Training mothers on umbilical cord care impacts on neonatal survival
Adama, the young woman from the hard-to-reach “overseas” communities, had given birth at the district hospital and was counselled and discharged a week earlier with an appointment to return for follow-up postnatal care on the sixth day after delivery. But for obvious reasons ‘outdooring’, fear of the evil eye, lack of transport etc. She failed to honour the appointment.
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Two days after the ‘outdooring’ of her handsome bouncy baby boy, she noticed suddenly that his feeding ability had reduced and spontaneous movement was almost absent with a very high body temperature. Her son’s condition worsened later and so she decided to return to the hospital to see the doctor. He was diagnosed to be suffering from umbilical sepsis attributable to the local concoctions that Adama’s mother-in-law had been applying to the cord. Sadly, he passed out shortly after treatment had commenced.
Adama’s predicament illustrates the number of neonates who die silently in our communities as a result of obnoxious traditional practices and inadequate knowledge among caregivers about umbilical cord care, and recognition of early danger signs.
Neonatal survival and under-five mortality remain stumbling blocks to Ghana’s achievement of the Fourth Millennium Development Goal (a 66 per cent reduction in under-five mortality from 1990 to 2015).
National figures depict an unacceptable under-five mortality rate of 80 per 1,000 live births as of 2008. The situation appears daunting, but studies have shown that neonatal survival and under-five mortality can be reduced substantially by delivering high quality interventions in a reliable manner during labour, delivery and early postnatal period.
The Upper East Region of Ghana has an under-five mortality rate of 93 per 1,000 live births, one of the highest in the country. As a characteristic of most rural regions, resource constraints, lack of counselling for mothers on hygienic cord care and health system failures account for the high neonatal and under-five mortality burden.
The Builsa District Hospital, which is one of the six public hospitals in the region, serves a population of about 84,000 people with an average of 53 deliveries per month. As of 2009, the neonatal death rate was estimated at 29 per 1,000 live births, an urgent situation that required immediate attention.
Once aware of the problem, the hospital formed a Quality Improvement (QI) team, consisting of nurses, midwives, biostatisticians, the pharmacist, laboratory technicians, physicians, and administrators. The team set their own aim to reduce neonatal mortality in the hospital from 29 to at least 20 per 1,000 live births (31 per cent reduction) by December 2010 through the application of QI methods and tools.
In addition, the QI team identified opportunities for changes that could improve outcomes for neonates through better management of labour and delivery, as well as promotion of early postnatal care (PNC) that was consistent with the new Ghana Health Service policy on postnatal care.
The specific changes that were developed and tested involved greater engagement and understanding from the mothers. It started by health staff admitting and monitoring all postpartum mothers for at least 24 hours at the facility so that any danger signs in both the mother and baby could be detected and managed timely by a skilled provider. In terms of hygiene, midwives taught mothers on admission hygienic methods for taking care of the umbilical cord and the risks associated with mismanagement.
After only three months of testing these ideas, the team found that 85 per cent of neonates attended early PNC by day two of life and 55 per cent by day seven, consistent with the new PNC policy of seeing all newborns twice in the first week of life. Additionally, all mothers had received advice on hygienic cord care.
Since August, 2010, these changes had brought about a more improved and reliable process of managing early postnatal care within the hospital system. This led to a reduction in neonatal deaths from 29 to 19 per 1,000 live births, representing a decline of 34 per cent: A feat that exceeded their original aim.
It is worthy to note that despite resource constraints in rural district hospitals, it is possible to create reliable systems for the prevention and management of neonatal complications. This can be achieved by involving all members of staff and educating all mothers and caregivers effectively on behaviour changes imperative to neonatal health. This hospital has put the PNC policy into action by adapting it locally to meet the needs of the mothers, and the result is saving the lives of neonates.
By Isaac Amenga-Etego/Ghana