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Mohammed M, Akuoko M. Subnational variations in electricity access and infant mortality: Evidence from Ghana. HEALTH POLICY OPEN 2022. [DOI: 10.1016/j.hpopen.2021.100057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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2
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Mangu CD, Rumisha SF, Lyimo EP, Mremi IR, Massawe IS, Bwana VM, Chiduo MG, Mboera LEG. Trends, patterns and cause-specific neonatal mortality in Tanzania: a hospital-based retrospective survey. Int Health 2021; 13:334-343. [PMID: 32975558 PMCID: PMC8253992 DOI: 10.1093/inthealth/ihaa070] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/14/2020] [Accepted: 08/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background Globally, large numbers of children die shortly after birth and many of them within the first 4 wk of life. This study aimed to determine the trends, patterns and causes of neonatal mortality in hospitals in Tanzania during 2006–2015. Methods This retrospective study involved 35 hospitals. Mortality data were extracted from inpatient registers, death registers and International Classification of Diseases-10 report forms. Annual specific hospital-based neonatal mortality rates were calculated and discussed. Two periods of 2006–2010 and 2011–2015 were assessed separately to account for data availability and interventions. Results A total of 235 689 deaths were recorded and neonatal deaths accounted for 11.3% (n=26 630) of the deaths. The majority of neonatal deaths (87.5%) occurred in the first week of life. Overall hospital-based neonatal mortality rates increased from 2.6 in 2006 to 10.4 deaths per 1000 live births in 2015, with the early neonates contributing 90% to this rate constantly over time. The neonatal mortality rate was 3.7/1000 during 2006–2010 and 10.4/1000 during 2011–2015, both periods indicating a stagnant trend in the years between. The leading causes of early neonatal death were birth asphyxia (22.3%) and respiratory distress (20.8%), while those of late neonatal death were sepsis (29.1%) and respiratory distress (20.0%). Conclusion The majority of neonatal deaths in Tanzania occur among the early newborns and the trend over time indicates a slow improvement. Most neonatal deaths are preventable, hence there are opportunities to reduce mortality rates with improvements in service delivery during the first 7 d and maternal care.
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Affiliation(s)
- Chacha D Mangu
- National Institute for Medical Research, Mbeya Research Centre, Mbeya, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Emanuel P Lyimo
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Irene R Mremi
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Isolide S Massawe
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Veneranda M Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania
| | - Mercy G Chiduo
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Leonard E G Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
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Debie A, Tesema GA. Time to early initiation of postnatal care service utilization and its predictors among women who gave births in the last 2 years in Ethiopia: a shared frailty model. ACTA ACUST UNITED AC 2021; 79:51. [PMID: 33858514 PMCID: PMC8048056 DOI: 10.1186/s13690-021-00575-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022]
Abstract
Background Most maternal and infant deaths occurred within the first month after birth. Nearly half of the maternal deaths and more than a million newborn deaths occurred within the first day of life but these were preventable through early initiation of postnatal care (PNC) services. However, the available evidence on the level of early initiation of PNC service utilization was not adequate to inform policy decisions. Therefore, this study aimed to assess time to early initiation of postnatal care and its predictors using the 2016 Ethiopian Demography and Health Survey (EDHS) datasets. Methods Two-stage stratified cluster sampling technique by separating each region into urban and rural areas. A total weighted sample of 6364 women of the 2016 EDHS datasets who gave birth within 2 years preceding the survey was used. Time to early initiation of the PNC visit was estimated using the Kaplan-Meier (K-M) method. Shared frailty model with baseline distributions (Weibull, Gompertz, exponential, log-logistic, and lognormal) and frailty distributions (gamma and inverse Gaussian) were used by taking enumeration areas/clusters as a random effect for predictors of time to early initiation of PNC visit. The adjusted hazard ratio (AHR) with a 95% confidence interval (CI) and p-value less than 0.05 were used to declare the significant predictor variables for time to early initiation of the PNC service utilization. Results The prevalence of women who utilized PNC services within 42 days was 13.27% (95% CI, 12.46, 14.13). Among these women, only 1.73% of them had got within the first 24 h of birth; 4.66% of them received within 48–72 h and 1.74% of them also had got within 7–14 days. Variables, such as parity (AHR = 1.61, 95% CI: 1.21, 2.15), media exposure (AHR = 1.42, 95% CI: 1.21, 1.68), place of delivery (AHR = 14.36, 95% CI: 11.76, 17.53), caesarean delivery (AHR = 2.17, 95% CI: 1.60, 2.95) and antenatal care visit (AHR = 2.07, 95% CI: 1.63, 2.63) had the higher hazard for PNC services utilization. On the other hand, women who faced with healthcare access problems (AHR = 0.74, 95% CI: 0.60, 0.87) had a lower hazard of PNC service utilization. Conclusion The overall postnatal care service utilization among women in the survey was low, particularly within the first 24 h of delivery. Policy-makers and implementers should promote the utilization of antenatal care and institutional delivery using mass media to increase the continuum of maternity care. The government should also design a new approach to enhance the uptake of postnatal care services for poor households and to scale up the PNC services, including the different possibilities for women who give births at the health facilities and homes. Future researchers had better assess the capacity and accessibility of the local health systems, the level of decentralized decision making, common cultural practices, knowledge, attitude, and perception of mothers towards PNC service utilization. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00575-7.
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Affiliation(s)
- Ayal Debie
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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4
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Akweongo P, Jackson EF, Appiah-Yeboah S, Sakeah E, Phillips JF. It's a woman's thing: gender roles sustaining the practice of female genital mutilation among the Kassena-Nankana of northern Ghana. Reprod Health 2021; 18:52. [PMID: 33648528 PMCID: PMC7923333 DOI: 10.1186/s12978-021-01085-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/24/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The practice of female genital mutilation (FGM/C) in traditional African societies is grounded in traditions of patriarchy that subjugate women. It is widely assumed that approaches to eradicating the practice must therefore focus on women's empowerment and changing gender roles. METHODS This paper presents findings from a qualitative study of the FGM/C beliefs and opinions of men and women in Kassena-Nankana District of northern Ghana. Data are analyzed from 22 focus group panels of young women, young men, reproductive age women, and male social leaders. RESULTS The social systemic influences on FGM/C decision-making are complex. Men represent exogenous sources of social influence on FGM/C decisions through their gender roles in the patriarchal system. As such, their FGM/C decision influence is more prominent for uncircumcised brides at the time of marriage than for FGM/C decisions concerning unmarried adolescents. Women in extended family compounds are relatively prominent as immediate sources of influence on FGM/C decision-making for both brides and adolescents. Circumcised women are the main source of social support for the practice, which they exercise through peer pressure in concert with co-wives. Junior wives entering a polygynous marriage or a large extended family are particularly vulnerable to this pressure. Men are less influential and more open to suggestions of eliminating the practice of FGM/C than women. CONCLUSION Findings attest to the need for social research on ways to involve men in the promotion of FGM/C abandonment, building on their apparent openness to social change. Investigation is also needed on ways to marshal women's social networks for offsetting their extended family familial roles in sustaining FGM/C practices.
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Affiliation(s)
| | - Elizabeth F Jackson
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Evelyn Sakeah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Upper East Region, Ghana
| | - James F Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
- School of Public Health, Columbia University, New York, NY, USA
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5
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Achan J, Wanzira H, Mpimbaza A, Tumwine D, Namasopo S, Nambuya H, Serwanga A, Nantanda R. Improving the quality of neonatal data capture and clinical care at a tertiary-care hospital in Uganda through enhanced surveillance, training and mentorship. Paediatr Int Child Health 2020; 40:92-104. [PMID: 31290375 DOI: 10.1080/20469047.2019.1638131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Accurate documentation of neonatal morbidity and mortality is limited in many countries in sub-Saharan Africa. This project aimed to establish a surveillance system for neonatal conditions as an approach to improving the quality of neonatal care.Methods: A systematic data capture and surveillance system was established at Jinja Regional Referral Hospital, Uganda using a standardised neonatal medical record form which collected detailed individual patient level data. Additionally, training and mentorship were conducted and basic equipment was provided.Results: A total of 4178 neonates were hospitalised from July 2014 to December 2016. Median (IQR) age on admission was one day (1-3) and 48.0% (1851/3859) were male. Median (IQR) duration of hospitalisation was 17 days (IQR 10-40) and the longest duration of hospitalisation was 47 days (IQR 41-58). The majority were referrals from government health facilities (54.4%, 2012/3699), though 30.6% (1123/3669) presented as self-referrals. Septicaemia (44.9%, 1962/4371), prematurity (21.0%, 917/4371) and birth asphyxia (19.1%, 833/4371) were the most common diagnoses. The overall mortality was 13.8% (577/4178) and the commonest causes of death included septicaemia (26.9%, 155/577), prematurity (24.3%, 140/577), birth asphyxia (21.0%, 121/577), hypothermia (9.9%, 57/577) and respiratory distress (8.0%, 46/577). The majority of deaths (51.5%, 297/577) occurred within the first 24 h of hospitalisation although a significant proportion of deaths also occurred after 7 days of hospitalisation (24.1%, 139/577). A modest decrease in mortality and improvement in clinical outcome were observed.Conclusion: Improvement in neonatal data capture and quality of care was observed following establishment of an enhanced surveillance system, training and mentorship.Abbreviations: aOR: adjusted odds ratio; CHRP: Centre for Health research and Programmes; HC: health centre; HMIS: Health Management Information System; JRRH: Jinja Regional Referral Hospital; NMRF: neonatal medical record form; PMTCT: prevention of mother-to-child transmission of HIV; UPA: Uganda Paediatric Association.
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Affiliation(s)
- Jane Achan
- Uganda Paediatric Association, Kampala, Uganda.,Disease Control and Elimination Theme, Medical Research Council Unit, Banjul, The Gambia
| | | | - Arthur Mpimbaza
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Sophie Namasopo
- Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Harriet Nambuya
- Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | | | - Rebecca Nantanda
- Uganda Paediatric Association, Kampala, Uganda.,Makerere University Lung Institute, Kampala, Uganda
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Babayara MNK, Addo B. Risk Factors for Child Mortality in the Kassena-Nankana District of Northern Ghana: A Cross-Sectional Study Using Population-Based Data. SCIENTIFICA 2018; 2018:7692379. [PMID: 30155343 PMCID: PMC6092989 DOI: 10.1155/2018/7692379] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/27/2018] [Accepted: 06/17/2018] [Indexed: 06/08/2023]
Abstract
Child mortality continues to be a major public health problem in Ghana, especially in northern Ghana where child survival rates are among the lowest. Though strategies are in place to address it, progress made is unsatisfactory and the Sustainable Development Goal 3 risks being missed. This makes the reexamination of the risk factors for child mortality crucial as results will aid in the modification of existing strategies aimed at addressing the problem. This study was a population-based case control study utilizing data (2007-2011) from the Demographic Surveillance System database of the Navrongo Health Research Center. Cases and controls were selected from the database and analysed unmatched. Cases were children who died before age five and controls were live children within the same year group. Univariate and bivariate analyses were performed using STATA (v13). The results revealed the main causes of death in the area to include malaria, diarrhoeal diseases, respiratory infections, and malnutrition. Mother's age at birth, mother's educational level, and mother's household socioeconomic status were significantly related to child mortality. On the basis of these results, we conclude that the known risk factors for child mortality in the Kassena-Nankana district have not changed much over the years. Current child survival strategies therefore need to be evaluated and modified where necessary to yield desired results.
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Affiliation(s)
| | - Bright Addo
- University of Ghana School of Public Health, Accra, Ghana
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Adama EA, Bayes S, Sundin D. Parents' experiences of caring for preterm infants after discharge with grandmothers as their main support. J Clin Nurs 2017; 27:3377-3386. [PMID: 28474752 DOI: 10.1111/jocn.13868] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore parents of preterm infants' experiences of caring for their preterm infants with the grandmother as their primary support after discharge. BACKGROUND Preterm delivery is the major cause of high neonatal mortality in sub-Saharan Africa. There is poor neonatal health outcome in the Ghanaian community with some illnesses culturally classified as not-for-hospital. In the community, grandmothers or older women provide support for new parents and decide treatment options for sick infants. However, there is paucity of research on how parents of preterm infants experience this support in the Ghanaian community. METHOD Qualitative narrative inquiry methodology was used. Face-to-face interviews using semi-structured interview guide were used to collect data from 21 mothers and nine fathers. Participant observation and field notes were used to complement interview data. Thematic content analysis of data within the three-dimensional narrative space was employed. Analysis focussed on the relationship of time, place, person and cultural practices affecting the care of preterm infants in the community. RESULTS Three themes emerged from the data, namely (i) Grandmother's prescriptions, (ii) Fighting for the well-being of the infant and (iii) Being in a confused state. Cultural practices mainly initiated by grandmothers resulted in adverse health problems for preterm infants and disruption in parents' mental health. CONCLUSION As grandmothers perform their traditional role of supporting new parents to care for preterm infants after discharge, they give both positive and negative advice which can adversely affect the health of vulnerable preterm infants in the community. RELEVANCE TO CLINICAL PRACTICE Grandmothers are the main support providers of parents of preterm infants after neonatal unit discharge. Nurses should identify and include grandmothers in predischarge education in order to equip them to render appropriate support to parents and preterm infants.
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Affiliation(s)
- Esther Abena Adama
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Sara Bayes
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Deborah Sundin
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
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8
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Cause of neonatal deaths in Northern Ethiopia: a prospective cohort study. BMC Public Health 2017; 17:62. [PMID: 28077109 PMCID: PMC5225539 DOI: 10.1186/s12889-016-3979-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 12/21/2016] [Indexed: 11/13/2022] Open
Abstract
Background Despite the significant reduction in childhood mortality, neonatal mortality has shown little or no concomitant decline worldwide. The dilemma arises in that the lack of documentation of cause of death in developing countries, where registration of vital events is virtually nonexistent. Understanding of the causes of death in neonates is important to guide public health interventions. The present study identifies the common causes of neonatal death in Ethiopia. Methods A prospective cohort study was conducted among neonates born between April 2014 and July 2014 in seven hospitals, in Tigray region, Ethiopia. Mothers were interviewed by midwifes respecting risk factors and infant survival. For neonates who died in hospital, causes of death were extracted from medical records, whereas a verbal autopsy method provided presumptive assignment of cause of death for those infants who died at home. Results Of the1152 live births, there were 68 deaths (63 per 1000 live births). Two thirds of deaths were attributable to prematurity 23 (34%) or asphyxia 21 (31%). Slight variance was seen between the morality patterns in early and late neonatal periods. In the early neonatal period, 37% were due to prematurity, while asphyxia (35%) was more common in the late neonatal period. All infection-related deaths occurred in neonate-mother dyads from rural areas. Conclusion Prematurity, asphyxia, and infections were the leading causes of neonatal deaths in Tigray region during the study period. Causes of deaths identified during early and late neonatal mortality differed, which clearly indicates the need for responsive and evidence-based interventions and policies.
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Ibrahim A, Maya ET, Donkor E, Agyepong IA, Adanu RM. Perinatal mortality among infants born during health user-fees (Cash & Carry) and the national health insurance scheme (NHIS) eras in Ghana: a cross-sectional study. BMC Pregnancy Childbirth 2016; 16:385. [PMID: 27931203 PMCID: PMC5146850 DOI: 10.1186/s12884-016-1179-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/04/2016] [Indexed: 11/18/2022] Open
Abstract
Background This research determined the rates of perinatal mortality among infants delivered under Ghana’s national health insurance scheme (NHIS) compared to infants delivered under the previous “Cash and Carry” system in Northern Region, especially as the country takes stock of its progress toward meeting the Millennium Development Goals (MDG) 4 and 5. Methods The labor and maternity wards delivery records of infants delivered before and after the implementation of the NHIS in Northern Region were examined. Records of available daily deliveries during the two health systems were extracted. Fisher’s exact tests of non-random association were used to examine the bivariate association between categorical independent variables and perinatal mortality. Results On average, 8% of infants delivered during the health user-fee (Cash & Carry) died compared to about 4% infant deaths during the NHIS delivery fee exemption period in Northern Region, Ghana. There were no remarkable difference in the rate of infant deaths among mothers in almost all age categories in both the Cash and Carry and the NHIS periods except in mothers age 35 years and older. Infants born to multiparous mothers were significantly more likely to die than those born to first time mothers. There were more twin deaths during the Cash and Carry system (p = 0.001) compared to the NHIS system. Deliveries by caesarean section increased from an average of 14% in the “Cash and Carry” era to an average of 20% in the NHIS era. Conclusion The overall rate of perinatal mortality declined by half (50%) in infants born during the NHIS era compared to the Cash and Carry era. However, caesarean deliveries increased during the NHIS era. These findings suggest that pregnant women in the Northern Region of Ghana were able to access the opportunity to utilize the NHIS for antenatal visits and possibly utilized skilled care at delivery at no cost or very minimal cost to them, which therefore improved Ghana’s progress towards meeting the MDG 4, (reducing under-five deaths by two-thirds).
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Affiliation(s)
| | - Ernest T Maya
- School of Public Health, University of Ghana, Accra, Ghana.
| | | | - Irene A Agyepong
- Ghana Health Service, Dodowa Health Research Center, Dodowa, Ghana
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Kujala S, Waiswa P, Kadobera D, Akuze J, Pariyo G, Hanson C. Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982-2011): a cross-sectional, population-based study. Trop Med Int Health 2016; 22:63-73. [PMID: 27910181 DOI: 10.1111/tmi.12807] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To identify mortality trends and risk factors associated with stillbirths and neonatal deaths 1982-2011. METHODS Population-based cross-sectional study based on reported pregnancy history in Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda. A pregnancy history survey was conducted among women aged 15-49 years living in the HDSS during May-July 2011 (n = 10 540). Time trends were analysed with cubic splines and linear regression. Potential risk factors were examined with multilevel logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS 34 073 births from 1982 to 2011 were analysed. The annual rate of decrease was 0.9% for stillbirths and 1.8% for neonatal mortality. Stillbirths were associated with several risk factors: multiple births (AOR 2.57, CI 1.66-3.99), previous adverse outcome (AOR 6.16, CI 4.26-8.88) and grand multiparity among 35- to 49-year-olds (AOR 1.97, CI 1.32-2.89). Neonatal deaths were associated with multiple births (AOR 6.16, CI 4.80-7.92) and advanced maternal age linked with parity of 1-4 (AOR 2.34, CI 1.28-4.25) and grand multiparity (AOR 1.44, CI 1.09-1.90). Education, marital status and household wealth were not associated with the outcomes. CONCLUSIONS The slow decline in mortality rates and easily identifiable risk factors calls for improving quality of care at birth and a rethinking of how to address obstetric risks, potentially a revival of the risk approach in antenatal care.
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Affiliation(s)
- Sanni Kujala
- Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden
| | - Peter Waiswa
- Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden.,Maternal and Newborn Centre of Excellence, Makerere University School of Public Health, Kampala, Uganda.,The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda
| | - Daniel Kadobera
- The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.,Mental Health Program, Clinical Services Division, Ministry of Health, Kampala, Uganda
| | - Joseph Akuze
- Maternal and Newborn Centre of Excellence, Makerere University School of Public Health, Kampala, Uganda
| | - George Pariyo
- The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.,Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Claudia Hanson
- Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden.,Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
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11
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Kayode GA, Grobbee DE, Koduah A, Amoakoh-Coleman M, Agyepong IA, Ansah E, van Dijk H, Klipstein-Grobusch K. Temporal trends in childhood mortality in Ghana: impacts and challenges of health policies and programs. Glob Health Action 2016; 9:31907. [PMID: 27558221 PMCID: PMC4996861 DOI: 10.3402/gha.v9.31907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/16/2016] [Accepted: 06/16/2016] [Indexed: 12/01/2022] Open
Abstract
Background Following the adoption of the Millennium Development Goal 4 (MDG 4) in Ghana to reduce under-five mortality by two-thirds between 1990 and 2015, efforts were made towards its attainment. However, impacts and challenges of implemented intervention programs have not been examined to inform implementation of Sustainable Development Goal 3.2 (SDG 3.2) that seeks to end preventable deaths of newborns and children aged under-five. Thus, this study aimed to compare trends in neonatal, infant, and under-five mortality over two decades and to highlight the impacts and challenges of health policies and intervention programs implemented. Design Ghana Demographic and Health Survey data (1988–2008) were analyzed using trend analysis. Poisson regression analysis was applied to quantify the incidence rate ratio of the trends. Implemented health policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify their impact and challenges. Results Since 1988, the annual average rate of decline in neonatal, infant, and under-five mortality in Ghana was 0.6, 1.0, and 1.2%, respectively. From 1988 to 1989, neonatal, infant, and under-five mortality declined from 48 to 33 per 1,000, 72 to 58 per 1,000, and 108 to 83 per 1,000, respectively, whereas from 1989 to 2008, neonatal mortality increased by 2 per 1,000 while infant and under-five mortality further declined by 6 per 1,000 and 17 per 1,000, respectively. However, the observed declines were not statistically significant except for under-five mortality; thus, the proportion of infant and under-five mortality attributed to neonatal death has increased. Most intervention programs implemented to address childhood mortality seem not to have been implemented comprehensively. Conclusion Progress towards attaining MDG 4 in Ghana was below the targeted rate, particularly for neonatal mortality as most health policies and programs targeted infant and under-five mortality. Implementing neonatal-specific interventions and improving existing programs will be essential to attain SDG 3.2 in Ghana and beyond.
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Affiliation(s)
- Gbenga A Kayode
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands;
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Augustina Koduah
- Ministry of Health, Accra, Ghana.,Social Science Group, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Mary Amoakoh-Coleman
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.,School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Irene A Agyepong
- School of Public Health, University of Ghana, Legon, Accra, Ghana.,Ghana Health Service, Greater Accra Region, Accra, Ghana
| | - Evelyn Ansah
- Ghana Health Service, Greater Accra Region, Accra, Ghana
| | - Han van Dijk
- Social Science Group, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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12
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Sankar MJ, Natarajan CK, Das RR, Agarwal R, Chandrasekaran A, Paul VK. When do newborns die? A systematic review of timing of overall and cause-specific neonatal deaths in developing countries. J Perinatol 2016; 36 Suppl 1:S1-S11. [PMID: 27109087 PMCID: PMC4848744 DOI: 10.1038/jp.2016.27] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 12/13/2022]
Abstract
About 99% of neonatal deaths occur in low- and middle-income countries. There is a paucity of information on the exact timing of neonatal deaths in these settings. The objective of this review was to determine the timing of overall and cause-specific neonatal deaths in developing country settings. We searched MEDLINE via PubMed, Cochrane CENTRAL, WHOLIS and CABI using sensitive search strategies. Searches were limited to studies involving humans published in the last 10 years. A total of 22 studies were included in the review. Pooled results indicate that about 62% of the total neonatal deaths occurred during the first 3 days of life; the first day alone accounted for two-thirds. Almost all asphyxia-related and the majority of prematurity- and malformation-related deaths occurred in the first week of life (98%, 83% and 78%, respectively). Only one-half of sepsis-related deaths occurred in the first week while one-quarter occurred in each of the second and third to fourth weeks of life. The distribution of both overall and cause-specific mortality did not differ greatly between Asia and Africa. The first 3 days after birth account for about 30% of under-five child deaths. The first week of life accounts for most of asphyxia-, prematurity- and malformation-related mortality and one-half of sepsis-related deaths.
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Affiliation(s)
- M J Sankar
- Newborn Health Knowledge Centre (NHKC), ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - C K Natarajan
- Newborn Health Knowledge Centre (NHKC), ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - R R Das
- Newborn Health Knowledge Centre (NHKC), ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - R Agarwal
- Newborn Health Knowledge Centre (NHKC), ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - A Chandrasekaran
- Newborn Health Knowledge Centre (NHKC), ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - V K Paul
- Newborn Health Knowledge Centre (NHKC), ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India,Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. E-mail:
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Knowledge and Perceptions about Clinical Trials and the Use of Biomedical Samples: Findings from a Qualitative Study in Rural Northern Ghana. PLoS One 2016; 11:e0152854. [PMID: 27035916 PMCID: PMC4817990 DOI: 10.1371/journal.pone.0152854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 03/21/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Clinical trials conducted in sub-Saharan Africa have helped to address the prevalent health challenges. The knowledge about how communities perceive clinical trials is however only now evolving. This study was conducted among parents whose children participated in past clinical trials in northern Ghana to assess their knowledge and perceptions of clinical trials and the use of biomedical samples. Method This was a qualitative study based on eighty in-depth interviews with parents. The participants were randomly selected from among parents whose children were enrolled in a clinical trial conducted in the Kassena-Nankana districts between 2000 and 2003. The interviews were transcribed and coded into emergent themes using Nvivo 9 software. The thematic analysis framework was used to analyze the data. Results Study participants reported that clinical trials were carried out to determine the efficacy of drugs and to make sure that these drugs were suitable for human beings to use. The conduct of clinical trials was perceived to have helped to reduce the occurrence of diseases such as malaria, cerebrospinal meningitis and diarrhea. Quality of care was reported to be better in clinical trials than in the routine care. Parents indicated that participation in clinical trials positively influenced their health-seeking behavior. Apprehensions about blood draw and the use to which samples were put were expressed, with suspicion by a few participants that researchers sold blood samples. The issue of blood draw was most contentious. Conclusion Parents perception about the conduct of clinical trials in the study districts is generally positive. However, misconceptions made about the use of blood samples in this study must be taken seriously and strategies found to improve transparency and greater community acceptability.
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Awoonor-Williams JK, Phillips JF, Bawah AA. Catalyzing the scale-up of community-based primary healthcare in a rural impoverished region of northern Ghana. Int J Health Plann Manage 2015; 31:e273-e289. [PMID: 26189569 DOI: 10.1002/hpm.2304] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
Ghana's Community-based Health Planning and Services (CHPS) initiative develops accessible healthcare with participatory community support, using strategies developed and tested by a project of the Navrongo Health Research Centre. In 1996, the project was expanded to a district-wide four-celled trial. In response to evidence that strategies could reduce fertility and childhood mortality, a replication project was launched to develop methods for scale-up. Based on experience gained, CHPS scale-up was launched in 2000. Although CHPS now reaches all of Ghana's districts, the pace of scale-up within districts has been slow. In response, the Ministry of Health conducted a review of factors that constrain CHPS scale-up and problems that detract from its original evidence-based design. To resolve problems that were identified, a project was launched in 2010 to test means of accelerating CHPS scale-up and expand its range of care. Known as the Ghana Essential Health Interventions Program (GEHIP), the project provided catalytic revenue to four treatment district managers for 3 years, in conjunction with implementation of strategies for comprehensive leadership development and community partnership. Monitoring systems were developed to gauge CHPS coverage time trends in all nine study districts. GEHIP successfully accelerated CHPS implementation, producing 100% of its targeted community coverage within 5 years of implementation. Coverage in comparison districts also improved. However, the rate of coverage and per cent of the population reached by CHPS in comparison districts was only half that of GEHIP districts. GEHIP success in completing CHPS coverage represents the initial stage of a national program for strengthening community health systems in Ghana. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- John Koku Awoonor-Williams
- Ghana Health Service PMB, Bolgatanga, Upper East Region, Ghana.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Peterplatz 4003, Basel, Switzerland
| | - James F Phillips
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Ayaga A Bawah
- Mailman School of Public Health, Columbia University, New York, New York, USA
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Okawa S, Ansah EK, Nanishi K, Enuameh Y, Shibanuma A, Kikuchi K, Yasuoka J, Gyapong M, Owusu-Agyei S, Oduro AR, Asare GQ, Hodgson A, Jimba M. High Incidence of Neonatal Danger Signs and Its Implications for Postnatal Care in Ghana: A Cross-Sectional Study. PLoS One 2015; 10:e0130712. [PMID: 26091424 PMCID: PMC4474560 DOI: 10.1371/journal.pone.0130712] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/22/2015] [Indexed: 11/24/2022] Open
Abstract
Background Reducing neonatal mortality is a major public health priority in sub-Saharan Africa. Numerous studies have examined the determinants of neonatal mortality, but few have explored neonatal danger signs which potentially cause morbidity. This study assessed danger signs observed in neonates at birth, determined the correlations of multiple danger signs and complications between neonates and their mothers, and identified factors associated with neonatal danger signs. Methods A cross-sectional study was conducted in three sites across Ghana between July and September in 2013. Using two-stage random sampling, we recruited 1,500 pairs of neonates and their mothers who had given birth within the preceding two years. We collected data on their socio-demographic characteristics, utilization of maternal and neonatal health services, and experiences with neonatal danger signs and maternal complications. We calculated the correlations of multiple danger signs and complications between neonates and their mothers, and performed multiple logistic regression analysis to identify factors associated with neonatal danger signs. Results More than 25% of the neonates were born with danger signs. At-birth danger signs in neonates were correlated with maternal delivery complications (r = 0.20, p < 0.001), and neonatal complications within the first six weeks of life (r = 0.19, p < 0.001). However, only 29.1% of neonates with danger signs received postnatal care in the first two days, and 52.4% at two weeks of life. In addition to maternal complications during delivery, maternal age less than 20 years, maternal education level lower than secondary school, and fewer than four antenatal care visits significantly predicted neonatal danger signs. Conclusions Over a quarter of neonates are born with danger signs. Maternal factors can be used to predict neonatal health condition at birth. Management of maternal health and close medical attention to high-risk neonates are crucial to reduce neonatal morbidity in Ghana.
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Affiliation(s)
- Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Keiko Nanishi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yeetey Enuameh
- Kintampo Health Research Centre, Kintampo, Brong-Ahafo, Ghana
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kimiyo Kikuchi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
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Lambon-Quayefio MP, Owoo NS. Examining the influence of antenatal care visits and skilled delivery on neonatal deaths in Ghana. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:511-522. [PMID: 24934923 DOI: 10.1007/s40258-014-0103-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Many Sub-Saharan African countries may not achieve the Millennium Development goal of reducing child mortality by 2015 partly due to the stalled reduction in neonatal deaths, which constitute about 60% of infant deaths. Although many studies have emphasized the importance of accessible maternal healthcare as a means of reducing maternal and child mortality, very few of these studies have explored the affordability and accessibility concerns of maternal healthcare on neonatal mortality. OBJECTIVE This study bridges this research gap as it aims to investigate whether the number of antenatal visits and skilled delivery are associated with the risk of neonatal deaths in Ghana. METHODS Using individual level data of women in their reproductive years from the 2008 Demographic and Health Survey, the study employs an instrumental variable strategy to deal with the potential endogeneity of antenatal care visits. RESULTS Estimates from the instrumental variable estimation show that antenatal care visits reduce the risk of neonatal death by about 2%, while older women have an approximately 0.2% higher risk of losing their neonates than do younger women. CONCLUSION Findings suggest that women who attend antenatal visits have a significantly lower probability of losing their babies in the first month of life. Further, results show that women's age significantly affects the risk of losing their babies in the neonatal stage. However, the study finds no significant effect of skilled delivery and education on neonatal mortality.
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Kayode GA, Ansah E, Agyepong IA, Amoakoh-Coleman M, Grobbee DE, Klipstein-Grobusch K. Individual and community determinants of neonatal mortality in Ghana: a multilevel analysis. BMC Pregnancy Childbirth 2014; 14:165. [PMID: 24884759 PMCID: PMC4036104 DOI: 10.1186/1471-2393-14-165] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 04/24/2014] [Indexed: 11/19/2022] Open
Abstract
Background Neonatal mortality is a global challenge; identification of individual and community determinants associated with it are important for targeted interventions. However in most low and middle income countries (LMICs) including Ghana this problem has not been adequately investigated as the impact of contextual factors remains undetermined despite their significant influence on under-five mortality and morbidity. Methods Based on a modified conceptual framework for child survival, hierarchical modelling was deployed to examine about 6,900 women, aged 15 – 49 years (level 1), nested within 412 communities (level 2) in Ghana by analysing combined data of the 2003 and 2008 Ghana Demographic and Health Survey. The aim was to identify individual (maternal, paternal, neonatal, antenatal, delivery and postnatal) and community (socioeconomic disadvantage communities) determinants associated with neonatal mortality. Results The results showed both individual and community characteristics to be associated with neonatal mortality. Infants of multiple-gestation [OR 5.30; P-value < 0.001; 95% CI 2.81 – 10.00], neonates with inadequate birth spacing [OR 3.47; P-value < 0.01; 95% CI 1.60 – 7.57] and low birth weight [OR 2.01; P-value < 0.01; 95% CI 1.23 – 3.30] had a lower chance of surviving the neonatal period. Similarly, infants of grand multiparous mothers [OR 2.59; P-value < 0.05; 95% CI 1.03 – 6.49] and non-breastfed infants [OR 142.31; P-value < 0.001; 95% CI 80.19 – 252.54] were more likely to die during neonatal life, whereas adequate utilization of antenatal, delivery and postnatal health services [OR 0.25; P-value < 0.001; 95% CI 0.13 – 0.46] reduced the likelihood of neonatal mortality. Dwelling in a neighbourhood with high socioeconomic deprivation was associated with increased neonatal mortality [OR 3.38; P-value < 0.01; 95% CI 1.42 – 8.04]. Conclusion Both individual and community characteristics show a marked impact on neonatal survival. Implementation of community-based interventions addressing basic education, poverty alleviation, women empowerment and infrastructural development and an increased focus on the continuum-of-care approach in healthcare service will improve neonatal survival.
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Affiliation(s)
- Gbenga A Kayode
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, P,O, Box 85500, Utrecht, GA 3508, The Netherlands.
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Brantuo MNA, Cristofalo E, Meheš MM, Ameh J, Brako NO, Boahene F, Adjei SB, Opoku E, Banda H, Wang YT, Forgor AA, Punguire D, Brightson K, Sottie C, Owusu-Agyei S, Williams JE, Sulemana A, Oduro AR, Gyampong M, Sarpong D, Andrews E, Gyansa-Lutterodt M, Hodgson A, Bannerman C, Abdullah F. Evidence-based training and mentorship combined with enhanced outcomes surveillance to address the leading causes of neonatal mortality at the district hospital level in Ghana. Trop Med Int Health 2014; 19:417-26. [PMID: 24495284 DOI: 10.1111/tmi.12270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the impact of a district hospital intervention focused on enhancing healthcare provider capacity to address leading causes of neonatal death: birth asphyxia, infection and prematurity. METHODS The neonatal quality improvement initiative was launched at two intervention referral district hospitals in Ghana. Local Health and Demographic Surveillance Systems were enlisted to enhance recording of neonatal and infant deaths in the community and at the facility. After baseline site assessments, a team of local paediatric experts conducted three clinical trainings on-site at each intervention hospital. Assessments were conducted to evaluate participant knowledge before and after participation in training modules. Monthly mentorship visits provided additional training to support the adoption of essential early neonatal care practices. RESULTS In the first year of implementation, the initiative provided focused clinical training to 278 participants. A comparison of pre- and post-training test results demonstrates significant improvement in provider knowledge (73% vs. 89% correct, P < 0.001), with even greater improvement among trainees receiving recurrent refresher training (86% vs. 94% correct, P < 0.001). Participant feedback following training revealed enthusiasm about the programme and improved confidence. CONCLUSIONS Locally led initiatives that invest directly in healthcare provider education and health systems strengthening represent a promising avenue for reducing neonatal morbidity and mortality. The NQI initiative demonstrates the positive impact of a district hospital intervention that combines on-site training, mentorship and enhanced demographic surveillance.
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Awoonor-Williams JK, Sory EK, Nyonator FK, Phillips JF, Wang C, Schmitt ML. Lessons learned from scaling up a community-based health program in the Upper East Region of northern Ghana. GLOBAL HEALTH: SCIENCE AND PRACTICE 2013; 1:117-33. [PMID: 25276522 PMCID: PMC4168550 DOI: 10.9745/ghsp-d-12-00012] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/08/2013] [Indexed: 11/18/2022]
Abstract
The original CHPS model deployed nurses to the community and engaged local leaders, reducing child mortality and fertility substantially. Key scaling-up lessons: (1) place nurses in home districts but not home villages, (2) adapt uniquely to each district, (3) mobilize local resources, (4) develop a shared project vision, and (5) conduct “exchanges” so that staff who are initiating operations can observe the model working in another setting, pilot the approach locally, and expand based on lessons learned. Ghana's Community-Based Health Planning and Service (CHPS) initiative is envisioned to be a national program to relocate primary health care services from subdistrict health centers to convenient community locations. The initiative was launched in 4 phases. First, it was piloted in 3 villages to develop appropriate strategies. Second, the approach was tested in a factorial trial, which showed that community-based care could reduce childhood mortality by half in only 3 years. Then, a replication experiment was launched to clarify appropriate activities for implementing the fourth and final phase—national scale up. This paper discusses CHPS progress in the Upper East Region (UER) of Ghana, where the pace of scale up has been much more rapid than in the other 9 regions of the country despite exceedingly challenging economic, ecological, and social circumstances. The UER employed 5 strategies that facilitated scale up: (1) nurse recruitment from their home districts to improve worker morale and cultural grounding, balanced with some social distance from the village community to ensure client confidentiality, particularly regarding family planning use; (2) prioritization of CHPS planning and continuous review in management meetings to make necessary modifications to the initiative's approach; (3) community engagement and advocacy to local politicians to mobilize resources for financing start-up costs; (4) a shared and consistent vision about CHPS among health administration leaders to ensure appropriate resources and commitment to the initiative; and (5) knowledge exchange visits between new and advanced CHPS implementers to facilitate learning and scale up within and between districts.
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Affiliation(s)
| | | | | | - James F Phillips
- Columbia University, Mailman School of Public Health , New York City, New York , USA
| | - Chen Wang
- Columbia University, Mailman School of Public Health , New York City, New York , USA
| | - Margaret L Schmitt
- Columbia University, Mailman School of Public Health , New York City, New York , USA
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Why are babies dying in the first month after birth? A 7-year study of neonatal mortality in northern Ghana. PLoS One 2013; 8:e58924. [PMID: 23527050 PMCID: PMC3602544 DOI: 10.1371/journal.pone.0058924] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/08/2013] [Indexed: 12/04/2022] Open
Abstract
Objectives To determine the neonatal mortality rate in the Kassena-Nankana District (KND) of northern Ghana, and to identify the leading causes and timing of neonatal deaths. Methods The KND falls within the Navrongo Health Research Centre’s Health and Demographic Surveillance System (HDSS), which uses trained field workers to gather and update health and demographic information from community members every four months. We utilized HDSS data from 2003–2009 to examine patterns of neonatal mortality. Results A total of 17,751 live births between January 2003 and December 2009 were recorded, including 424 neonatal deaths 64.8%(275) of neonatal deaths occurred in the first week of life. The overall neonatal mortality rate was 24 per 1000 live births (95%CI 22 to 26) and early neonatal mortality rate was 16 per 1000 live births (95% CI 14 to 17). Neonatal mortality rates decreased over the period from 26 per 1000 live births in 2003 to 19 per 1000 live births in 2009. In all, 32%(137) of the neonatal deaths were from infections, 21%(88) from birth injury and asphyxia and 18%(76) from prematurity, making these three the leading causes of neonatal deaths in the area. Birth injury and asphyxia (31%) and prematurity (26%) were the leading causes of early neonatal deaths, while infection accounted for 59% of late neonatal deaths. Nearly 46% of all neonatal deaths occurred during the first three postnatal days. In multivariate analysis, multiple births, gestational age <32 weeks and first pregnancies conferred the highest odds of neonatal deaths. Conclusions Neonatal mortality rates are declining in rural northern Ghana, with majority of deaths occurring within the first week of life. This has major policy, programmatic and research implications. Further research is needed to better understand the social, cultural, and logistical factors that drive high mortality in the early days following delivery.
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Azongo DK, Awine T, Wak G, Binka FN, Oduro AR. A time series analysis of weather variability and all-cause mortality in the Kasena-Nankana Districts of Northern Ghana, 1995-2010. Glob Health Action 2012. [PMID: 23195508 PMCID: PMC3508691 DOI: 10.3402/gha.v5i0.19073] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Climate and weather variability can have significant health consequences of increased morbidity and mortality. However, today the impact of climate and weather variability, and consequentially, of climate change on population health in sub-Saharan Africa is not well understood. In this study, we assessed the association of daily temperature and precipitation with daily mortality by age and sex groups in Northern Ghana. Methods We analysed daily mortality and weather data from 1995 to 2010. We adopted a time-series Poisson regression approach to examine the short-term association of daily mean temperature and daily mean precipitation with daily mortality. We included time factors and daily lagged weather predictors. The correlation between lagged weather predictors was also considered. Results For all populations, a statistically significant association of mean daily temperature with mortality at lag days 0–1 was observed below and above the 25th (27.48°C) and 75th (30.68°C) percentiles (0.19%; 95% confidence interval CI: 0.05%, 0.21%) and (1.14%; 95% CI: 0.12%, 1.54%), respectively. We also observed a statistically significant association of mean daily temperature above 75th percentile at lag days 2–6 and lag days 7–13 (0.32%; 95% CI: 0.16%, 0.25%) and (0.31% 95% CI: 0.14%, 0.26%), respectively. A 10 mm increase
in precipitation was significantly associated with a 1.71% (95% CI: 0.10%, 3.34.9%) increase in mortality for all ages and sex groups at lag days 2–6. Similar results were also observed at lag days 2–6 and 14–27 for males, 2.92% (95% CI: 0.80%, 5.09%) and 2.35% (95% CI: 0.28%, 4.45%). Conclusion Short-term weather variability is strongly associated with mortality in Northern Ghana. The associations appear to differ among different age and sex groups. The elderly and young children were found to be more susceptible to short-term temperature-related mortality. The association of precipitation with mortality is more pronounced at the short-term for all age and sex groups and in the medium short-term among males. Reducing exposure to extreme temperature, particularly among the elderly and young children, should reduce the number of daily deaths attributable to weather-related mortality.
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Affiliation(s)
- Daniel K Azongo
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.
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Mehta U, Clerk C, Allen E, Yore M, Sevene E, Singlovic J, Petzold M, Mangiaterra V, Elefant E, Sullivan FM, Holmes LB, Gomes M. Protocol for a drugs exposure pregnancy registry for implementation in resource-limited settings. BMC Pregnancy Childbirth 2012; 12:89. [PMID: 22943425 PMCID: PMC3500715 DOI: 10.1186/1471-2393-12-89] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The absence of robust evidence of safety of medicines in pregnancy, particularly those for major diseases provided by public health programmes in developing countries, has resulted in cautious recommendations on their use. We describe a protocol for a Pregnancy Registry adapted to resource-limited settings aimed at providing evidence on the safety of medicines in pregnancy. METHODS/DESIGN Sentinel health facilities are chosen where women come for prenatal care and are likely to come for delivery. Staff capacity is improved to provide better care during the pregnancy, to identify visible birth defects at delivery and refer infants with major anomalies for surgical or clinical evaluation and treatment. Consenting women are enrolled at their first antenatal visit and careful medical, obstetric and drug-exposure histories taken; medical record linkage is encouraged. Enrolled women are followed up prospectively and their histories are updated at each subsequent visit. The enrolled woman is encouraged to deliver at the facility, where she and her baby can be assessed. DISCUSSION In addition to data pooling into a common WHO database, the WHO Pregnancy Registry has three important features: First is the inclusion of pregnant women coming for antenatal care, enabling comparison of birth outcomes of women who have been exposed to a medicine with those who have not. Second is its applicability to resource-poor settings regardless of drug or disease. Third is improvement of reproductive health care during pregnancies and at delivery. Facility delivery enables better health outcomes, timely evaluation and management of the newborn, and the collection of reliable clinical data. The Registry aims to improves maternal and neonatal care and also provide much needed information on the safety of medicines in pregnancy.
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Affiliation(s)
- Ushma Mehta
- Independent Pharmacovigilance Consultant, Cape Town, Kenilworth 7708, South Africa
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Causes of community stillbirths and early neonatal deaths in low-income countries using verbal autopsy: an International, Multicenter Study. J Perinatol 2012; 32:585-92. [PMID: 22076413 PMCID: PMC3922534 DOI: 10.1038/jp.2011.154] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Six million stillbirths (SB) and early neonatal deaths (END) occur annually worldwide, mostly in rural settings distant from health facilities. We used verbal autopsy (VA), to understand causes of non-hospital, community-based SB and END from four low-income countries. STUDY DESIGN This prospective observational study utilized the train-the-trainer method. VA interviewers conducted standardized interviews; in each country data were reviewed by two local physicians who assigned an underlying causes of deaths (COD). RESULT There were 252 perinatal deaths (118 END; 134 SB) studied from pooled data. Almost half (45%) the END occurred on postnatal day 1, 19% on the second day and 16% the third day. Major early neonatal COD were infections (49%), birth asphyxia (26%), prematurity (17%) and congenital malformations (3%). Major causes of SB were infection (37%), prolonged labor (11%), antepartum hemorrhage (10%), preterm delivery (7%), cord complications (6%) and accidents (5%). CONCLUSION Many of these SB and END were from easily preventable causes. Over 80% of END occurred during the first 3 days of postnatal life, and >90% were due to infection, birth asphyxia and prematurity. The causes of SB were more varied, and maternal infections were the most common cause. Increased attention should be targeting at interventions that reduce maternal and neonatal infections and prevent END, particularly during the first 3 days of life.
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Moyer CA, Aborigo RA, Logonia G, Affah G, Rominski S, Adongo PB, Williams J, Hodgson A, Engmann C. Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs. BMC Pregnancy Childbirth 2012; 12:50. [PMID: 22703032 PMCID: PMC3482570 DOI: 10.1186/1471-2393-12-50] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 05/23/2012] [Indexed: 11/10/2022] Open
Abstract
Background Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness. Methods In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0. Results 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or “red earth sand.” Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill. Conclusions This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the disconnect between healthcare providers and the community, and the critical role grandmothers play in ensuring clean delivery practices. Future interventions to address clean delivery and prevention of neonatal infections include educating healthcare providers about harmful traditional practices so they are specifically addressed, strengthening facilities, and incorporating influential community members such as grandmothers to ensure success.
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Affiliation(s)
- Cheryl A Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, 48104, USA.
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Engmann C, Walega P, Aborigo RA, Adongo P, Moyer CA, Lavasani L, Williams J, Bose C, Binka F, Hodgson A. Stillbirths and early neonatal mortality in rural Northern Ghana. Trop Med Int Health 2011; 17:272-82. [PMID: 22175764 DOI: 10.1111/j.1365-3156.2011.02931.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To calculate perinatal mortality (stillbirth and early neonatal death: END) rates in the Upper East region of Ghana and characterize community-based stillbirths and END in terms of timing, cause of death, and maternal and infant risk factors. METHODS Birth outcomes were obtained from the Navrongo Health and Demographic Surveillance System over a 7-year period. RESULTS Twenty thousand four hundred and ninty seven pregnant women were registered in the study. The perinatal mortality rate was 39 deaths/1000 deliveries, stillbirth rate 23/1000 deliveries and END rates 16/1000 live births. Most stillbirths were 31 weeks gestation or less. Prematurity, first-time delivery and multiple gestation all significantly increased the odds of perinatal death. Approximately 70% of END occurred during the first 3 postnatal days, and the most common causes of death were birth asphyxia and injury, infections and prematurity. CONCLUSION Stillbirths and END remain a significant problem in Navrongo. The main causes of END occur during the first 3 days and may be modifiable with simple targeted perinatal policies.
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Affiliation(s)
- Cyril Engmann
- Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC 27599-7596, USA.
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Outwater AH, Mgaya E, Campbell JC, Becker S, Kinabo L, Menick DM. Homicide of children in Dar es Salaam, Tanzania. EAST AFRICAN JOURNAL OF PUBLIC HEALTH 2010; 7:345-9. [PMID: 22066333 PMCID: PMC4164234 DOI: 10.4314/eajph.v7i4.64758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although data are sparse, it has been estimated that the highest rates of homicide death amongst children are in Africa. Little information is available on ages 0-14 years. No known quantitative surveillance of early neonaticide (killed at less than one week) has been conducted previously in Africa. METHODS A Violent Death Survey following WHO/CDC Guidelines was completed in Dar es Salaam region, Tanzania (population 2.845 million) in 2005. Qualitative and quantitative data were gathered and analyzed. RESULTS The overall age adjusted rate of discarded and killed children in DSM was 2.05 per 100,000. The rate of early neonaticide was 27.7 per 100,000 while the rate of homicide incidence for children older than one week was 0.54 per 100,000 DISCUSSION The overall estimated homicide rate for Africa of children under age 15 was 4.53 per 100,000. The rate in DSM was closer to the estimated global rate of 1.7 per 100,000. The results in DSM show that broad age groupings such as "< 1 year", "0-4 years" and "0-14 years" may mask a high incidence of neonaticide and an otherwise low incidence of murdered children. The print media provided good in-depth coverage for a few cases but it is not known if the reported cases are representative. CONCLUSION Eighty percent of homicides of children in DSM were neonaticides. Since it is believed that the forces behind neonaticide are fundamentally different than homicides of older children, it is suggested that data of future surveys be parsed to include neonates, until the phenomenon is more clearly understood and addressed. Further understanding of the mother and father of the deceased is needed. Continued surveillance data collection is important to expand the sample size.
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Affiliation(s)
- Anne H Outwater
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tazania.
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Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S. 3.6 million neonatal deaths--what is progressing and what is not? Semin Perinatol 2010; 34:371-86. [PMID: 21094412 DOI: 10.1053/j.semperi.2010.09.011] [Citation(s) in RCA: 300] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Each year 3.6 million infants are estimated to die in the first 4 weeks of life (neonatal period)--but the majority continue to die at home, uncounted. This article reviews progress for newborn health globally, with a focus on the countries in which most deaths occur--what data do we have to guide accelerated efforts? All regions are advancing, but the level of decrease in neonatal mortality differs by region, country, and within countries. Progress also differs by the main causes of neonatal death. Three major causes of neonatal deaths (infections, complications of preterm birth, and intrapartum-related neonatal deaths or "birth asphyxia") account for more than 80% of all neonatal deaths globally. The most rapid reductions have been made in reducing neonatal tetanus, and there has been apparent progress towards reducing neonatal infections. Limited, if any, reduction has been made in reducing global deaths from preterm birth and for intrapartum-related neonatal deaths. High-impact, feasible interventions to address these 3 causes are summarized in this article, along with estimates of potential for lives saved. A major gap is reaching mothers and babies at birth and in the early postnatal period. There are promising community-based service delivery models that have been tested mainly in research studies in Asia that are now being adapted and evaluated at scale and also being tested through a network of African implementation research trials. To meet Millennium Development Goal 4, more can and must be done to address neonatal deaths. A critical step is improving the quantity, quality and use of data to select and implement the most effective interventions and strengthen existing programs, especially at district level.
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Affiliation(s)
- Joy E Lawn
- Saving Newborn Lives/Save the Children-US, Cape Town, South Africa.
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Educational impact of a hospital-based neonatal resuscitation program in Ghana. Resuscitation 2010; 81:1180-2. [PMID: 20599314 DOI: 10.1016/j.resuscitation.2010.04.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 04/05/2010] [Accepted: 04/29/2010] [Indexed: 11/21/2022]
Abstract
AIM OF THE STUDY To assess midwives' baseline cognitive knowledge of evidence-based neonatal resuscitation practices, and short- and long-term educational effects of teaching a neonatal resuscitation program in a hospital setting in West Africa. METHODS All midwives (n=14) on the labor ward at Ridge Hospital in Ghana were trained using materials modified from the American Academy of Pediatrics (AAP) Neonatal Resuscitation Program (NRP). This training program included didactic and practical teaching and was assessed by direct observation within delivery rooms and written pre- and post-test evaluations. Written and practical modules 9-12 months after the initial training session were also conducted to assess retention of NRP knowledge and skills. RESULTS Fourteen midwives received NRP training on the labor ward. Both written and practical evaluation of neonatal resuscitation skills increased after training. The percentage of items answered correctly on the written examination increased from 56% pre-training to 71% post-training (p<0.01). The percentage of items performed correctly on the practical evaluation of skills increased from 58% pre-training to 81% (p<0.01). These results were sustained 9-12 months after the initial training session. CONCLUSION After receiving NRP training, neonatal resuscitation knowledge and skills increased among midwives in a hospital in West Africa and were sustained over a 9-month period. This finding demonstrates the sustained effectiveness of a modified neonatal resuscitation training program in a resource constrained setting.
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Denham AR, Adongo PB, Freydberg N, Hodgson A. Chasing spirits: Clarifying the spirit child phenomenon and infanticide in Northern Ghana. Soc Sci Med 2010; 71:608-615. [PMID: 20605304 DOI: 10.1016/j.socscimed.2010.04.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 04/06/2010] [Accepted: 04/14/2010] [Indexed: 11/19/2022]
Abstract
In the Kassena-Nankana District of Ghana, researchers and health interventionists describe a phenomenon wherein some children are subject to infanticide because they are regarded as spirit children sent "from the bush" to cause misfortune and destroy the family. This phenomenon remains largely misunderstood and misrepresented. Based upon both ethnographic research and verbal autopsy data from 2006 to 2007 and 2009, this paper clarifies the characteristics of and circumstances surrounding the spirit child phenomenon, the role it plays within community understandings of childhood illness and mortality, and the variations present within the discourse and practice. The spirit child is a complex explanatory model closely connected to the Nankani sociocultural world and understandings surrounding causes of illness, disability, and misfortune, and is best understood within the context of the larger economic, social, and health concerns within the region. The identification of a child as a spirit child does not necessarily indicate that the child was a victim of infanticide. The spirit child best describes why a child died, rather than how the death occurred. In addition to shaping maternal and child health interventions, these findings have implications for verbal autopsy assessments and the accuracy of demographic data concerning the causes of child mortality.
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Affiliation(s)
- Aaron R Denham
- Northern Arizona University, Department of Anthropology, Flagstaff, AZ, United States.
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Lawn JE, Kerber K, Enweronu-Laryea C, Massee Bateman O. Newborn survival in low resource settings--are we delivering? BJOG 2010; 116 Suppl 1:49-59. [PMID: 19740173 DOI: 10.1111/j.1471-0528.2009.02328.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The annual toll of losses resulting from poor pregnancy outcomes include half a million maternal deaths, more than three million stillbirths, of whom at least one million die during labour and 3.8 million neonatal deaths--up to half on the first day of life. Neonatal deaths account for an increasing proportion of child deaths (now 41%) and must be reduced to achieve Millennium Development Goal (MDG) 4 for child survival. Newborn survival is also related to MDG 5 for maternal health as the interventions are closely linked. This article reviews current progress for newborn health globally, with a focus on the countries where most deaths occur. Three major causes of neonatal deaths (infections, complications of preterm birth, intrapartum-related neonatal deaths) account for almost 90% of all neonatal deaths. The highest impact interventions to address these causes of neonatal death are summarised with estimates of potential for lives saved. Two priority opportunities to address newborn deaths through existing maternal health programmes are highlighted. First, antenatal steroids are high impact, feasible and yet under-used in low resource settings. Second, with increasing investment to scale up skilled attendance and emergency obstetric care, it is important to include skills and equipment for simple immediate newborn care and neonatal resuscitation. A major gap is care during the early postnatal period for mothers and babies. There are promising models that have been tested mainly in research studies in Asia that are now being adapted and evaluated at scale including through a network of African implementation research trials.
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Affiliation(s)
- J E Lawn
- Saving Newborn Lives/Save the Children-USA, Cape Town 7405, South Africa.
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Evaluating the effectiveness of a strategy for teaching neonatal resuscitation in West Africa. Resuscitation 2009; 80:1308-11. [DOI: 10.1016/j.resuscitation.2009.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 06/29/2009] [Accepted: 08/02/2009] [Indexed: 11/22/2022]
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Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Pediatr Infect Dis J 2009; 28:S3-9. [PMID: 19106760 DOI: 10.1097/inf.0b013e3181958755] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Infections are a major contributor to newborn deaths in developing countries. Majority of these deaths occur at home without coming to medical attention. The Millennium Development Goal for child survival cannot be achieved without substantial reductions in infection-specific neonatal mortality. We describe the burden of neonatal infections in developing countries and discuss the need for community-based management approaches to improve survival from neonatal infections in these countries. METHODS We reviewed community-based studies published since 1990 from developing countries to estimate the rates of neonatal and young infant infections and infection-specific neonatal mortality. RESULTS Thirty-two studies reviewed suggest that infections may be responsible for 8% to 80% of all neonatal deaths and as many as 42% of deaths in the first week of life. Eleven reports provided data on incidence of infections in neonates and infants up to 60 days of life. Rates of neonatal sepsis were as high as 170/1000 live births (clinically diagnosed) and 5.5/1000 live births (blood culture-confirmed). CONCLUSIONS Considerable heterogeneity exists among included studies, and more accurate data and standardized methodologies are required. However, data indicate that a significant proportion of neonatal deaths in developing countries are due to infections. Current recommendations of hospitalization and parenteral therapy for managing neonatal infections are inadequately followed in developing countries. Approaches for detecting and managing serious infections within the community, at home or first-level health facilities, may be more effective options in settings where delays and reluctance to seek care, health system inefficiencies, socioeconomic and cultural, as well as logistic constraints exist.
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Clerk CA, Bruce J, Affipunguh PK, Mensah N, Hodgson A, Greenwood B, Chandramohan D. A randomized, controlled trial of intermittent preventive treatment with sulfadoxine-pyrimethamine, amodiaquine, or the combination in pregnant women in Ghana. J Infect Dis 2008; 198:1202-11. [PMID: 18752443 DOI: 10.1086/591944] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The use of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) is threatened by the spread of resistance to SP. Therefore, we studied the efficacy, safety, and tolerance of amodiaquine (AQ) or the combination of AQ and SP (SPAQ) as possible alternative treatments. METHODS The study was performed in Ghana from June 2004 through February 2007. Women were individually randomized to receive IPTp with SP (n=1328), AQ (n= 986), or SPAQ (n=1328). Incidences of anemia, peripheral anemia, and placental parasitemia at delivery were assessed for paucigravidae, as were the birth weights of their infants. Delivery outcomes and the incidence of adverse events were investigated for all women. RESULTS The prevalences of anemia (as defined by a hemoglobin concentration of <11.0 g/dL) at delivery were comparable between the SP and AQ groups and between the SP and SPAQ groups. Similarly, there was no significant difference between the SP and AQ groups or between the SP and SPAQ groups with regard to the incidences of low birth weight (LBW). Women who received AQ or SPAQ were more likely to report adverse events than were those who received SP. CONCLUSION The effects of IPTp with AQ or SPAQ on maternal anemia and LBW were comparable to the effects of IPTp with SP; however, IPTp regimens that contain AQ are unlikely to be useful as an alternative to IPTp with SP in Ghana, because of a high frequency of associated adverse events. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT00146783 .
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Rakotoseheno H, Rakotonirina E, Randriatsarafara F, Rakotonantoanina J, Randrianarimanana V, Rakotomanga J, Ranjalahy Rasolofomanana J. Consultations prénatales et mortalité périnatale à Madagascar. ACTA ACUST UNITED AC 2008; 37:505-9. [DOI: 10.1016/j.jgyn.2008.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 07/13/2007] [Accepted: 04/28/2008] [Indexed: 10/21/2022]
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Lawn JE, Osrin D, Adler A, Cousens S. Four million neonatal deaths: counting and attribution of cause of death. Paediatr Perinat Epidemiol 2008; 22:410-6. [PMID: 18782248 PMCID: PMC3428888 DOI: 10.1111/j.1365-3016.2008.00960.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Each year there are an estimated four million neonatal deaths and at least 3.2 million stillbirths. Three-quarters of the world's neonatal deaths are counted only through five-yearly retrospective household surveys. Without these surveys we would have no data, but limitations remain particularly in detecting deaths on the first day of life. Comparable reliable neonatal cause of death data through vital registration are available for less than 5% of the world's neonatal deaths, necessitating modelled estimates for the majority of the world. Improving the quantity, quality and frequency of data for numbers and causes of neonatal deaths is essential to effectively guide the increasing investments to reduce these deaths. Advancing the data requires general investment in information systems and specific improvements of tools and methods for both household surveys and verbal autopsy, particularly the use of consistent case definitions and hierarchical attribution of cause of death. An important paradigm shift is from historical categories for cause of death ('perinatal causes') to programmatic categories which are consistent with the International Classification of Diseases. If neonatal deaths remain uncounted, they cannot count in policy and in programmes.
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Affiliation(s)
- Joy E. Lawn
- Saving Newborn Lives/Save the Children-US, Cape Town
,Health Systems Research Unit, Medical Research Council, South Africa
,Centre for International Health and Development, University College London
| | - David Osrin
- Centre for International Health and Development, University College London
| | - Alma Adler
- London School of Hygiene and Tropical Medicine, London, UK
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, UK
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Edmond KM, Quigley MA, Zandoh C, Danso S, Hurt C, Owusu Agyei S, Kirkwood BR. Aetiology of stillbirths and neonatal deaths in rural Ghana: implications for health programming in developing countries. Paediatr Perinat Epidemiol 2008; 22:430-7. [PMID: 18782251 DOI: 10.1111/j.1365-3016.2008.00961.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In developing countries many stillbirths and neonatal deaths occur at home and cause of death is not recorded by national health information systems. A community-level verbal autopsy tool was used to obtain data on the aetiology of stillbirths and neonatal deaths in rural Ghana. Objectives were to describe the timing and distribution of causes of stillbirths and neonatal deaths according to site of death (health facility or home). Data were collected from 1 January 2003 to 30 June 2004; 20,317 deliveries, 696 stillbirths and 623 neonatal deaths occurred over that time. Most deaths occurred in the antepartum period (28 weeks gestation to the onset of labour) (33.0%). However, the highest risk periods were during labour and delivery (intrapartum period) and the first day of life. Infections were a major cause of death in the antepartum (10.1%) and neonatal (40.3%) periods. The most important cause of intrapartum death was obstetric complications (59.3%). There were significantly fewer neonatal deaths resulting from birth asphyxia in the home than in the health facilities and more deaths from infection. Only 59 (20.7%) mothers of neonates who died at home reported that they sought care from an appropriate health care provider (doctor, nurse or health facility) during their baby's illness. The results from this study highlight the importance of studying community-level data in developing countries and the high risk of intrapartum stillbirths and infectious diseases in the rural African mother and neonate. Community-level interventions are urgently needed, especially interventions that reduce intrapartum deaths and infection rates in the mother and infant.
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Affiliation(s)
- Karen M Edmond
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana.
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Edmond KM, Quigley MA, Zandoh C, Danso S, Hurt C, Owusu Agyei S, Kirkwood BR. Diagnostic accuracy of verbal autopsies in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana. Paediatr Perinat Epidemiol 2008; 22:417-29. [PMID: 18782250 DOI: 10.1111/j.1365-3016.2008.00962.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study evaluated the diagnostic accuracy of a verbal autopsy (VA) tool in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana and was nested within a community-based maternal vitamin A supplementation trial (ObaapaVitA trial). All stillbirths and neonatal deaths between 1 January 2003 and 30 June 2004 were prospectively included. Community VAs were carried out within 6 months of death and were classified with a primary cause of death by three experienced paediatricans. The reference standard diagnosis was obtained by the study paediatrician in 4 district hospitals in the study area. There were 20,317 deliveries, 661 stillbirths and 590 neonatal deaths with a VA diagnosis in the study population. A total of 311 stillbirths and 191 neonatal deaths had both a VA and a hospital reference standard diagnosis. The VA performed poorly for stillbirth diagnoses such as congenital abnormalities and maternal haemorrhage. Accuracy was higher for intrapartum obstetric complications and antepartum maternal disease. For neonatal deaths, sensitivity was >60% for all major causes; specificity was 76% for birth asphyxia but >85% for prematurity and infection. Overall, VA diagnostic accuracy was higher than expected in this rural African setting. Our classification system was based on the expected public health importance of the individual causes of death, differing implications for intervention and the ability to distinguish between the individual causes in low-resource settings. We believe this system was easier to use than traditional approaches and resulted in high precision and accuracy. However, further simplifications are needed to allow use of the World Health Organisation VA in routine child health programmes. The diagnostic accuracy of the VA tool should also be assessed in other regions and in multicentre studies.
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Affiliation(s)
- Karen M Edmond
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana.
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Kruk ME. Emergency preparedness and public health systems lessons for developing countries. Am J Prev Med 2008; 34:529-34. [PMID: 18471591 PMCID: PMC7135738 DOI: 10.1016/j.amepre.2008.02.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 01/23/2008] [Accepted: 02/28/2008] [Indexed: 11/17/2022]
Abstract
Low- and middle-income countries, where emerging diseases often make their debut, are also likely to bear the harshest consequences of a potential influenza pandemic. Yet public health systems in developing countries are underfunded, understaffed, and in many cases struggling to deal with the existing burden of disease. As a result, developed countries are beginning to expand assistance for emergency preparedness to the developing world. Given developing countries' weak infrastructure and many competing public health priorities, it is not clear how to best direct these resources. Evidence from the U.S. and other developed countries suggests that some investments in bioterror and pandemic emergency preparedness, although initially implemented as vertical programs, have the potential to strengthen the general public health infrastructure. This experience may hold some lessons for how global funds for emergency preparedness could be invested in developing countries to support struggling public health systems in responding to current health priorities as well as potential future public health threats.
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Affiliation(s)
- Margaret E Kruk
- University of Michigan School of Public Health, Department of Health Management and Policy, Ann Arbor, Michigan 48109, USA.
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Chandramohan D, Shibuya K, Setel P, Cairncross S, Lopez AD, Murray CJL, Zaba B, Snow RW, Binka F. Should data from demographic surveillance systems be made more widely available to researchers? PLoS Med 2008; 5:e57. [PMID: 18303944 PMCID: PMC2253613 DOI: 10.1371/journal.pmed.0050057] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND TO THE DEBATE Demographic surveillance--the process of monitoring births, deaths, causes of deaths, and migration in a population over time--is one of the cornerstones of public health research, particularly in investigating and tackling health disparities. An international network of demographic surveillance systems (DSS) now operates, mostly in sub-Saharan Africa and Asia. Thirty-eight DSS sites are coordinated by the International Network for the Continuous Demographic Evaluation of Populations and Their Health (INDEPTH). In this debate, Daniel Chandramohan and colleagues argue that DSS data in the INDEPTH database should be made available to all researchers worldwide, not just to those within the INDEPTH Network. Basia Zaba and colleagues argue that the major obstacles to DSS sites sharing data are technical, managerial, and financial rather than proprietorial concerns about analysis and publication. This debate is further discussed in this month's Editorial.
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Affiliation(s)
- Daniel Chandramohan
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Maternal mortality decline in the Kassena-Nankana district of northern Ghana. Matern Child Health J 2007; 12:577-85. [PMID: 17957459 DOI: 10.1007/s10995-007-0289-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 10/01/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In the absence of an adequate vital registration system in Ghana, the Navrongo demographic surveillance system (NDSS) established in 1993 presents a viable alternative to monitor, in a poor rural district, the UN Millennium Development Goal on maternal health (MDG) of reducing maternal mortality by 75% between 1990 and 2015. METHODS Of the 518 women aged 12-49 years identified in the NDSS database to have died in the Kassena-Nankana district in the period January 2002-December 2004, spouses or family members completed verbal autopsy interviews for 516 female deaths. RESULT Of the 516 female deaths, 45 were identified as maternal deaths. 71% of the maternal deaths were attributed to direct maternal causes while 29% were due to indirect maternal causes. Abortion-related deaths were the most frequent cause of maternal deaths. The maternal mortality ratio for the period 2002-2004 was 373 maternal deaths per 100,000 live births indicating a 40% reduction of maternal mortality from the 1995-1996 level of 637 maternal deaths per 100,000 live births. However, the health-facility based maternal mortality ratio in the district (which excludes maternal deaths outside health facilities) was 141 maternal deaths per 100,000 live births for the period 2002-2004. CONCLUSION This district may be on track to achieve the MDG on maternal health. Ultimately, strengthening vital registration systems to provide timely information to policymakers should supersede the other methods of measuring maternal mortality.
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