Mary Thwaites and C. A. Pearson

Little guidance is available concerning the type of children's ward accommodation most suitable for the tropics. Hospitals are still being built without any children's wards and special facilities for neonates are seldom found outside teaching hospitals. Where such facilities exist, design has conformed to the traditional type of premature baby unit, which may be neither suitable nor desirable for developing countries. In 1969 a neonatal unit specially designed for the tropics, allowing for close observation, and full involvement of the infant's mother, was added to the pediatric wards of the Wesley Guild Hospital, Ilesha. The purpose of this paper is to review the work of thinunit during its first two years. The neonatal unit is part of a 175-bedded general hospital situated in the rain forest zone of Western Nigeria, which together with a government general hospital serves a.population of 475,000. In 1968 child in-patients aged 0-5 years numbered 3,353 out of a total of 6,524 hospital admissions. Approximately 10% of the children were less than one month old and the neonatal mortality rate was 20.8%. The overall mortality rate for the children's ward has been 12.5% over a four-year period, 1968-1971 inclusive. There had been a growing awareness of the need to provide more individual care and supervision for this large number of babies previously nursed in the general pediatric wards, and at the same time allow their mothers to stay in the ward, learning and participating in this care. The unit was designed to meet these two objectives and was built at a cost of £8,000 (approximately £330 per cot). It was opened in April 1969. Ward Design and Staffing. The unit has accommodation for 24 neonates and their mothers. As shown in Fig. 1, six cubicles are arranged facing a central nursing area. Each cubicle has two cots and is joined to an outer room where the mother sleeps, and rests during the day when she is not with her baby. Access to this room is by an outer corridor, as shown. The mother, although in constant contact with her child, does not pass through the nursing area, nor does she enter other cubicles. Such an arrangement facilitates participation by the mother but should reduce to a minimum the possibility of