Neglected Child Health Interventions; The Cause Of High Neonatal Mortalities
Leading to the flaming out of the Millennium Development Goals (MDGs) across the globe, the MDG4 had one target; to reduce by two thirds, between 1990 and 2015, the under-five mortality rate. This goal wasn’t met because there was little reduction in Neonatal Mortality Rate (NMR) and the hardest hit was sub-Saharan Africa.
In 2017, the infant mortality rate for Ghana was 35.7 deaths per 1,000 live births. It fell gradually from 120.6 deaths per 1000 live births in 1968 to 35.7 deaths per 1000 live births in 2017, whilst neonatal mortality rate of Ghana fell gradually from 60 deaths per 1,000 live births in 1968 to 24.2 deaths per 1,000 live births in 2017 (World Development Indicators, The World Bank, 2017).
In the ranking by neonatal mortality rate including 193 countries, Ghana ranked 79th that is close to the positions of such countries as Côte d'Ivoire and Lesotho. Compared to Australia, which at the top of the ranking with neonatal mortality rate of 2.1 deaths per 1,000 live births in 2017, Ghana has 1,052.38 % percent higher neonatal mortality rate (World Development Indicators, The World Bank, 2017).
The MDG 5, which was put in place to improve maternal health, had two targets to reduce the Maternal Mortality Rate (MMR) by three quarters (75%) between 1990 and 2015 and achieve universal access to reproductive health. In Ghana, Suboptimal newborn care practices amongst other challenges such as limited Neonatal and Intensive Care Units (NICUs) space to accommodate premature/preterm babies, few incubators, shortfall of skilled personnel, still persist and neonatal mortality rates have been resistant to change and now contribute about 40% of all under-five deaths world-wide. Hence, Ghana made little progress towards the child survival target.
The problem in Ghana mainly has to do with inadequate healthcare financing, which affects inputs of both soft and hardware hence ultimately affecting neonatal survival. Over two-thirds of newborns could be saved through existing maternal and child health programs that relate to cord care to decrease sepsis, temperature control and initiation of early breastfeeding.
Ghana has a fertility rate of 3.87% (World Bank) and more than one quarter of births still occur at homes in the rural areas even with a skilled birth delivery of 74% rate (Saaka, Ali, & Vuu, 2018). Why are neonatal deaths still high?
Our health expenditure of GDP as of 2015 is 5.9% and Ghana ranked 159th globally. Ghana had 37.45% lower health expenditure as a share of GDP (World Development Indicators, The World Bank, 2017).
Many countries are reported to have made little or no progress towards the child survival target, and that some countries in sub-Saharan Africa had even witnessed a deterioration in child survival rates. In 2017, 7,000 newborns died daily (The Lancet, 2008), mostly from preventable and treatable conditions. In recent times, Ghana has been inundated with news reports of neonatal deaths nationwide coupled with congested NICUs without adequate skilled personnel, and under- resourced with the necessary equipment. Most NICUs in Ghana lack phototherapy machines, incubators, heart rate monitors, cardiorespiratory monitors, pulse oximeters, blood pressure monitors, temperature probes, transcutaneous oxygen/carbon dioxide monitors, ultrasounds, x-ray machines, CT scan machines, endotracheal tubes, respiratory or mechanical ventilators, continuous positive airway pressure (CPAP) set, extracorporeal membrane oxygenation, baby cots adequate for temperature control, infusion pumps, ambient oxygen analyzers and syringe pumps.
They also lack transcutaneous pO2 and pCO2 monitors or intravascular oxygen transducers, surface blood recorders, nasogastric tubes, facilities for frequent blood gas analyses using micromethods, facilities for frequent biochemical analyses including glucose, bilirubin and electrolytes by micromethods.
Of great importance to neonatal survival is the establishment and strict adherence to recommended newborn and NICUs standards and design (Franck et al., 2014). Our system design lacks most of these standards and should incorporate same into our neonatal care delivery. They are;
- Unit configuration
- NICU location within each district hospital
- Minimum space, clearance and privacy requirements for the infant space (a minimum of 120 ft2 (11.2 m2) of clear floor space, excluding handwashing stations. An aisle adjacent to each Infant space with a minimum width of 4 ft (1.2 m) in multiple bedrooms. When single- infant rooms or fixed cubicle partitions are utilized in the design, there shall be an adjacent aisle of not less than 8 ft (2.4 m) in clear and unobstructed width to permit passage of equipment and personnel. In multiple bedrooms, there shall be a minimum of 8 ft (2.4 m) between infant beds. Each infant space shall be designed to allow privacy for the infant and family)
- Electrical, gas supply and mechanical needs
- Airborne infection isolation room(s)
- Family entry and reception area
- Handwashing stations
- General support space
- Staff support space
- Family transition room(s)
- Family support space
- Support space for ancillary services
- Administrative space
- Ambient lighting in infant-care area
- Procedure lighting in infant-care areas
- Illumination of support areas
- Floor surfaces
- Wall surfaces
- Ceiling finishes
- Ambient temperature and ventilation
- Acoustic environment
- Safety/infant security
- Access to nature and other positive distractions
- Staff training
- Focused antenatal care to address issues related to each pregnancy to avert premature births
Most of the hospitals and NICUs do not have potable water to aid health workers in NICU have a safe pair of hands to offer quality delivery. A new WHO and UNICEF report (April 2019) indicated that, one in four healthcare facilities lacks basic water services, affecting over 2 billion people globally and therefore do not have the basic requirements to provide quality care globally.
It also reported that one in five health care facilities has no sanitation service, impacting 1.5billion people. It further revealed that many health centres lack basic facilities for hand hygiene and safe segregation and disposal of health care waste.
These services are crucial to preventing infections, reducing the spread of antimicrobial resistance and providing quality care, particularly for safe childbirth and neonatal care. Seventeen million women in developing countries give birth in health centres with inadequate water, sanitation and hygiene. Babies born in health facilities without adequate water, sanitation and hygiene risk contracting infection and death. More than 1 million mortalities annually are due to unclean births and infections account for 26% of neonatal mortalities.