Beyond symptom recognition: care-seeking for ill newborns in rural Ghana

OBJECTIVES To assess newborn care-seeking practices in a rural area of Ghana where most births take place at home in order to inform potential strategies for reducing newborn mortality. METHODS Qualitative, ethnographic study with quantitative data from a birth cohort collected as part of the surveillance system of an ongoing randomized controlled trial. Data collected comprised 84 h of participant observation (including following an ill newborn through a hospital visit), 14 in-depth interviews with key informants (older mothers and grandmothers), 45 semistructured interviews with mothers, 28 case histories from women who had recently given birth and 32 expert interviews with local health providers. Thirteen focus groups were held with men and women, and narrative histories of newborn deaths were taken from eight women. Birth cohort data came from 2878 singletons born alive in the study district within the year July 2003-June 2004. RESULTS Significant delays in care seeking for ill newborns occur in Kintampo District, Ghana. 2.1 % of 2878 newborns in the birth cohort had a serious illness during the first 4 weeks of life, but care was only sought outside the home for 61% of those and from a doctor or hospital for 39%. Barriers to prompt allopathic care seeking include sequential care-seeking practices, with often exclusive use of traditional medicine as first-line treatment for 7 days, previous negative experiences with health service facilities, financial constraints and remoteness from health facilities. CONCLUSIONS Improvements in care seeking are urgently needed. Families should be urged to seek medical care for any symptom of illness in a newborn; financial and socio-cultural barriers to care seeking for newborns must be addressed in order to improve neonatal survival.