Health service delivery factors influencing neonatal mortality in health facilities in the bono region of Ghana

Abstract

Background: The neonatal period is the transitional time from intrauterine to independent existence. Deaths within this period can be further categorized as early neonatal deaths between 0 and 7 completed days of birth. Moreover, late neonatal deaths; are deaths after seven days to 28 completed days of delivery. The Bono Region of Ghana was selected as one of the only eight Regions to benefit from the MEBCI program (Making Every Child Count Initiative). Under the program, all regional districts received staff training, and various stakeholders were contacted for support. This was to reverse the trend of neonatal mortality, which is increasing annually. Identifying the factors that drive this unusual shift will help in targeted intervention. This study, therefore, seeks to establish health service delivery factors influencing neonatal mortality in the region as a lesson learned for the country. Method: The study used a mixed-method approach involving quantitative and qualitative studies. The quantitative study administered structured questionnaires to 187 health workers. The data were analyzed using STATA 14.0. Univariate and multivariate analyses were performed to establish human Resource information factors influencing neonatal mortality. Also, Chi-square analyses were performed to establish an association between referral protocols, partograph protocols and neonatal mortality. The qualitative data were obtained using a semi-structured interview guide from 16 in-charges and unit heads of newborn intensive care units in the various hospitals. The data were analyzed thematically, facilitated by manual analysis. Results: The human resource factors such as participants' district were more likely to influence neonatal mortalities in the Sunyani Municipal (AOR= 2.719, 95% CI = 0.373 – 19.845) and Berekum Municipal (AOR= 0.132, 95% CI = 0.022 – 0.782). Majority of the respondents adhered to the GHS referral guidelines, such as the availability of copies of the referral guidelines (84.0%), familiarity with referral policy (71.7%), documentation and keeping of duplicates (85.0%), booking (83.4%), a feedback mechanism (69.5%) and emergency transport system (83.4%). Also, the majority of the respondents adhered to the WHO partograph protocols such as placing guidelines on the desk (86.1%), assessing and recording moulding caput formation (88.8%), recording contraction per 10min and30mins (84.4%), recording the administration of oxytocin (84.0%), recording of drugs given (85.0%), recording of IV fluids given (85.0%), recording the temperature of mothers (87.7%) and recording the pulse of the mother (85.6%). Finally, participants mentioned leadership challenges, inadequate supervision and monitoring activities, challenges with essential resources, and non-involvement of in-charges during management meetings as institutional challenges for neonatal care. Conclusions: Adherence to referral and partograph protocols using MOH/GHS and WHO/GHS guidelines was high, respectively. However, institutional challenges such as leadership style were identified as the primary factor contributing to Neonatal Mortality. Therefore, the Ghana Health Service and its partners should change the current Leadership practices through capacity building with a focus on rural districts.