According to the Neonatal Mortality Formative Research Working Group, “Every year four million babies die during the neonatal period, the first 4 weeks of life. Another 4 million are stillborn; they die in utero in the last 3 months of pregnancy, 0.9 million during the 12h before delivery” (2008, p. S2). The fourth Millennium Development Goal (MGD) is to reduce under-5 mortality by two-thirds by the year 2015. Thus far, there has been a decline in infant and under-5 childhood mortality, however, neonatal mortality remains relatively unchanged (Enweronu-Laryea, Nkyekyer, & Rodrigues, 2008). If the MGD going to be achieved there must be a drastic reduction in neonatal mortality. Enweronu-Laryea, Nkyekyer, and Rodrigues (2008) suggest that to address neonatal mortality the community and hospital-based neonatal services must be linked through improved health systems.
In 2004, Ghana updated their neonatal intensive care unit (NICU) at its largest teaching hospital, Korle Bu Teaching Hospital (KBTH), with the goal of reducing the rate of neonatal mortality in Ghana. Although we did not have the opportunity to see first-hand how KBTH operates we did, however, work in the NICU at 37 Military Hospital (MH) in Accra. We can vouch for Ghana and state that we observed high quality care being provided to the sick neonates at 37 MH. From our perspective, it was evident that the NICU staff worked hard to maintain a safe and clean environment for their tiny patients. The staff were very strict and ensured all visitors wore proper protective gear (gown, clean slippers) prior to entering this specialty unit. Our instructor, who had been to Ghana two years prior with another group of University of Alberta nursing students, claimed that there had been many advancements at 37 MH particularly in the NICU.
Although Ghana, specifically 37 MH and KBTH, have made drastic upgrades in their NICU facilities to conserve the lives of their neonates, neonatal mortality continues to be an issue. So what else has to be done in order to save more neonates? Pond, Addai, & Kwashie (2005) state that there needs to be a change in how we monitor and assess the quality as well as the coverage of maternity care. More specifically, survey data must be available in order to assess the number of women being provided antenatal care. Antenatal care visits provide vital services such as screening for preeclampsia, anemia, and syphilis, all of which conditions can be harmful and or life threatening to the neonate. In addition to antenatal screening, effective assessment of the mother and fetus during pregnancy are critical. Lack of assessment can lead to a number of problems, the most serious being death of the neonate and or the mother. According to a multicountry analysis by McKinnon, Harper, Kaufman, and Bergevin, “most neonatal deaths can be avoided with effective low-cost interventions, such as clean delivery practices, exclusive breastfeeding, and access to emergency obstetric and neonatal care” (2014, p. 165).
Despite an international agreement regarding the required interventions to reduce neonatal mortality rates (NMRs), our greatest challenge is accessibility. In order to lower NMRs we must develop ways to expand access to vital interventions, with emphasis placed on disadvantaged populations with limited access to health services (McKinnon, Harper, Kaufman, & Bergevin, 2014).
Accessibility is not only the availability of well-equipped maternity units with skilled attendants within reasonable distance from the patients’ homes, but includes the removal of impediments to the provision of essential obstetric care such as hospital service charges prior to the provision of treatment, the discarding of harmful traditional or cultural beliefs and practices. (African Health Monitor, 2004)
It is apparent from the above statement that accessibility goes beyond skilled birth attendants and the distance one must travel to reach health facilities; it also lies within health systems as a whole. Strengthening these systems is vital in working towards decreasing NMRs. To strengthen these systems Wright et al., (2014) suggest that, “the removal of user fees, ensuring increased and sustainable funding for health services, and working to expand and strengthen the health workforce” are three fundamental areas in this respect. In order for Ghana to achieve its goal of lowering NMRs it must strengthen and ensure equitable distribution of healthcare.
-Courtney Bachman and Katelyn Gorman
African Health Monitor. (2004). Reducing maternal and infant mortality in Africa. Retrieved
Enweronu-Laryea, C. C., Nkyekyer, K., & Rodrigues, O. P. (2008). The impact of improved
neonatal intensive care facilities on referral pattern and outcome at a teaching hospital in
Ghana. Journal of Perinatology, 28(1), 561-565. doi:
McKinnon, B., Harper, S., Kaufman, J. S., & Bergevin, Y. (2014). Socioeconomic inequality in
neonatal mortality in countries of low and middle income: a multicountry analysis. The
Lancet Global Health, 2(3), 165-173. doi:10.1016/S2214-109X(14)70008-7
Neonatal Mortality Formative Research Working Group. (2008). Developing community-based
intervention strategies to save newborn lives: lessons learned from formative research in
five countries. Journal of Perinatology, 28(1), S2-S8. doi:
Pond, B., Addai, E., & Kwashie, S. (2005). Stagnation of Ghana’s under-5 mortality rate. Lancet,
365(9474), 1846. doi:10.1016/S0140-6736(05)66610-X
Wright, S., Mathieson, K., Brearley, L., Jacobs, S., Holly, L., & Wickremasinghe, R.
(2014). Ending Newborn Deaths: Ensuring Every Baby Survives. London: Save the