Uchenna Ekwochi1, Ikenna K Ndu1, Chidiebere D I Osuorah2, Kenechi S Onah3, Ejike Obuoha1, Odutola I Odetunde4, Ikenna Nwokoye5, Nnenne I Obumneme-Anyim4, Ifeyinwa B Okeke1, Ogechukwu F Amadi1. 1. Department of Paediatrics, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria. 2. Child Survival Unit, Medical Research Council UK, The Gambia Unit, Fajara, Gambia. 3. Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria. 4. Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria. 5. Department of Paediatrics, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
Abstract
BACKGROUND: In most parts of the world, neonatal mortality rates have shown a slower decline when compared with under-5 mortality decline. A sick newborn can die within minutes if there is a delay in presentation, thus early diagnosis and treatment are essential for the survival of a critically ill newborn. This study investigated factors responsible for delays in healthcare services for the sick newborn and maternal socio-demographic variables that influence these delays in Enugu, South-East Nigeria. METHODS: This was a community-based descriptive study. A total of 376 respondents were randomly selected from 4 of the 17 local government areas of Enugu State. Mothers and/or caregivers that were nursing or had nursed a child in the previous 2 years were enrolled. Self-reported data on delays encountered during healthcare for sick newborn were collected using pretested structured questionnaire. Chi-square and multivariate logistic regression were used to determine the association between causes of delays in newborn healthcare services, maternal socio-demographics and relationships with newborn mortality. RESULTS: Delays in reaching healthcare facilities accounted for the most common delays encountered by respondents, 78.0%, in this study, followed by delays at household level, 24.2% and delays at health facility level 16.0% (P = 0.000). Mothers with knowledge of ≥3 WHO recognized danger signs compared with those with ≤2 were significantly less likely to delay at household (level 1: 40.7 versus 59.3%) (P = 0.017) and reaching healthcare service (level 2: 19.9 versus 80.1%) (P = 0.028). Delays at health facility level (level 3) occurred more at tertiary health facilities (59.0%), secondary health facilities (39.1%) and primary healthcare facilities (19.7%) compared with private health facilities (13.5%) (P = 0.000). CONCLUSIONS: Delays in seeking healthcare at all levels especially those related to transporting the sick newborn to the hospital are a contributor to newborn mortality in Nigeria. Improving access to healthcare could potentially reduce mortality in the sick newborn.
BACKGROUND: In most parts of the world, neonatal mortality rates have shown a slower decline when compared with under-5 mortality decline. A sick newborn can die within minutes if there is a delay in presentation, thus early diagnosis and treatment are essential for the survival of a critically ill newborn. This study investigated factors responsible for delays in healthcare services for the sick newborn and maternal socio-demographic variables that influence these delays in Enugu, South-East Nigeria. METHODS: This was a community-based descriptive study. A total of 376 respondents were randomly selected from 4 of the 17 local government areas of Enugu State. Mothers and/or caregivers that were nursing or had nursed a child in the previous 2 years were enrolled. Self-reported data on delays encountered during healthcare for sick newborn were collected using pretested structured questionnaire. Chi-square and multivariate logistic regression were used to determine the association between causes of delays in newborn healthcare services, maternal socio-demographics and relationships with newborn mortality. RESULTS: Delays in reaching healthcare facilities accounted for the most common delays encountered by respondents, 78.0%, in this study, followed by delays at household level, 24.2% and delays at health facility level 16.0% (P = 0.000). Mothers with knowledge of ≥3 WHO recognized danger signs compared with those with ≤2 were significantly less likely to delay at household (level 1: 40.7 versus 59.3%) (P = 0.017) and reaching healthcare service (level 2: 19.9 versus 80.1%) (P = 0.028). Delays at health facility level (level 3) occurred more at tertiary health facilities (59.0%), secondary health facilities (39.1%) and primary healthcare facilities (19.7%) compared with private health facilities (13.5%) (P = 0.000). CONCLUSIONS: Delays in seeking healthcare at all levels especially those related to transporting the sick newborn to the hospital are a contributor to newborn mortality in Nigeria. Improving access to healthcare could potentially reduce mortality in the sick newborn.
Authors: Ikenna Kingsley Ndu; Chidiebere D I Osuorah; Ogechukwu F Amadi; Uchenna Ekwochi; Bismark C Ekeh; Obinna C Nduagubam; Ifeyinwa B Okeke Journal: J Emerg Trauma Shock Date: 2020-03-19