---
title: "Preventive practices for newborn hypothermia among post-natal mothers in Kilimanjaro public facili"
id: "plos-one-12-exploring-preventive-practices-of-newborn-hypothermia-among-post-natal-mothers"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-12-exploring-preventive-practices-of-newborn-hypothermia-among-post-natal-mothers"
content_type: "clinical_feed_article"
specialty: "Pediatrics"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357756"
published_at: "2026-09-10T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Preventive practices for newborn hypothermia among post-natal mothers in Kilimanjaro public facili
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-12-exploring-preventive-practices-of-newborn-hypothermia-among-post-natal-mothers
- **Specialty:** [Pediatrics](https://medichelpline.com/clinical-feed/pediatrics.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357756)
- **Published At:** 2026-09-10T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This qualitative descriptive study explored how post-natal mothers in selected public health facilities in the Kilimanjaro region prevent **newborn hypothermia** during the early postnatal period. - Data were collected April–June 2024 using in-depth semi-structured interviews with 12 purposively sampled post-natal mothers in postnatal wards across four facilities (Hai district hospital, Pasua, Longoi, Majengo). - The study used an interpretivist paradigm and conventional thematic analysis; the principal researcher employed reflexive methods including bracketing and journaling to reduce bias. - Four main themes emerged: **body covering measures** (multiple cotton layers, preparing clothing before delivery); **room temperature control** (indoor heating and use of lighting to warm rooms); **skin-to-skin and feeding practices** (continuous physical contact for warmth and breastfeeding); and **body care measures** (oil massage to retain warmth and delayed bathing). - Common preventive actions reported were keeping neonates well covered, maintaining a warm room, sustained **skin-to-skin contact** with timely initiation of **breastfeeding**, and postponing the first bath. - Findings highlight maternal practices that may inform educational interventions or future quantitative studies to evaluate the effectiveness of these behaviors in reducing neonatal hypothermia and associated risks. - Details such as participant demographics, exact quotes, or raw transcripts are not publicly available due to confidentiality; full data are within the manuscript and supporting files per the authors’ data statement.
## Clinical Analysis & Structured Key Points
Exploring preventive practices of newborn hypothermia among post-natal mothers in selected public health facilities in Kilimanjaro region: Qualitative descriptive study | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures Figures Abstract Background Newborn hypothermia is a condition that affects newborn survival if measures are not taken to prevent heat loss, especially in the first 28 days of life. Various studies have been conducted in this area, but there is a lack of information about how post-natal mothers specifically keep their newborns warm in a hospital setting. This study explored the preventive practices for newborn hypothermia among post-natal mothers in selected health facilities in the Kilimanjaro region. Method A qualitative descriptive study with a constructivist approach was conducted from April to June 2024 in the Kilimanjaro region involving 12 post-natal mothers. Participants were selected purposively at the post-natal ward. In-depth interview, guided by a semi-structured interview guide developed by researchers together with an audio recorder, was used to collect information from the participants. Data was analyzed using conventional thematic analysis. Results Twelve (12) semi-structured interviews were conducted with post-natal mothers. Four (4) themes and eight sub-themes emerged; Body covering measures (Covering baby with multiple coats of cottoned materials, Preparing baby clothing before delivery), diversity of room temperature controlling measures(Maintaining indoor heating to warm the room and maintaining indoor lighting to increase room temperature), skin-to-skin and feeding practices(Keep a baby in physical contact with the mother for warmth and Breastfeeding practices and body care measures(Massaging the neonates with oil to maintain skin warmth and bathing practices). Conclusion Keeping the baby appropriately covered, ensuring the room is warm, maintaining continuous skin-to-skin contact with timely breastfeeding, and delaying bathing were commonly practiced reports by participants and may inform educational interventions or future quantitative studies evaluating their effectiveness. Citation: Daniel E, Seif SA, Millanzi WC (2026) Exploring preventive practices of newborn hypothermia among post-natal mothers in selected public health facilities in Kilimanjaro region: Qualitative descriptive study. PLoS One 21(9): e0357756. https://doi.org/10.1371/journal.pone.0357756 Editor: Syeda Humaida Hasan, Chittagong Medical College, BANGLADESH Received: November 23, 2025; Accepted: August 23, 2026; Published: September 10, 2026 Copyright: © 2026 Daniel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: Concerning the data set of the underlying results of the manuscript. All relevant data are within the manuscript and its supporting files. Raw data, such as transcripts and translations, cannot be shared publicly because of the confidentiality assurance given to participants at the time of consent. Hence, the data can be accessed through the institutional research review committee (IRRC) of the University of Dodoma through drpc@udom.ac.tz after being processed and accepted by the committee. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Introduction Every family prepares for a newborn with great anticipation and pleasure, but losing a newborn due to hypothermia, which can be prevented with low-cost resources, can dismantle their family bond and provide psychological trauma. Newborn hypothermia is said to occur when the core body temperature of a newborn drops to 36.5°C and is classified into mild hypothermia (36 0 C-36.4 0 C), moderate hypothermia (32 0 C-35.9 0 C), and severe hypothermia <32 0 C [ 1 ]. Newborns are vulnerable to temperature fluctuation, especially in the first 28 days of life, which predisposes them to different complications like hypothermia, hypoglycemia, sepsis, and asphyxia, which are core contributors to newborn mortality [ 2 ]. According to the World Health Organization (WHO), it was estimated that 2.3 million newborns died within the first 28 days of life in 2022, with sub-Saharan Africa having the highest neonatal mortality rate in the world at 27 deaths per 1,000 live births (6). Moreover, in Tanzania, it is estimated that newborn mortality is about 24 deaths per 1,000 live births, while the target is 12 per 1,000 live births by 2030 [ 3 ]which indicates a double increase instead of a decline. This also shows there was a need to intervene appropriately by providing appropriate thermal care and other related interventions. Hypothermia is an important aspect in the avoidance of preventable newborn deaths, so great care is highly required, especially in this period, to achieve Sustainable Development Goal 3.2 [ 4 ], and post-natal mothers are important in maintaining newborn thermal protection, particularly after being discharged from the hospital when clinical oversight is minimal. Previous studies have shown that most of the post-natal mothers lacked sufficient knowledge on preventing hypothermia [ 5 ], some knew exactly how to keep the newborn warm [ 6 ], and others had poor practices, like early bathing [ 7 ]. This also highlights the need to explore the preventive practices of newborn hypothermia. In lower and middle-income countries(LMIC), the preventive practices employed by post-natal mothers, including skin-to-skin contact, early initiation of breastfeeding, and avoidance of cold exposure, directly impact newborn outcomes [ 8 ]. Moreover, post-natal mothers play a great role in newborn’ lives, and their practices will have an impact on the existence of the problem, as previous studies have reported post-natal mothers did not practice skin-to-skin contact, newborns were soaked in water in the first 24 hours after delivery, and late initiation of breastfeeding was reported, all of which influence newborn hypothermia [ 9 , 10 ]. These findings highlight the critical need to explore the preventive practices among postnatal mothers. Moreover, women from different cultures, especially in lower and middle-income countries, have their own way of caring for children to prevent hypothermia; some practices may be detrimental, as they are not scientifically based, such as bathing a newborn within 24 hours after delivery [ 11 , 12 ]. Furthermore, there is limited data in the setting on the adopted preventive practices of neonatal hypothermia by postnatal mothers, as previous studies focused on medical treatment and use guidelines rather than exploring the real practices implemented by the postnatal mothers. Therefore, the study intended to explore the preventive practices of newborn hypothermia among postnatal mothers in the Kilimanjaro region. Materials and methods Study approach and design This study was grounded in the interpretivist paradigm, adopting a relativist ontology that acknowledges the existence of multiple, subjective realities shaped by individual contexts. To operationalize this perspective, a qualitative descriptive design was employed. The researcher opted for this design because it provides a direct description of participants’ experiences without a deep theoretical context of a particular topic under investigation, and also because the design is flexible and has sufficient procedures to provide a thorough understanding of the phenomenon [ 13 ] Researcher characteristics and reflexivity The principal researcher is a midwifery specialist with eight years of clinical and academic experience spanning labor and delivery, postnatal care, and neonatal units. This background provided high levels of theoretical sensitivity, allowing for deep immersion in the clinical stance of newborn care. However, the research recognized that this professional expertise could introduce pre-understandings or subjective biases. To mitigate this, the study adopted a stance of reflexive objectivity. The research employed Husserlian bracketing, deliberately setting aside personal clinical assumptions to approach the data from a tabula rasa perspective. This was operationalized through rigorous reflexive practices, including reflexive journaling, whereas a dedicated log was maintained to document personal feelings, expectations, and emerging insights, ensuring a clear distinction between participant narratives and researcher interpretations. Moreover, the study used field notes from the observations of non-verbal cues and environmental context, which were recorded to provide a thick description of the interview setting. Peer debriefing was also employed through ongoing dialogue with the research team, which served as a reflexive check, challenging potential subjectivity and ensuring the findings were anchored strictly in the participants’ voices. By utilizing the self as a reflexive instrument rather than a mere data collection tool, the researcher ensured that the findings present an authentic co-construction of meaning, balanced by clinical insight and methodological detachment. Study setting The study was conducted in selected health facilities, including Hai district hospital, Pasua, Longoi, and Majengo health centres, involving post-natal mothers. These facilities were chosen due to the high number of deliveries and the diversity of care provided to reflect the variation of newborn prevention practices across the Kilimanjaro region. Hai district hospital and Pasua health centre, located in urban areas, handle approximately 236 and 218 deliveries per month, respectively, and offer comprehensive emergency obstetric and newborn care (EmONC), neonatal intensive care units (NICU), as well as basic emergency obstetric and newborn care (BEmonc). Moreover, Majengo and Longoi health centres, situated in urban and rural areas respectively, have around 196 and 60 deliveries each month and provide basic emergency obstetric and newborn care, including kangaroo mother care. Interviews were conducted in private, conducive, and friendly environments within the hospital or health centre. Sampling strategy The study employed a criterion-based purposive sampling, a strategic approach designed to identify and recruit information-rich cases that align with the research objectives. The primary goal was to engage participants who possessed a broad experiential understanding of the phenomenon, specifically regarding newborn hypothermia preventive practices. To ensure a holistic and comprehensive dataset, the research utilized a maximum variation sampling technique. This involved the deliberate inclusion of participants with diverse socio-demographic backgrounds, including variations in parity, educational attainment, occupational status, and the level of health facility utilized for delivery. This diversity was essential to capture a wide spectrum of perspectives and to mitigate the risk of homogenous bias. In alignment with qualitative methodology, the final sample size was not predetermined. Instead, recruitment was guided by the dual principles of data saturation; Consequently, participants were enlisted until thematic saturation was reached, characterized by the moment when additional interviews produced no new conceptual revelations or developing themes [ 14 ]. Furthermore, participants were recruited purposively through an oral announcement in the study setting, in which the postnatal mothers were approached individually. Study population The study population comprised 12 postnatal mothers with newborns who received delivery services at the selected healthcare facilities. To ensure data accuracy, participants were selected purposively based on specific inclusion criteria, including being in the postnatal period and having the cognitive and linguistic capacity to provide detailed verbal accounts of their experiences. Nevertheless, the study applied strict exclusion criteria to uphold ethical standards, including the exclusion of mothers with acute post-delivery complications or those categorised as critically ill, to prioritise maternal well-being and ensure that participants were in a stable condition to participate in the interview process. Data collection method A face-to-face in-depth interview was used to collect qualitative data on preventive practices for newborn hypothermia among postnatal mothers. Procedure : The in-depth interview was conducted in a private, comfortable room with adequate lighting where participants felt at ease expressing themselves. To ensure confidentiality and privacy, the door was closed during the interview. The researcher positioned himself directly in front of the participant and introduced himself, along with a research assistant, to establish a therapeutic relationship before beginning. The interviews started after the researcher explained the purpose, benefits, risks, voluntary nature of participation, privacy, and confidentiality. Subsequently, the researcher obtained informed consent from participants and provided codes to protect their identities. Initially, a researcher gathered demographic data and asked participants to consent to an audio recording. The interview was conducted by two researchers: the principal researcher, who led the interview, and a research assistant, a nurse working in the labour and post-natal wards, responsible for noting non-verbal cues and preparing the environment, including setting up and testing the audio recorder. The interview was conducted in Swahili to facilitate active participation. The researcher began each interview with a general question to gain a broad understanding of the participants’ experiences, followed by several probing questions to delve deeper into the preventive practices related to newborn hypothermia. The researcher used an audio recorder to record the interviews and field notes to capture verbal cues and memos. The interview duration depended on the participant’s tolerance and patience in describing their experiences related to the topic being interviewed. However, the duration of the interview varied from 30 to 90 minutes, and the researcher, together with the research assistant, summarised the key issues immediately after each conducted interview. Data collection tool The qualitative interview guide was used to collect data ( S1 File : Interview guide). The researcher designed the tool in accordance with the research question. Before the main data collection, the tool was piloted to 6 participants from a non-study facility to ensure questions were clear, relevant, and culturally acceptable. Their feedback was used to refine the tool accordingly. The tool focused on questions regarding preventive practices for newborn hypothermia, with three main interview topics to delve into the details of this phenomenon, enabling participants to share their experiences that closed-ended questions might miss. Additionally, the audio recorder was used to capture and preserve the interview audio. Furthermore, the audio recorder was pre-tested before the actual data collection to ensure its functionality, data transferability, and audible sound capture, thereby ensuring the tool’s credibility for this study. Data analysis plan The study employed Conventional Thematic analysis, following the rigorous six-phase recursive framework established by Braun and Clarke [ 15 ]. The initial phase of data preparation involved the exact transcription of audio recordings, followed by their translation into English. The translation procedure was executed in partnership by both authors, who are native speakers of the Swahili language. A verification of the translated transcripts against the original was conducted to guarantee linguistic fidelity and conceptual richness. The English transcripts were subsequently examined and re-examined by two authors to acquire understanding of the contents. To enhance the inductive nature of the study, analysis was conducted at the manifest level, prioritizing the explicit meanings shared by participants. The process was operationalized as follows: Familiarisation was the first stage at the manifest level of thematic analysis that involved transcribing the data from audio to text, reading and re-reading the data, and identifying the initial ideas about the interviewed topics to familiarise with the collected data. Secondly, generating initial codes was the second stage after familiarisation, where the researcher systematically coded the interesting and peculiar characteristics of the entire data set, assembling data relevant to each code. The researcher identified meaningful units of text in the form of phrases that were highlighted with colours. Moreover, the two coders discussed differences in their codes until they came to a consensus. Thirdly, searching for themes which involved organizing codes from various interview participants into potential themes, combining multiple codes to create a single theme. The researcher identified patterns among the concepts and began to develop themes according to the coding patterns. Reviewing themes was another stage in which the researcher reviewed and refined the themes to ensure they were accurate and relevant to the data. The themes were compared with the data to ensure a true presentation of the participant’s voice. After identifying the final themes, the researcher defined and named them in a way that presented the real meaning of the phenomenon. Also, the researcher examined the names of the themes to ensure they were sufficiently descriptive and brief for inclusion in the report. Also, the identified themes were reviewed and discussed by the research team. Lastly, producing a report and writing up was the final stage of thematic analysis that involved writing the report using the analysed data. The report comprised a narrative description and quotations from participants. Trustworthiness To ensure the trustworthiness and authenticity of the findings, the study adhered to the criteria proposed by Lincoln and Guba [ 16 ], including: Credibility: Credibility was ensured through persistent observation of the participants to identify participants’ cues, behaviors, and unique features presented by the participants. In addition, data were audio recorded and then transcribed verbatim to ensure that each information provided by the participants was captured and analysed. Dependability was ensured by recruiting participants purposefully, using an interview guide, and triangulating two methods of data collection using field notes and audio recording, to capture the data during data analysis. Also, audit trails were ensured through a clear explanation of the research process, data collection and analysis to enable external auditors to value the study. Confirmability was ensured by participant validation of transcripts (member checking) through reviewing the original interview data alongside the analysed data, use of participants’ verbatim quotes to present the results, repeated reading of transcripts to grasp the content, and careful generation of themes to reflect participants’ voices. Ethical consideration Ethical clearance was sought from the institutional research review committee (IRRC) of the University of Dodoma on 30 January 2024, with Ref. No. MA.84/261/69/2. The study abided by the ethical principles of the Declaration of Helsinki by the World Medical Association (2001). The participants, before the data collection process, were given detailed information about the purpose of the study, benefits and risks of participation, research procedures, participants’ ro
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