Date of Award

12-2023

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr. Shelina Bhamani

Second Advisor

Iqbal Azam

Department

Community Health Sciences

Abstract

Abstract: Background: In the challenging environment of the Neonatal Intensive Care Unit (NICU), parents of preterm newborns often experience significant stress. This phenomenon is well documented globally, but studies specifically investigating the correlation between caregiver burden and parental stress in South Asia, especially in countries like Pakistan, are limited. Recognizing the importance of parental mental health in the context of NICU experiences is paramount for enhancing early childhood development. By understanding the intricate relationship between caregiver burden and parental stress, we can establish the groundwork for improved support and care for these parents during demanding times. This understanding is not only crucial for the well-being of the parents but also has far reaching implications for the early development of their infants.
OBJECTIVE: To assess the relationship between caregiver burden and stress in parents of preterm newborns admitted in the NICU at tertiary care hospitals in Karachi, Pakistan.
METHODS: We conducted an analytical cross-sectional study on 90 parents with preterm newborns admitted to the NICU of Aga Khan University Hospital (AKUH) during three months of data collection, from July 2023 to October 2023. Caregiver burden was assessed by the impact on Family Scale-Revised and Stress by Parental Stressor Scale: Neonatal Intensive Care unit (PSS: NICU), while parents’ demographics, preterm characteristics, and reproductive and neonatal intensive care unit (NICU) history were assessed. The outcome variable, parental stress, was based on a continuous scale, and we used a multiple linear regression technique for the analysis. For continuous variables, we calculated means and standard deviations. Categorical variables were reported as frequencies with percentages. For all important associations, B coefficients with 95% confidence intervals were reported.
RESULTS: Out of 138 parents, 90 were recruited for the study. The mean score of total stress was 2.72. Out of all four subscales of PSS: NICU, the highest mean scores were of ‘Relationship with baby and parental role 3.73 ± 0.16 followed by “Infant behavior and appearance”, i.e., 3.30 ± 0.16). Two-thirds of participants (66.67%) were mothers, with an average age of around 30 years. Parents of preterm newborns with complications reported higher stress compared to those without complications, 0.40 (0.01, 0.80). The birthplace of the preterm newborn significantly influenced the total stress score, with parents of newborns born outside AKUH showing stress levels 0.64 (0.21, 1.07) compared to those born in AKUH. A notable interaction observed between caregiver burden and parents with a history of miscarriages and neonatal death, indicating that for every one-unit increase in caregiver burden among parents with such a history, the estimated mean total stress score decreased by 0.05(-0.10, -0.010).
CONCLUSION: This study highlights the need for tailored interventions to reduce parental stress and caregiver burden in NICU settings, ultimately improving the well-being of parents and preterm infants. These insights can inform clinical practices, influence policies, and guide future research in this area, benefiting NICU parents and their infants.

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