ABSTRACT
Background: Annually, about 5.9 million perinatal deaths occur worldwide, leaving millions bereaved due to stillbirths or early neonatal deaths. The highest burden of stillbirths (97%) and newborn deaths (98%) occurs in lower- and middle-income countries, with the majority occurring in Sub-Saharan African countries. Method: This cross-sectional qualitative study was conducted to identify existing policies and protocols to support bereaved families, explore the needs of bereaved families, and to also assess the impact of perinatal death on families in Ghana. All in-depth interviews were audio-recorded, transcribed verbatim and analyzed thematically. The results were presented in narratives and supported with illustrative quotes from respondents. Results: In all, 42 in-depth interviews were conducted with 10 (23.8%) from the Northern belt (Upper East), 11 (26.2%) from the middle belt (Ashanti) and 21 (50.0%) from the Southern belt (Greater Accra). The study revealed that practicing health professionals and other stakeholders within the health service delivery chain were not aware of protocols, written guidelines or written documents to initiate counseling at the facility in the event of a mother losing a child. Most of the respondents did not know what to do in the event that a mother loses a baby during delivery or immediately after. Respondents were in favor of having a policy or guidelines which will help them to counsel families who go through perinatal bereavement. Respondents were of the view that it is important for families who experience perinatal grief to be supported. Conclusion: All staff who meet the pregnant mother during her pre-and-post-delivery stages should be trained on the use of guidelines or policies. There is the need to have a policy, train and equip health staff to ensure that families experiencing perinatal grief are provided with effective counseling. Ghana Health Service should consider training and recruiting professional counselors who will support the health staff in dealing with perinatal grief.
ABSTRACT
Background: The coronavirus disease (COVID-19) has spread worldwide with an increasing number of patients, including pregnant women and neonates. This study aims to evaluate morbidity and mortality in the COVID-19 era compared to the preceding year in the Neonatal Intensive Care Unit (NICU) at Tamale Teaching Hospital, Ghana. Methods: This is a cross-sectional study carried out on neonates admitted to NICU between March 1st to August 31st, 2019 (pre-COVID-19 era) and March 1st to August 31st, 2020 (COVID-19 era). Multivariate logistic regression was performed to identify predictors of mortality for both periods. Results: From 2,901 neonates, 1,616 (56%) were admitted before, and 1,285 (44%) were admitted during the pandemic. Admissions decreased during the COVID-19 era, reaching their lowest point between June and August 2020. Compared to the previous year, during the COVID-19 era, admissions of patients born at TTH, delivered at home, and with infections decreased from 50 to 39%, 7 to 4%, and 22 to 13%, respectively. Referred status (OR = 3.3) and vaginal delivery (OR = 1.6) were associated with an increased likelihood of mortality. For low- birth weight neonates, admissions of patients born at TTH, with vaginal and home delivery decreased from 62 to 48%, 8 to 2%, and 59 to 52%, respectively. Neonatal infections and congenital anomalies decreased from 8 to 4%, 5 to 3%, respectively. The likelihood of mortality among referred patients increased by 50%. Conclusion: We observed a marked decrease in admissions and change in the diagnosis landscape and related mortality during the pandemic. Underlying challenges, including fear, financing, and health system capacity, might intensify delays and lack of access to newborn care in northern Ghana, leading to higher rates of lifelong disabilities and mortality. Immediate damage control measures, including an improved home-based continuum of care and equipping families to participate in the newborn care with complemented m-health approaches, are needed with urgency.
