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The Profile, Health Seeking Behavior, Referral Patterns, and Outcome of Outborn Neonates Admitted to a District and Regional Hospital in the Upper West Region of Ghana: A Cross-Sectional Study.

ABSTRACT: Neonatal mortality is the major contributor to under-five mortality rates in many low and middle income countries. We examined the health practices, care-seeking behavior, and referral of sick outborn neonates to a district and regional hospital in the Upper West Region of Ghana. The study was a cross-sectional study conducted over an eight (8) month period in 2018. Data were obtained from caregiver interviews and case notes. Altogether, 153 outborn neonates were examined. Inappropriate practices including the use of enemas, cord care with cow dung, and herbal baths were found. Three babies treated this way died. The majority of caregivers sought care at a health facility. However, 67 (44%) sought care only after their babies were ill for ?7 days, suggesting the influence of a period of confinement on health seeking. More than half, 94 (61.4%), of the facilities visited referred patients to destination hospitals without giving any treatment. Delayed care-seeking was associated with a low birth weight, using home remedies, and a maternal age of ?30 years. Altogether, 12 neonates (7.8%) died, consisting of three males and nine females (p = 0.018). Socio-cultural factors strongly influence health seeking behavior and the health outcome of neonates in this setting. There appeared to be a limited repertoire of interventions for treating neonatal disease in primary care.

SUBMITTER: Tette EMA

PROVIDER: S-EPMC7072572 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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The Profile, Health Seeking Behavior, Referral Patterns, and Outcome of Outborn Neonates Admitted to a District and Regional Hospital in the Upper West Region of Ghana: A Cross-Sectional Study.

Tette Edem M A EMA Nuertey Benjamin Demah BD Azusong Emmanuel A EA Gandau Naa Barnabas NB

Children (Basel, Switzerland) 20200218 2

Neonatal mortality is the major contributor to under-five mortality rates in many low and middle income countries. We examined the health practices, care-seeking behavior, and referral of sick outborn neonates to a district and regional hospital in the Upper West Region of Ghana. The study was a cross-sectional study conducted over an eight (8) month period in 2018. Data were obtained from caregiver interviews and case notes. Altogether, 153 outborn neonates were examined. Inappropriate practice ...[more]

PMID: 32085390

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Project description:BackgroundThere is limited knowledge on cost of treating malaria in children under-five years in northern Ghana which poses a challenge in determining whether interventions such as the National Health Insurance Scheme (NHIS) and Community-based Health Planning and Services (CHPS) have reduced the economic burden of malaria to households or not. This study examined the malaria care seeking and cost of treatment in children under-five years in the Upper West Region of Ghana.MethodsThe study used a cross-sectional, quantitative design and data were collected between July and August 2016 in three districts in the Upper West Region of Ghana. A total of 574 women who had under-five children were interviewed. Socio-demographic characteristics of respondents, malaria seeking patterns for under-five children with malaria as well as direct medical and non-medical costs associated with treating under-five children with malaria were collected from the patient perspective. Analysis was performed using STATA 12.ResultsOut of 574 women visited, about 63% (360) had children who had malaria and sought treatment. Most treatment was done at formal health facilities such as the health centres (37%) and the CHPS (35%) while 3% had self-treatment at home. The main reason for choice of place of treatment outside home was nearness to home (53%). The average direct medical and non-medical costs associated with treating an under-five child with malaria were US$4.13 and US$3.04 respectively. The average cost on transportation alone was US$2.64. Overall, the average direct medical and non-medical cost associated with treating an under-five child with malaria was US$4.91(range: minimum = US$0.13 -maximum = US$46.75). Children who were enrolled into the NHIS paid an average amount of US$4.76 compared with US$5.88 for those not enrolled, though the difference was not statistically significant (p-value = 0.15).ConclusionsThe average cost to households in treating an under-five child with malaria was US$4.91. This amount is considerably high given the poverty level in the area. Children not insured paid a little over one US dollar for malaria treatment compared to those insured. Efforts to improve enrolment into the NHIS may be needed to reduce the cost of malaria treatment to households. Construction of more health facilities near to community members and at hard to reach areas will improve access to health care and reduce direct non-medical cost such as transportation costs.

Project description:IntroductionRespiratory distress syndrome is the major cause of neonatal death. However, data on the mortality and predictors related to respiratory distress syndrome were scarce. Hence, this study aimed to assess the incidence and predictors of death among neonates admitted with respiratory distress syndrome in West Oromia Referral Hospitals, Ethiopia, 2022.MethodsA retrospective follow-up study was conducted among 406 neonates admitted with respiratory distress syndrome at five referral hospitals from, 1 January 2019 to, 31 December 2021 in West Oromia, Ethiopia. The data were collected using a structured checklist and participants were selected using simple random sampling technique. The data were entered into Epi data version 4.6.0.2 and exported to STATA version 14 for cleaning, coding and analysis. The Kaplan-Meier curve was used to estimate survival time. The Weibull regression model was fitted to identify the predictors of mortality and variables with a P-value < 0.05 was taken as significant predictors of mortality.ResultFour hundred six neonates with respiratory distress syndrome were included in the analysis. The overall incidence of neonatal mortality was 59.87/1000 neonates-days observations (95%CI: 51.1-70.2) with a proportion of 152 (37.44%) (95% CI: 32.7-42.2). The median time of follow-up was 11 days (95% CI: 10-23). Very low birthweight (AHR = 4.5, 95%CI: 2.0-10.9) and low birth weight (AHR = 3.1, 95%CI: 1.4-6.6), perinatal asphyxia (AHR = 2.7, 95%CI: 1.8-4), Chorioamnionitis (AHR = 2.2, 95%CI: 1.4-3.5) and multiple pregnancies (AHR = 2.2, 95%CI: 1.4-3.4) increased the hazard of death, whereas, antenatal corticosteroid administration (AHR = 0.33, 95%CI: 0.2-0.7) was negatively associated with neonatal mortality.Conclusion and recommendationHigh mortality rate of neonates with respiratory distress syndrome was observed. Chorioamnionitis, perinatal asphyxia, low birth weight and multiple pregnancies increase the, mortality hazard while administering antenatal corticosteroids decreases it. Thus, administering corticosteroids- before giving birth and special emphasis on children with Chorioaminoitis, asphyxia, low birth weight and multiple pregnancies is important for reducing neonatal mortality.

Project description:Poverty, a pervasive and consequential global issue, has garnered significant attention due to its wide-reaching prevalence and profound implications. Various strategies, including microfinance, have been implemented to tackle this pressing concern. One such strategy is the Microfinance and Small Loans Centre (MASLOC) in Ghana, which aims to reduce poverty. However, despite its potential, MASLOC's role in poverty reduction has yet to be thoroughly examined, leading to inconclusive findings, and necessitating this study. A single case study design addressed this research gap and provided valuable insights. A comprehensive dataset was compiled through interviews and observations involving 40 MASLOC beneficiaries and officials. Thematic analysis was utilized to dissect the collected data, revealing noteworthy patterns and trends. The study's outcomes shed light on MASLOC's effectiveness in mitigating poverty. Specifically, it was found that MASLOC played a pivotal role in poverty reduction by bolstering income levels, amplifying consumption patterns, facilitating access to fundamental necessities, and enabling the accumulation of valuable assets. Nevertheless, the analysis also highlighted specific challenges. Issues related to loan repayment and staffing emerged as constraints within the MASLOC framework. In essence, the study established that MASLOC contributes to the overarching goal of poverty reduction. The findings are helpful because fostering a positive attitude towards loan repayment is crucial, and this endeavour should be complemented by the strategic recruitment of competent staff members who can effectively navigate the intricacies of the scheme to ensure the sustainability of MASLOC. What sets this study apart is its innovative exploration of the impact of MASLOC on poverty-a primarily overlooked facet. By delving into this uncharted territory, the study enriches the ongoing discourse surrounding government microfinance schemes' influence on its beneficiaries. This research contributes not only to the academic realm but also to the practical realm, as it offers actionable insights for policymakers in poverty reduction.

Project description:BackgroundThere is a paucity of data on the epidemiology of sepsis in outborn neonates being referred to level-3 units in low- and middle-income countries (LMIC). The objective of the present study was to evaluate the prevalence of sepsis and outcomes of outborn neonates with sepsis, and to characterize the pathogen profile and antimicrobial resistance (AMR) patterns of common isolates in them.MethodsIn this prospective observational cohort study (2011-2015), a dedicated research team enrolled all neonates admitted to an outborn level-3 neonatal unit and followed them until discharge/death. Sepsis work-up including blood culture(s) was performed upon suspicion of sepsis. All the isolates were identified and tested for antimicrobial susceptibility. Gram-negative pathogens resistant to any three of the five antibiotic classes (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam) were labeled multi-drug resistant.ResultsOf the total of 2588 neonates enrolled, culture positive sepsis and total sepsis-i.e. culture positive and/or culture negative sepsis-was diagnosed in 13.1% (95% CI 11.8% to 14.5%) and 54.7% (95% CI 52.8% to 56.6%), respectively. The case fatality rates were 23.4% and 11.0% in culture-positive and total sepsis, respectively. Sepsis accounted for two-thirds of total neonatal deaths (153/235, 63.0%). Bacterial isolates caused about three-fourths (296/401; 73.8%) of the infections. The two common pathogens-Klebsiella pneumoniae (n = 50, 12.5%) and Acinetobacter baumannii (n = 46, 11.5%)-showed high degree of multi-drug resistance (78.0% and 91.3%, respectively) and carbapenem resistance (84.0% and 91.3%, respectively). About a quarter of infections were caused by Candida spp. (n = 91; 22.7%); almost three-fourths (73.7%) of these infections occurred in neonates born at or after 32 weeks' gestation and about two-thirds (62.1%) in those weighing 1500 g or more at birth.ConclusionsIn this large outborn cohort, we report high burden of sepsis, high prevalence of systemic fungal infections, and alarming rates of antimicrobial resistance among bacterial pathogens.

Dataset Information

The Profile, Health Seeking Behavior, Referral Patterns, and Outcome of Outborn Neonates Admitted to a District and Regional Hospital in the Upper West Region of Ghana: A Cross-Sectional Study.

Publications

The Profile, Health Seeking Behavior, Referral Patterns, and Outcome of Outborn Neonates Admitted to a District and Regional Hospital in the Upper West Region of Ghana: A Cross-Sectional Study.

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