title: High Incidence of Neonatal Danger Signs and Its Implications for Postnatal Care in Ghana: A Cross-Sectional Study.
abstract: BACKGROUND
  Reducing neonatal mortality is a major public health priority in sub-Saharan Africa. Numerous studies have examined the determinants of neonatal mortality, but few have explored neonatal danger signs which potentially cause morbidity. This study assessed danger signs observed in neonates at birth, determined the correlations of multiple danger signs and complications between neonates and their mothers, and identified factors associated with neonatal danger signs.
  
  
  METHODS
  A cross-sectional study was conducted in three sites across Ghana between July and September in 2013. Using two-stage random sampling, we recruited 1,500 pairs of neonates and their mothers who had given birth within the preceding two years. We collected data on their socio-demographic characteristics, utilization of maternal and neonatal health services, and experiences with neonatal danger signs and maternal complications. We calculated the correlations of multiple danger signs and complications between neonates and their mothers, and performed multiple logistic regression analysis to identify factors associated with neonatal danger signs.
  
  
  RESULTS
  More than 25% of the neonates were born with danger signs. At-birth danger signs in neonates were correlated with maternal delivery complications (r = 0.20, p < 0.001), and neonatal complications within the first six weeks of life (r = 0.19, p < 0.001). However, only 29.1% of neonates with danger signs received postnatal care in the first two days, and 52.4% at two weeks of life. In addition to maternal complications during delivery, maternal age less than 20 years, maternal education level lower than secondary school, and fewer than four antenatal care visits significantly predicted neonatal danger signs.
  
  
  CONCLUSIONS
  Over a quarter of neonates are born with danger signs. Maternal factors can be used to predict neonatal health condition at birth. Management of maternal health and close medical attention to high-risk neonates are crucial to reduce neonatal morbidity in Ghana.
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Sumiyo
authors.initials: S
authors.lastname: Okawa
authors.affiliation: Research and Development Division, Ghana Health Service, Accra, Ghana.
authors.forename: Evelyn Korkor
authors.initials: EK
authors.lastname: Ansah
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Nanishi
authors.affiliation: Kintampo Health Research Centre, Kintampo, Brong-Ahafo, Ghana.
authors.forename: Yeetey
authors.initials: Y
authors.lastname: Enuameh
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shibanuma
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kimiyo
authors.initials: K
authors.lastname: Kikuchi
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Yasuoka
authors.affiliation: Dodowa Health Research Centre, Dodowa, Greater Accra, Ghana.
authors.forename: Margaret
authors.initials: M
authors.lastname: Gyapong
authors.affiliation: Kintampo Health Research Centre, Kintampo, Brong-Ahafo, Ghana.
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
authors.affiliation: Navrongo Health Research Centre, Navrongo, Upper East, Ghana.
authors.forename: Abraham Rexford
authors.initials: AR
authors.lastname: Oduro
authors.affiliation: Ghana Health Service, Accra, Ghana.
authors.forename: Gloria Quansah
authors.initials: GQ
authors.lastname: Asare
authors.affiliation: Research and Development Division, Ghana Health Service, Accra, Ghana.
authors.forename: Abraham
authors.initials: A
authors.lastname: Hodgson
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D005869:Ghana / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000473:pathology; D016015:Logistic Models; D008423:Maternal Age; D008875:Middle Aged; D009035:Mothers / Q000193:education; D007744:Obstetric Labor Complications; D011181:Postnatal Care / Q000706:statistics & numerical data; D049590:Postpartum Period; D011247:Pregnancy; D012307:Risk Factors; D055815:Young Adult