Neonatal mortality in the central districts of Ghana: analysis of community and composition factors

Predictors of neonatal mortality in the Eastern Regional Hospital in Ghana: A retrospective cohort study

Neonatal mortality accounts for nearly half of under-5 mortality in Ghana. The aim of this study was to identify the predictors of neonatal mortality in the Eastern Regional Hospital, Ghana. This was a retrospective cohort study conducted using secondary data from electronic medical records from the Eastern Regional Hospital between 1st January 2022 and 31st December 2022. The Kaplan-Meier estimator and adjusted Cox regression model were used to estimate survival probability and to assess the predictors of neonatal mortality. Data on 1684 neonates were analyzed and we found that 11.82% deaths occurred with a neonatal mortality rate (NMR) of 13.98 (95% CI: 12.05, 15.91) per 1000 person-days. Most neonatal deaths occurred within the first 24hrs of life (9.9%). The predictors of neonatal mortality were found to be low birthweight [Adjusted hazard rate (aHR): 1.63, 95% CI: 1.04, 2.54], hypothermia (aHR: 1.82, 95% CI: 1.16, 2.85), hyperthermia (aHR: 1.85, 95% CI: 1.01, 3.39), birth asphyxia (aHR: 3.69, 95% CI: 1.68, 8.11), and multiparty (aHR: 1.66, 95% CI: 1.02, 2.70). However, neonates aged 8-28 days (aHR: 0.41, 95% CI: 0.21, 0.81), born in the Eastern Regional Hospital (aHR: 0.39, 95% CI: 0.28, 0.55), walk-in neonates (aHR: 0.54, 95% CI: 0.32, 0.90), and neonates whose mothers had 8 or more antenatal contacts (aHR: 0.54, 95% CI: 0.32, 0.92) had lower neonatal mortality. There was high NMR in the Eastern Regional Hospital in Ghana. Averting complications such as low birthweight, hypothermia, hyperthermia, birth asphyxia, including the provision of obstetric and early neonatal care within the first 24 hours of life is critical to reducing neonatal mortality. Adherence to the World Health Organization's recommendation of 8 or more antenatal contacts among pregnant women is also essential in reducing neonatal mortality.

Postpartum care needs assessment: women's understanding of postpartum care, practices, barriers, and educational needs

BACKGROUND

Complications in the postpartum period pose substantial risks to women and can result in significant maternal morbidity and mortality. However, there is much less attention on postpartum care compared to pregnancy and childbirth. The goal of this study was to gather information on women's knowledge of postpartum care and complications, recovery practices after childbirth, perceived barriers to receiving care during the postpartum period, and educational needs in four health centers. The findings can inform the development of appropriate curriculum and interventions for postnatal care education in similar settings.

METHODS

A descriptive qualitative study design was employed. Eight focus group discussions were conducted among 54 postpartum women who delivered in four health centers in Sagnarigu District in Tamale, Ghana. Audio recordings of focus group data were transcribed and translated, and thematic analysis was conducted.

RESULTS

There were six main themes that emerged from the focus group discussions: 1) baby focused postpartum care; 2) postpartum practices; 3) inadequate knowledge ofpostpartum danger signs; 4) barriers to accessing postpartum care 5) experiences of poor mental health; and 6) need for postpartum education.

CONCLUSIONS

Postpartum care for women in this study was primarily perceived as care of the baby post-delivery and missing key information on physical and mental health care for the mother. This can result in poor adjustment postpartum and critically, a lack of knowledge on danger signs for common causes of morbidity and mortality in the postpartum period. Future research needs to understand how to communicate important information on postpartum mental and physical health to better protect mothers in the region.

Women's perspectives on human milk banking in Ghana: results from a cross-sectional study

Background

Although political and academic interest exists in Ghana to include human milk banks (HMB) into current maternal and child health programs, efforts to establish a HMB have not yet been subjected to any real empirical inspection with the view toward implementation. Furthermore, views toward the establishment of a HMB in Ghana have not been assessed among Ghanaian women. The aims of the current study were to examine Ghanaian women's views about HMB, and to investigate women's willingness to donate to a HMB.

Methods

Quantitative and qualitative responses were received from Ghanaian females (n = 1,270) aged 18+ years. Excluding outliers and missing data (n = 321), a final sample of 949 was retained for final analysis. Chi-square tests and logistic regression analysis were computed on quantitative data; Thematic analysis was performed on the qualitative responses.

Results

In our sample, 64.7% of respondents indicated that Ghana is ready for a HMB. The majority (77.2%) were willing to donate milk, and 69.4% believed that donating to the HMB would favor their child. The main concerns for the unwillingness to donate excess milk included: (i) the idea of HMBs as strange/bizarre (n = 47), (ii) fear of infections (n = 15), (iii) religious beliefs (n = 9), and (iv) insufficient information (n = 24). This study serves as the first step toward the development of a HMB in Ghana.

Conclusions

Overall, Ghanaian women support the building of a HMB to enhance infant nutrition and reduce childhood morbidity and mortality.

Sociodemographic characteristics and reproductive health factors associated with maternal knowledge and practice of infection prevention in neonates in North Dayi District, Ghana

Background

Neonates are at a greater risk of infection, but data on the maternal knowledge and practice of infection prevention in neonates (IPNs) are scarce. This study aimed to assess sociodemographic characteristics and reproductive health factors associated with maternal knowledge and practice of IPNs in North Dayi District, Ghana.

Methods

This was a multicenter cross-sectional study conducted among 612 mothers. A structured questionnaire was used for data collection adapted from previous studies and the IPN guidelines of the World Health Organization (WHO). Bivariable analyses were performed to determine the association between maternal knowledge and practice of IPNs and sociodemographic characteristics and reproductive health factors.

Results

Analysis showed that less than one-fifth of the mothers (12.9%) had poor knowledge of IPNs, while 21.6% incorrectly practiced it. Mothers who had poor knowledge of IPNs [adjusted odds ratio (AOR) = 13.33 (95% CI: 7.69-23.26), p < 0.001] were more likely to have a poor practice of IPNs.

Conclusion

About one-fifth of the mothers in this study had poor knowledge or poor practice of IPNs according to the WHO's guidelines. The Health Directorate of North Dayi District should explore the risk factors associated with poor IPNs and increase successful guideline adherence with intensified educational outreach and campaigns.

Sepsis among Neonates in a Ghanaian Tertiary Military Hospital: Culture Results and Turnaround Times

In this study, we described the bacterial profile, antibiotic resistance pattern, and laboratory result turnaround time (TAT) in neonates with suspected sepsis from a tertiary-level, military hospital in Accra, Ghana (2017-2020). This was a cross-sectional study using secondary data from electronic medical records. Of 471 neonates clinically diagnosed with suspected sepsis in whom blood samples were collected, the median TAT from culture request to report was three days for neonates who were culture-positive and five days for neonates who were culture-negative. There were 241 (51%) neonates discharged before the receipt of culture reports, and of them, 37 (15%) were culture-positive. Of 471 neonates, twenty-nine percent (n = 139) were bacteriologically confirmed, of whom 61% (n = 85) had late-onset sepsis. Gram-positive bacterial infection (89%, n = 124) was the most common cause of culture-positive neonatal sepsis. The most frequent Gram-positive pathogen was coagulase-negative Staphylococcus (55%, n = 68) followed by Staphylococcus aureus (36%, n = 45), of which one in two were multidrug resistant. The reasons for large numbers being discharged before the receipt of culture reports need to be further explored. There is a need for improved infection prevention and control, along with ongoing local antimicrobial resistance surveillance and antibiotic stewardship to guide future empirical treatment.