Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Infant illness spanning the antenatal to early neonatal continuum in rural northern Ghana: local perceptions, beliefs and practices

Journal of Perinatology volume 33, pages 476–481 (2013)Cite this article

Subjects

Abstract

Objective:

To explore community understanding of perinatal illness in northern Ghana.

Study Design:

A cross-sectional descriptive study design.

Result:

253 community members participated in in-depth interviews and focus group discussions, including women with newborn infants, grandmothers and health care providers. Four overarching themes emerged: (1) Local understanding of illness affects treatment practices. Respondents recognized danger signs of illness spanning antenatal to early neonatal periods. Understanding of causation often had a distinctly local flavor, and thus treatment sometimes differed from mainstream recommendations; (2) Mothers are frequently blamed for their infant’s illness; (3) Healthcare decisions regarding infant care are often influenced by community members aside from the infant’s mother and (4) Confidence in healthcare providers is issue-specific, and many households use a blended approach to meet their health needs.

Conclusion:

Despite widespread recognition of danger signs and reported intentions to treat ill infants through the formal health care system, traditional approaches to perinatal illness remain common. Interventions need to be aligned with community perceptions if they are to succeed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010; 375: 1969–1987.

    Article  Google Scholar 

  2. Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I et al. Stillbirths: Where? When? Why? How to make the data count? Lancet 2011; 377: 1448–1463.

    Article  Google Scholar 

  3. Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR et al. Progress toward Millenium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet 2011; 378: 1139–1165.

    Article  Google Scholar 

  4. Shiffman J . Issue attention in global health: the case of newborn survival. Lancet 2010; 375: 2045–2049.

    Article  Google Scholar 

  5. Engmann C, Garces A, Jehan I, Ditekemena J, Phiri M, Mazariegos M et al. Causes of community stillbirths and early neonatal deaths in low-income countries using verbal autopsy: an international, multicenter Study. J Perinatol 2012; 32: 585–592.

    Article  CAS  Google Scholar 

  6. Lawn JE, Cousens S, Bhutta ZA, Darmstadt GL, Martines J, Paul V et al. Why are 4 million newborn babies dying each year? Lancet 2004; 364: 399–401.

    Article  Google Scholar 

  7. Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S et al. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med 2011; 8: e1001080.

    Article  Google Scholar 

  8. Engmann C, Walega P, Aborigo RA, Adongo P, Moyer CA, Lavasani L et al. Stillbirths and early neonatal mortality in rural Northern Ghana. Trop Med Int Health 2012; 17 (3): 272–282.

    PubMed  Google Scholar 

  9. Murray CJ, Lopez AD, Black R, Ahuja R, Ali SM, Baqui A et al. Population Health Metrics Research Consortium gold standard verbal autopsy validation study: design, implementation, and development of analysis datasets. Popul Health Metr 2011; 9: 27.

    Article  Google Scholar 

  10. Lopez AD, Mathers CD . Measuring the global burden of disease and epidemiological transitions: 2002-2030. Ann Trop Med Parasitol 2006; 100: 481–499.

    Article  CAS  Google Scholar 

  11. Kallander K, Hildenwall H, Waiswa P, Galiwango E, Peterson S, Pariyo G . Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study. Bull World Health Organ 2008; 86: 332–338.

    Article  Google Scholar 

  12. Kalter HD, Salgado R, Babille M, Koffi AK, Black RE . Social autopsy for maternal and child deaths: a comprehensive literature review to examine the concept and the development of the method. Popul Health Metr 2011; 9: 45.

    Article  Google Scholar 

  13. Waiswa P, Kallander K, Peterson S, Tomson G, Pariyo GW . Using the three delays model to understand why newborn babies die in eastern Uganda. Trop Med Int Health 2010a; 15: 964–972.

    Article  Google Scholar 

  14. Thaddeus S, Maine D . Too far to walk: maternal mortality in context. Soc Sci Med 1994; 38: 1091–1110.

    Article  CAS  Google Scholar 

  15. de Savigny D, Mayombana C, Mwageni E, Masanja H, Minhaj A, Mkilindi Y et al. Care-seeking patterns for fatal malaria in Tanzania. Malar J 2004; 3: 27.

    Article  Google Scholar 

  16. Kallander K, Tomson G, Nsungwa-Sabiiti J, Senyonjo Y, Pariyo G, Peterson S . Community referral in home management of malaria in western Uganda: a case series study. BMC Int Health Hum Rights 2006; 6: 2.

    Article  Google Scholar 

  17. Kalter HD, Salgado R, Moulton LH, Nieto P, Contreras A, Egas ML et al. Factors constraining adherence to referral advice for severely ill children managed by the Integrated Management of Childhood Illness approach in Imbabura Province, Ecuador. Acta Paediatr 2003; 92: 103–110.

    Article  CAS  Google Scholar 

  18. Krug A, Pattinson RC, Power DJ . Saving children—an audit system to assess under-5 health care. S Afr Med J 2004; 94: 198–202.

    CAS  PubMed  Google Scholar 

  19. Reyes H, Perez-Cuevas R, Salmeron J, Tome P, Guiscafre H, Gutierrez G . Infant mortality due to acute respiratory infections: the influence of primary care processes. Health Policy Plan 1997; 12: 214–223.

    Article  CAS  Google Scholar 

  20. Sutrisna B, Reingold A, Kresno S, Harrison G, Utomo B . Care-seeking for fatal illnesses in young children in Indramayu, west Java, Indonesia. Lancet 1993; 342: 787–789.

    Article  CAS  Google Scholar 

  21. Edmond KM, Quigley MA, Zandoh C, Danso S, Hurt C, Owusu Agyei S et al. Aetiology of stillbirths and neonatal deaths in rural Ghana: implications for health programming in developing countries. Paediatr Perinat Epidemiol 2008a; 22: 430–437.

    Article  Google Scholar 

  22. Edmond KM, Quigley MA, Zandoh C, Danso S, Hurt C, Owusu Agyei S et al. Diagnostic accuracy of verbal autopsies in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana. Paediatr Perinat Epidemiol 2008b; 22: 417–429.

    Article  Google Scholar 

  23. Moyer CA, Aborigo R, Logonia G, Affah G, Rominski S, Adongo P et al. Clean delivery practices in rural northern Ghana: A qualitative study of community and provider knowledge, attitudes, and belief systems. BMC Pregnancy Childbirth 2012; 12 (50): 1–14 . Available at: http://www.biomedcentral.com/1471-2393/12/50/.

    Google Scholar 

  24. Aborigo RA, Moyer CA, Rominski S, Adongo P, Hodgson A, Williams J et al. Infant nutrition in the first seven days of life in rural northern Ghana: a qualitative study. BMC Pregnancy Childbirth 2012; 12: 76.

    Article  Google Scholar 

  25. Parlato RP, Darmstadt GL, Tinker A . Saving Newborn Lives—Tools for newborn health. Qualitative research to improve newborn care practices 2004. Save the Children: US, Washington.

    Google Scholar 

  26. Beale B, Cole R, Hillege S, McMaster R, Nagy S . Impact of in-depth interviews on the interviewer: roller coaster ride. Nurs Health Sci 2004; 6: 141–147.

    Article  Google Scholar 

  27. Tong A, Sainsbury P, Craig J . Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care. Int J Qual Health Care 2007; 19: 349–357.

    Article  Google Scholar 

  28. Allotey P, Reidpath D . Establishing the causes of childhood mortality in Ghana: the 'spirit child'. Soc Sci Med 2001; 52: 1007–1012.

    Article  CAS  Google Scholar 

  29. Denham AZ, Adongo PB, Freydberg N, Hodgson A . Chasing spirits: Clarifying the spirit child phenomenon and infanticide in Northern Ghana. Soc Sci Med 2010; 71: 608–615.

    Article  Google Scholar 

  30. Smith LA, Bruce J, Gueye L, Helou A, Diallo R, Gueye B et al. From fever to anti-malarial: the treatment-seeking process in rural Senegal. Malar J 2010; 9: 333.

    Article  Google Scholar 

  31. G S. Final evaluation of CANAH Project 11. Christian Children’s Fund August 2006 1–102.

  32. Kallander K, Kadobera D, Williams TN, Nielsen RT, Yevoo L, Mutebi A et al. Social autopsy: INDEPTH Network experiences of utility, process, practices, and challenges in investigating causes and contributors to mortality. Popul Health Metr 2011; 9: 44.

    Article  Google Scholar 

  33. Awasthi S, Verma T, Agarwal M . Danger signs of neonatal illnesses: perceptions of caregivers and health workers in northern India. Bull World Health Organ 2006; 84: 819–826.

    Article  Google Scholar 

  34. Hill Z, Kendall C, Arthur P, Kirkwood B, Adjei E . Recognizing childhood illnesses and their traditional explanations: exploring options for care-seeking interventions in the context of the IMCI strategy in rural Ghana. Trop Med Int Health 2003; 8: 668–676.

    Article  Google Scholar 

  35. Waiswa P, Peterson S, Tomson G, Pariyo GW . Poor newborn care practices - a population based survey in eastern Uganda. BMC Pregnancy Childbirth 2010b; 10: 9.

    Article  Google Scholar 

  36. Bazzano AN, Kirkwood BR, Tawiah-Agyemang C, Owusu-Agyei S, Adongo PB . Beyond symptom recognition: care-seeking for ill newborns in rural Ghana. Trop Med Int Health 2008; 13: 123–128.

    Article  Google Scholar 

  37. Warren C . Care of the newborn: Community perceptions and health seeking behavior. Ethiop J Health Dev 2010; 24: 110–114.

    Google Scholar 

  38. Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M et al. Understanding home-based neonatal care practice in rural southern Tanzania. Trans R Soc Trop Med Hyg 2008; 102: 669–678.

    Article  Google Scholar 

  39. Syed U, Khadka N, Khan A, Wall S . Care-seeking practices in South Asia: using formative research to design program interventions to save newborn lives. J Perinatol 2008; 28 (Suppl 2): S9–13.

    Article  Google Scholar 

  40. Waiswa P, Kemigisa M, Kiguli J, Naikoba S, Pariyo GW, Peterson S . Acceptability of evidence-based neonatal care practices in rural Uganda - implications for programming. BMC Pregnancy Childbirth 2008; 8: 21.

    Article  Google Scholar 

  41. Owais A, Sultana S, Stein AD, Bashir NH, Awaldad R, Zaidi AK . Why do families of sick newborns accept hospital care? A community-based cohort study in Karachi, Pakistan. J Perinatol 2011; 31: 586–592.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to express our thanks to the Navrongo Health Research Center, the African Social Research Initiative and Global REACH at the University of Michigan, the Department of Pediatrics at the University of North Carolina, and most importantly, to the people of the Kassena-Nankani District in Ghana.

Author information

Authors and Affiliations

  1. Departments of Pediatrics and Maternal Child Health, Neonatal-Perinatal Medicine, University of North Carolina Schools of Medicine and Public Health, Chapel Hill, NC, USA

    C Engmann

  2. University of Ghana, Legon, Ghana

    P Adongo

  3. Navrongo Health Research Centre, Navrongo, Ghana

    R Akawire Aborigo, G Logonia, G Affah & A Hodgson

  4. School of Medicine and Health Sciences, MONASH University, Selangor Darul Ehsan, Malaysia

    R Akawire Aborigo

  5. University of Michigan, Ann Arbor, MI, USA

    M Gupta & C A Moyer

  6. College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda

    P Waiswa

Authors
  1. C Engmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P Adongo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R Akawire Aborigo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G Logonia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G Affah
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P Waiswa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A Hodgson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C A Moyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C Engmann.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Engmann, C., Adongo, P., Akawire Aborigo, R. et al. Infant illness spanning the antenatal to early neonatal continuum in rural northern Ghana: local perceptions, beliefs and practices. J Perinatol 33, 476–481 (2013). https://doi.org/10.1038/jp.2012.151

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2012.151

Keywords

This article is cited by

Search

Advanced search

Quick links