Families at the heart of health systems change: A Ghanaian perspective on small and sick newborn care along the continuum of care
Keywords:
Small and Sick Newborn Care (SSNC)2024Abstract
Globally, the challenge of caring for small and sick newborns is significant. In2020,oneinevery ten newborns was born prematurely (<37 weeks gestational age), and one in five was born small for gestational age (SGA). Each year, over 30 million newborns worldwide require inpatient hospitalization, with over 1.3 million surviving with long-term disabilities (WHO, 2019, 2024). The greatest burden of these conditions is reported from Sub- Saharan Africa and Southern Asia (Lawn et al., 2023). Unfortunately, the magnitude of neonatal morbidities and disabilities in low- and middle-income countries (LMICs) remains largely under reported and unknown1,2. Families experience significant emotional, social and financial burdens. These challenges have long -lasting impacts on the newborns’ developmental, social, and cognitive growth3,4. Meanwhile, some cultural beliefs, myths and misinformation frequently expose small or sick newborns to compromised care5 .Hence, the inclusion of families’ perspectives and cultural beliefs is essential for shaping effective healthcare strategies and policies in LMICs.
References
WHO. Survive and thrive: transforming care for every small and sick newborn. 2019.
WHO, Newborn Health. 2024, World Health Organization: Geneva.
Lawn, J.E., et al., Small babies, big risks: global estimates of prevalence and mortality for vulnerable newborns to accelerate change and improve counting. The Lancet, 2023. 401(10389): p. 1707-1719.
Ashorn, P., et al., Small vulnerable newborns—big potential for impact. The Lancet, 2023. 401(10389): p. 1692-1706.
Rosa-Mangeret, F., et al., 2.5 Million Annual Deaths-Are Neonates in Low- and Middle-Income Countries Too Small to Be Seen? A Bottom-Up Overview on Neonatal Morbi-Mortality. Trop Med Infect Dis, 2022. 7(5).
Moxon, S.G., et al., Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth, 2015. 15 Suppl 2: p. S7.
Adama, E.A., D. Sundin, and S. Bayes, Socio-cultural Practices Affecting the Care of Preterm Infants in the Ghanaian Community. Journal of Trans-cultural Nursing, 2021. 32(5): p.458-465.
Schuler, C., G.E. Ntow, and F. Agbozo, Mothers' experiences with neonatal care for low birth weight infants at home; A qualitative study in the Hohoe municipality, Ghana. Journal Pediatric Nursing, 2019. 45: p. e44-e52.
NEST360 and UNICEF. Newborn toolkit. 2024 [cited 2024 02.10.2024]; Available from: https://www.newborntoolkit.org/.
Shajani, Z. and D. Snell, Wright and Leahey's Nurses and Families A guide to Family Assessment & Intervention. 8 ed. 2023: F.A. DAVIS, Philadelphia.
Wright, L.M. and M. Leahey, Nurses and Families: A Guide to Family Assessment and Intervention,. 6 ed. 2013, Philadelphia: F.A Davis Company.
Bell, J.M., Family Nursing Is More Than Family Centered Care. Journal of Family Nursing, 2013. 19(4): p. 411-417.
Bell, J.M., Family Systems Nursing: Re-examined. Journal of Family Nursing, 2009. 15(2): p. 123-129.
Schuler, C., et al., Experiences of families and health professionals along the care continuum for low-birth weight neonates: A constructivist grounded theory study. Journal of Advanced Nursing, 2023. 79(5): p. 1840-1855.
Maguire, L., et al., Skin-to-Skin Contact. Are we doing enough? Journal of Neonatal Nursing, 2024.
WHO, Standards for improving quality of care for small and sick newborns in health facilities. 2020: Geneva: World Health Organization.
Aubel, J., S.L. Martin, and K. Cunningham, Introduction: A family systems approach to promote maternal, child and adolescent nutrition. Maternal & Child Nutrition, 2021. 17 (S1): p. e13228.
Preusse-Bleuler, B., BAIA – working tool for a familycentered anamnesis interview based on the Calgary Family Assessment and Intervention Model. palliative ch, 2019.
Wright, L.M., What Is the Most Compelling Global Family Nursing Clinical Skill? Curious Compassion. J. Family Nursing, 2024. 30(3): p. 195-198.
Holtslander, L., Clinical Application of the 15-Minute Family Interview: Addressing the Needs of Postpartum Families. J. Family Nursing, 2005. 11 (1): p. 5-18.
Lythgoe, C., et al., How women's experiences and perceptions of care influence uptake of postnatal care across sub-Saharan Africa: a qualitative systematic review. BMC Pregnancy and Childbirth, 2021. 21(1): p. 506.
Ndwiga, C., et al., Experience of care of hospitalized newborns and young children and their parents: A scoping review. PLOS ONE, 2022. 17(8): p. e0272912.
Schuler, C., et al., Family involvement along the care continuum for small and sick newborns – attitudes and skills of healthcare providers in Ghana. Journal of Health, Population and Nutrition, 2025. 44(1): p.277.
Schuler, C., et al., Healthsystem drivers influencing the continuum of care linkages for low-birth-weight infants at the different care levels in Ghana. BMC Pediatrics, 2023. 23(1): p. 501.
Schuler, C., et al., Families’ perception of cognitive and emotional support from healthcare professionals across the Maternal and Newborn Care Continuum Wiley Critical Care Nursing, 2025. Manuscript ID: 5895133(Under Review).
Konlan, K.D., et al., Factors influencing the utilization of Focused antenatal care services during pregnancy, a study among postnatal women in a tertiary healthcare facility, Ghana. Nursing Open, 2020. 7(6): p. 1822-1832.
NEST360 and UNICEF. Newborntoolkit - Linkage to Maternal Care. 2024 [cited 2024 06.10.2024]; Available from: https://www.newborntoolkit.org/toolkit/linkages-to-maternal/overview?tab=Overview&page=1.
Deshmukh, V., S. John, and N.K. Arora, Utilization of Postnatal Healthcare Services Delivered through Home Visitation and Health Facilities for Mothers and Newborns: An Integrative Review from Developing Countries. The Indian Journal of Pediatrics, 2020. 87(3): p. 207-216.
NEST360 and UNICEF. Newborntoolkit - Post-Discharge-Follow-Up. 2024 [cited 2024 06.10.2024]; Available from: https://www.newborntoolkit.org/toolkit/post-discharge/overview.
Seidu, A.-A., et al., Continuum of care for maternal, newborn, and child health in 17 sub-Saharan African countries. BMC Health Services Research, 2022. 22(1): p. 1394.
Elsey, H., et al., Implementation of the Community-based Health Planning and Services (CHPS) in rural and urban Ghana: a history and systematic review of what works, for whom and why. Front Public Health, 2023. 11: p. 1105495.
NEST360 and UNICEF. Newborntoolkit - Human Resources. 2024 [cited 2024 06.10.2024]; Available from: https://www.newborntoolkit.org/toolkit/human-resources/overview.
Wright, L.M. and M. Leahey, Maximizing Time, Minimizing Suffering: The 15-Minute (or less) Family Interview. Journal of Family Nursing, 1999. 5(3): p. 259-274.
WHO, WHO recommendations on maternal and newborn care for a positive postnatal experience. Geneva: World Health Organization, 2022. Licence: CC BY-NC-SA 3.0 IGO.
Schuler, C., et al., Context matters: examining factors influencing the implementation of evidence-based family systems care for small and sick newborns across the care continuum. Frontiers in Health Services, 2025. Volume 5 - 2025.
Pfeiffer, E., et al., Building health system capacity to improve maternal and newborn care: a pilot leadership program for frontline staff at a tertiary hospital in Ghana. BMC Medical Education, 2019. 19(1): p. 52.
Adawudu, E.A., et al., The Effects of Ghana’s Free Maternal and Healthcare Policy on Maternal and Infant Healthcare: A Scoping Review. Health Services Insights, 2024. 17: p.11786329241274481.
NEST360 and UNICEF. Newborntoolkit - Referral System. 2024 [cited 2024 06.10.2024]; Available from: https://www.newborntoolkit.org/toolkit/referral-system/overview.
NEST360 and UNICEF. Newborntoolkit - Equipment and Commodities. 2024; Available from: https://www.newborntoolkit.org/toolkit/equipment-commodity/overview.
Schuler, C., et al., Implementing Family Systems Care Programme for Small and Sick Newborns in Ghana: A Qualitative Exploration of Context from the Perspectives of Families and Healthcare professionals U. Data, Editor. 2024.
Mills, T., et al., Parents' experiences of care and support after stillbirth in rural and urban maternity facilities: a qualitative study in Kenya and Uganda. BJOG: An International J Obstetrics & Gynaecology, 2021. 128(1): p. 101-109.
Dugle, G., B.A.A. Akanbang, and G.A. Abiiro, Exploring factors influencing adverse birth outcomes in a regional hospital setting in Ghana: A configuration theoretical perspective. Women and Birth, 2021. 34(2): p. 187-195.
NEST360 and UNICEF. New borntoolkit - Infrastructure. 2024 [cited 2024 06.10.2024]; Available from: https://www.newborntoolkit.org/toolkit/infrastructure/space-and-design?tab=overview.
Bergström, A., et al., Health system context and implementation of evidence-based practices—development and validation of the Context Assessment for Community Health (COACH) tool for low-and middle-income settings. Implementation Science, 2015.10(1): p. 120.
Amoateng, C.N.A. and E.K. Achampong, Impact of the Light wave Health Information Management Software on the Dimensions of Quality of Healthcare Data. Healthc Inform Res, 2024. 30(1): p. 35-41.
NEST360 and UNICEF. Newborntoolkit - Data System & QI. 2024 [cited 2024 05.10.2024]; Available from: https://www.newborntoolkit.org/toolkit/data-systems-qi/overview.
Yin, R.K., Case study research and applications: design and methods. 6 ed. 2017: Sage Publications Thousand Oaks, CA.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 JOURNAL OF AFRICAN NEONATOLOGY
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.