comprehensive emergency obstetric and newborn care (EmONC) and those offering basic EmONC and kangaroo mother care.
A criterion-based purposive sampling strategy with maximum variation was used to recruit information-rich postnatal mothers of diverse parity, education, occupation, and delivery setting. The final sample comprised 12 postnatal mothers recruited purposively in postnatal wards; recruitment continued until thematic saturation was reached. Mothers with acute post-delivery complications or who were critically ill were excluded.
Data were collected through face-to-face, in-depth interviews between April and June 2024 using a semi-structured interview guide and audio recording. Interviews were conducted in private, supportive settings within the participating facilities. Analysis followed conventional thematic analysis procedures, producing four main themes and eight subthemes that reflect the range of preventive practices mothers described.
The authors note that raw transcripts and translations cannot be publicly shared because participants were assured confidentiality; however, relevant data are presented in the manuscript and supporting files. The study received no specific funding, and the authors reported no competing interests.
Postnatal mothers in the selected Kilimanjaro facilities commonly reported practical, low-cost measures to prevent newborn hypothermia, including ensuring neonates are well covered, keeping rooms warm, maintaining skin-to-skin contact with timely breastfeeding, and delaying the first bath. These maternal behaviors may be useful targets for educational interventions and for future quantitative research to assess their effectiveness in reducing neonatal hypothermia and related morbidity.
Note: Participant quotes, detailed demographic tables, and full thematic coding were reported in the original manuscript. Raw interview data remain restricted to protect participant confidentiality, accessible only through institutional review procedures as described by the authors.