title: Quality of newborn care: a health facility assessment in rural Ghana using survey, vignette and surveillance data.
abstract: OBJECTIVE
  To assess the structural capacity for, and quality of, immediate and essential newborn care (ENC) in health facilities in rural Ghana, and to link this with demand for facility deliveries and admissions.
  
  
  METHODS
  Health facility assessment survey and population-based surveillance data.
  
  
  METHODS
  Seven districts in Brong Ahafo Region, Ghana.
  
  
  METHODS
  Heads of maternal/neonatal wards in all 64 facilities performing deliveries.
  
  
  METHODS
  Indicators include: the availability of essential infrastructure, newborn equipment and drugs, and personnel; vignette scores and adequacy of reasons given for delayed discharge of newborn babies; and prevalence of key immediate ENC practices that facilities should promote. These are matched to the percentage of babies delivered in and admitted to each type of facility.
  
  
  RESULTS
  70% of babies were delivered in health facilities; 56% of these and 87% of neonatal admissions were in four referral level hospitals. These had adequate infrastructure, but all lacked staff trained in ENC and some essential equipment (including incubators and bag and masks) and/or drugs. Vignette scores for care of very low-birth-weight babies were generally moderate-to-high, but only three hospitals achieved high overall scores for quality of ENC. We estimate that only 33% of babies were born in facilities capable of providing high quality, basic resuscitation as assessed by a vignette plus the presence of a bag and mask. Promotion of immediate ENC practices in facilities was also inadequate, with coverage of early initiation of breastfeeding and delayed bathing both below 50% for babies born in facilities; this represents a lost opportunity.
  
  
  CONCLUSIONS
  Unless major gaps in ENC equipment, drugs, staff, practices and skills are addressed, strategies to increase facility utilisation will not achieve their potential to save newborn lives.
  
  
  BACKGROUND
  http://clinicaltrials.gov NCT00623337.
authors.affiliation: Department of Nutrition and Public Health Intervention Research, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Vesel
authors.forename: Alexander
authors.initials: A
authors.lastname: Manu
authors.forename: Terhi J
authors.initials: TJ
authors.lastname: Lohela
authors.forename: Sabine
authors.initials: S
authors.lastname: Gabrysch
authors.forename: Eunice
authors.initials: E
authors.lastname: Okyere
authors.forename: Augustinus H A
authors.initials: AH
authors.lastname: Ten Asbroek
authors.forename: Zelee
authors.initials: Z
authors.lastname: Hill
authors.forename: Charlotte Tawiah
authors.initials: CT
authors.lastname: Agyemang
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
authors.forename: Betty R
authors.initials: BR
authors.lastname: Kirkwood
keywords: Epidemiology; Neonatology; Public health