Protecting Ghana’s Fresh Citizens


Kobina Mensah Mannoh, a banker, was expecting his wife to go the full nine months of conception before delivery, but events turned out otherwise.

Few months into his wife’s pregnancy, doctors had to conduct a Caesarean section to save the baby and the mother due to complications.

But the successful delivery of the preterm baby was the beginning of weeks of strives for Mr Mannoh to save his little child.

Ama (not real name) was preterm and needed to be placed at the neonatal intensive care unit of the Child Health Department of the Korle-Bu Teaching Hospital.

Preterm babies need special care because of their condition. They get cold more easily and may need more help to feed than full-term babies. Because their bodies are not yet fully developed, they may have problems breathing and can also suffer from other complications including infections.

Narrating the condition of his little daughter, Mr Mannoh disclosed;

‘When we got to the hospital, she was so small that the officer in-charge of the ambulance asked where the baby is.’

Days run into weeks and there was very little improvement in Ama’s health, ‘but we never gave up; we prayed.

‘There were days I would look at my daughter and wonder if she could make it,’ he added.

Fortunately, with help and encouragements from health professionals, little Ama’s condition progressed steadily and she was soon discharged from the hospital.

Unlike Mr Mannoh, who had access to one of the best healthcare facilities to cater for his baby, many parents lose their babies every day to preventable causes.

Neonatal (newborn) mortality rate in Ghana is currently pegged at 82 per a 1000 live births, representing 40 per cent of all under-five deaths.

Considering this situation, Ghana is obviously far from meeting the Millennium Development Goal (MDG) four (4) target of reducing under-five mortality to 41 per 1000 live births by 2015.

Neonatal Deaths
The Ghana Health Service has over the years developed initiatives to reduce significantly under-five mortality which stood at 111 deaths per a 1000 live births some ten years ago.

Through intensified healthcare initiatives like the expanded programme on immunisation, establishment of community-based health facilities and frameworks such as the Ghana Under-Five Child Health Policy: 2007-2015 and Under-Five Child Health Strategy: 2007-2015, the number of children who die before age five has, since 2011, dropped to 82.

The reduction in under-five mortality has however not reflected in the most vulnerable group—newborns—with as many as 30,000 newborns dying every year.

‘This change largely reflects improvements in the health of infants and older children. A decrease in neonatal deaths has not kept pace,’ said Dr Isabella Sagoe Moses, National Child Health Coordinator of the National Child Health Promotion Planning Committee.

‘Indeed, newborns have accounted for a disproportionate number of total under-five deaths and the burden has grown in the past five years,’ she added.

Susan Ngongi, United Nations Children Fund (UNICEF) Country Representative, said mortality in the newborn age group (1-28 days) has not changed during the past ten years despite the country’s reduction of under-five deaths.

Giving a clearer picture of the worrisome situation, she noted that among all children born alive this year in Ghana, close to 90 died each day before reaching the first month of their lives.

‘Looking at the number of children born alive each year in Ghana, this means in real terms that every 60 minutes four babies are dying – one newborn every 15 minutes,’ she observed.

According to the UNICEF ChildInfo Monitoring the Situation of Children and Women website, the primary causes of newborn deaths in Ghana are complications of prematurity (accounting for 29%), adverse intra-partum events including birth asphyxia (accounting for 27%) and infections (31%).

Action Plan
Having realised that neonatal mortality rates in Ghana are too high, and that the existing initiatives being implemented by the Health Service provide very little focus on newborn care, health authorities, together with development partners, have developed the National Newborn Health Strategy and Action Plan.

The four year plan, contained in a handbook, seeks to address the gaps in newborn care while integrating existing maternal and child health strategies and action plans. It cuts across implementing policies that support care, building the capacity of health workers and facilities to strengthening, monitoring and evaluation.

‘The plan in itself is an important milestone in addressing the morbidity and mortality of newborn babies in Ghana,’ Ms Ngongi added.

Dr Sagoe Moses said the plan has clearly outlined targets that need to be achieved within specific time frames.

‘We have targets; for example by 2018 it seeks to increase the proportion of deliveries conducted by skilled attendants from 68% in 2011 to 82%, increase the proportion of babies receiving the first postnatal visit within 48 hours from 56% in 2011 to 90% and increase early initiation of breastfeeding (within one hour of birth) from 49.5 % in 2011 to 80%,’ she explained.

The key element in the action plan is the newborn health intervention package.

Based on the concept that newborn care is somewhat different from the care of older children or infants, the newborn package is designed to focus on newborn health risk, needs and treatment, with emphasis on the dangerous time between labour and delivery and the first week after birth during which three out of four neonatal deaths occur.

‘The package will focus on basic essential newborn care, management of adverse intrapartum events (including birth asphyxia), care of the preterm, low birth weight or growth restricted baby and management of neonatal infection and care of the sick newborn,’ she enumerated.

‘This strategy is in line with the Global Every Newborn Action Plan; and I believe it will not only guide us in the fulfilment of our duties but also our accountability to newborn babies in Ghana,’ Ms Ngongi asserted.

Challenges
Despite these clearly laid down plans and strategies in saving the lives of more of Ghana’s newborns and meeting key health targets set forth in the MDG 4, obstacles still exist.

Major gaps in access to health facilities in rural communities and quality of service work against the survival of the newborn, as well as the use of non-evidence based traditional practices are detrimental to the health and wellbeing of newborn babies.

Again, bad road networks, non-availability of transport services for emergency referrals and delay in seeking healthcare by families also cost the lives of young babies.

A Promise Renewed
On July 30, 2014, the Ghana Health Service and the Ministry of Health, together with UNICEF, held a meeting to ‘renew the promise’ of stakeholders in the care of newborns as they create awareness on the state of the newborn.

The meeting, themed ‘Unite to Save Newborns: A Promised Renewed’, also shared best practices to reduce newborn deaths while appealing to the public to take action.

Ms Ngongi pointed out that about 24,000 newborns can easily be saved through simple, effective and low-cost interventions that are all within the reach of the ordinary person.

‘What we need are skilled human resources,’ she stated.

‘I mean skilled health personnel, equitable distribution, who provide quality care to mothers during pregnancy, to mothers and their newborns during childbirth and also continued quality care to the newborns during their first month of life.’

She advocated the provision of necessary equipment and commodities for newborn care and collaboration with communities, so as to break with all the negative beliefs and harmful practices that are detrimental to the health and survival of newborns.

‘This unity of purpose within the diversity of our respective contributions is required to address this all important issue of newborn survival at large.’

She added; ‘It stretches beyond the provision of medical care; it is an issue of a fundamental right—the right to survival—but also an issue of social justice.’

Side Bar>>>>>>> National Newborn Health Strategy and Action Plan

The National Newborn Health Strategy and Action Plan is an integrated, comprehensive, and data-driven road map to measurably improve services and care for newborns by 2018.

It translates urgent need into life-saving action by galvanising stakeholders and resources to protect Ghana’s most vulnerable citizens.

In developing the action plan, experts throughout Ghana collaborated to determine the cost of activities and create timeliness for implementation in the hope of facilitating resource mobilisation, monitoring and evaluation and expansion of the proposed newborn interventions.

The development of the National Newborn Health Strategy and Action Plan at a cost of $81 million showcases the country’s deep commitment to protecting mothers and infants during pregnancy, birth and the first weeks of life.

It is thus expected that all stakeholders working towards improving the health of children in Ghana will buy into and support the strategy and collaborate to attain its goals and objectives.

By Jamila Akweley Okertchiri

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