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**28** 

Hippolite O. Amadi *Imperial College London* 

*United Kingdom* 

**Neonatal Thermoneutrality in a Tropical Climate** 

Sub-Saharan African countries are notably among the nations with high neonatal mortality (NNMR) and morbidity rates (WHO, 2009). A number of issues have been previously raised in the literature in attempt to define some of the factors that contribute to these such as level of illiteracy among mothers and short supply of healthcare workers (Amadi et al., 2007). However, little has been said of the impact of environmental temperature regulation on the wellness and survival of neonates in this region. The sub-Saharan Africa is well-known for its harsh climatic conditions of high sun intensity and ambient temperatures, often in excess of 35°C, coupled with societal condition of abject poverty. Nursing environment of the neonate, especially pre-terms, is a crucial factor for the maintenance of appropriate body temperature for the physiological stability of the newborn. Classical management of neonatal thermoneutrality in this region of Africa has been dominated by procedures that were handed down from industrialised societies; these being fundamentally compliant to

In the last decade, there has been concerted effort to scientifically investigate factors that may be subtly contributing to high neonatal mortality and morbidity in this region. These include meteorological, socio-cultural and technological factors that define the macro- and micro-environments immediate to the neonate. This knowledge is fundamental for the tweaking or outright replacement of the present morbidity-high techniques. This chapter will attempt to explore these factors and their consequences, and discuss the present interventions and techniques that are coincidentally yielding improved outcome in some neonatal centres in the region. The ideas expressed in this chapter were drawn from on-thespot clinical practice experiences in a decade-on collaborative project that has involved up to 21 neonatal referral Centres across the entire geographical region of the West African state of Nigeria (Figure 1). Recent publications show that this region of African is currently far behind the United Nation's Millennium Development Goal (MDG) target on the survival of infants, and neonatal mortality rate is steadily making this worse (Federal Ministry of Health [FMOH], 2011). Neonatal survival might not necessarily improve by the flooding of the region with 'foreign-culture-biased' sophisticated incubator systems that are not so easy to handle by the users despite the high pricing of these that limit their procurement by the poor countries. There is a perceived socio-cultural dimension of the work place attitude that militates against effective practice of neonatal thermoregulation. This needed to be properly addressed perhaps by the use of affordable and manageable appropriate incubation

the peculiar climatic factors and social advantages of the countries of origin.

technology that the people can easily identify with.

**1. Introduction** 

