Abstract

Neonatal mortality is a significant problem in many low-resource countries, yet for every death there are many more newborns who suffer a life-threatening complication but survive. These “near-misses” are not well defined, nor are they well understood. This study sought to explore how health care providers at three tertiary care centers in Ghana (each with neonatal intensive care units (NICUs)) understand the term “near-miss.” Eighteen providers from the NICUs at three teaching hospitals in Ghana (Korle Bu Teaching Hospital in Accra, Komfo Anokye Teaching Hospital in Kumasi, and Cape Coast Teaching Hospital in Cape Coast) were interviewed in depth regarding their perceptions of neonatal morbidity, mortality, and survival. Near the end of the interview, they were specifically asked what they understood the term “near-miss” to mean. Participants included nurses and physicians at various levels and with varying years of practice (mean years of practice = 9.33, mean years in NICU = 3.66). Results indicate that the concept of “near-misses” is not universally understood, and providers differ on whether a baby is a near-miss or not. Providers disagreed on the utility of a near-miss classification for clinical practice, with some suggesting it would be helpful to draw their attention to those at highest risk of dying, with others suggesting that the acuity of illness in a NICU means any baby could become a ‘near-miss’ at any moment. Further efforts are needed to standardize the definitions of neonatal near-misses, including developing criteria that are able to be assessed in a low-resource setting. In addition, further research is warranted to determine the practical implications of using a near miss tool in the process of providing care in a resource-limited setting and whether it might be best reserved as a retrospective indicator of overall quality of care provided.

Highlights

  • 3 million newborn babies die every year, and one third of these deaths occur in the first 24 hours after delivery[1,2]

  • Data were collected from April through August 2015 at the Cape Coast Teaching Hospital (CCTH), Komfo-Anokye Teaching Hospital (KATH), and Korle Bu Teaching Hospital (KBTH) in southern Ghana

  • This study suggests that few providers in Ghanaian neonatal intensive care unit (NICU) had heard of neonatal near-misses or were familiar with what might constitute a near-miss

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Summary

Introduction

3 million newborn babies die every year, and one third of these deaths occur in the first 24 hours after delivery[1,2]. In sub-Saharan Africa alone, newborn mortality accounts for 44% of all deaths of children under age 5.[4]. While neonatal mortality is a significant problem in LMICs, for every death there are many more newborns who narrowly miss dying and may suffer long-term consequences as a result. Neonatal “near misses” are newborns who survive a life-threatening condition.[5] One study conducted in Brazil found that neonatal near misses outnumber neonatal deaths three to one [6], meaning that for every neonatal death there were three infants who nearly died but didn’t. Other studies suggest neonatal near-misses could outnumber deaths five or six to one.[7]

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