title: Delays in healthcare delivery to sick neonates in Enugu South-East Nigeria: an analysis of causes and effects.
abstract: In most parts of the world, neonatal mortality rates have shown a slower decline when compared with under-5 mortality decline. A sick newborn can die within minutes if there is a delay in presentation, thus early diagnosis and treatment are essential for the survival of a critically ill newborn. This study investigated factors responsible for delays in healthcare services for the sick newborn and maternal socio-demographic variables that influence these delays in Enugu, South-East Nigeria.
  
  
  
  This was a community-based descriptive study. A total of 376 respondents were randomly selected from 4 of the 17 local government areas of Enugu State. Mothers and/or caregivers that were nursing or had nursed a child in the previous 2 years were enrolled. Self-reported data on delays encountered during healthcare for sick newborn were collected using pretested structured questionnaire. Chi-square and multivariate logistic regression were used to determine the association between causes of delays in newborn healthcare services, maternal socio-demographics and relationships with newborn mortality.
  
  
  
  Delays in reaching healthcare facilities accounted for the most common delays encountered by respondents, 78.0%, in this study, followed by delays at household level, 24.2% and delays at health facility level 16.0% (P = 0.000). Mothers with knowledge of ≥3 WHO recognized danger signs compared with those with ≤2 were significantly less likely to delay at household (level 1: 40.7 versus 59.3%) (P = 0.017) and reaching healthcare service (level 2: 19.9 versus 80.1%) (P = 0.028). Delays at health facility level (level 3) occurred more at tertiary health facilities (59.0%), secondary health facilities (39.1%) and primary healthcare facilities (19.7%) compared with private health facilities (13.5%) (P = 0.000).
  
  
  
  Delays in seeking healthcare at all levels especially those related to transporting the sick newborn to the hospital are a contributor to newborn mortality in Nigeria. Improving access to healthcare could potentially reduce mortality in the sick newborn.
authors.affiliation: Department of Paediatrics, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria.
authors.forename: Uchenna
authors.initials: U
authors.lastname: Ekwochi
authors.affiliation: Department of Paediatrics, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria.
authors.forename: Ikenna K
authors.initials: IK
authors.lastname: Ndu
authors.affiliation: Child Survival Unit, Medical Research Council UK, The Gambia Unit, Fajara, Gambia.
authors.forename: Chidiebere D I
authors.initials: CD
authors.lastname: Osuorah
authors.affiliation: Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
authors.forename: Kenechi S
authors.initials: KS
authors.lastname: Onah
authors.affiliation: Department of Paediatrics, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria.
authors.forename: Ejike
authors.initials: E
authors.lastname: Obuoha
authors.affiliation: Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria.
authors.forename: Odutola I
authors.initials: OI
authors.lastname: Odetunde
authors.affiliation: Department of Paediatrics, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
authors.forename: Ikenna
authors.initials: I
authors.lastname: Nwokoye
authors.affiliation: Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria.
authors.forename: Nnenne I
authors.initials: NI
authors.lastname: Obumneme-Anyim
authors.affiliation: Department of Paediatrics, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria.
authors.forename: Ifeyinwa B
authors.initials: IB
authors.lastname: Okeke
authors.affiliation: Department of Paediatrics, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria.
authors.forename: Ogechukwu F
authors.initials: OF
authors.lastname: Amadi
mesh_terms: D000293:Adolescent; D000328:Adult; D003695:Delivery of Health Care; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007224:Infant Care; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008427:Maternal Health Services; D009035:Mothers / Q000523:psychology*; D009549:Nigeria; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Enugu; delays; healthcare services; mortality; newborn