Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-18T21:20:23.324Z Has data issue: false hasContentIssue false
  • English
  • Français

‘Asram is really killing us here’: attribution for pregnancy losses and newborn mortality in the Ashanti Region of Ghana

Published online by Cambridge University Press:  24 June 2020

Ashura Bakari ,
April J. Bell ,
Samuel Oppong ,
Jessica Woodford ,
Elizabeth Kaselitz  and
Cheryl A. Moyer Open the ORCID record for Cheryl A. Moyer [Opens in a new window]
Ashura Bakari
Affiliation:
Suntreso Government Hospital, Ghana Health Service, Kumasi, Ghana
April J. Bell
Affiliation:
University of Michigan, Ann Arbor, MI, USA
Samuel Oppong
Affiliation:
Korle Bu Teaching Hospital, Accra, Ghana
Jessica Woodford
Affiliation:
University of Michigan, Ann Arbor, MI, USA
Elizabeth Kaselitz
Affiliation:
University of Michigan, Ann Arbor, MI, USA
Cheryl A. Moyer*
Affiliation:
University of Michigan, Ann Arbor, MI, USA
*
*Corresponding author. Email: camoyer@umich.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

While overall neonatal mortality rates are improving in Ghana, the Ashanti Region has the highest mortality rate in the country. The clinical causes of newborn deaths are well known, yet local beliefs about illness aetiology, cause of death and care-seeking are less well understood. This exploratory qualitative study sought to understand how community members perceive and respond to neonatal illness. Researchers worked with public health nurses, community health nurses and opinion leaders in the Ashanti Region of Ghana to identify women who had lost a baby, either during pregnancy or after delivery. In-depth interviews and focus group discussions were conducted about knowledge, attitudes and beliefs regarding neonatal mortality. The transcripts were coded and analysed using NVivo 10.0. A total of 100 participants were interviewed: 24% reported a previous stillbirth; 37% reported a previous miscarriage; and 45% reported losing a baby who was born alive. Nine per cent experienced more than one type of loss. The local illness of asram – an illness with supernatural causes – was cited as a leading cause of death of newborns. Every participant reported hearing of, knowing someone, or having a child who had become ill with asram. While women gave varying information on symptoms, method of contraction and treatment, all participants agreed that asram was common and often fatal. Four overarching themes emerged: 1) asram is not a hospital sickness; 2) there is both a fear of traditional healers as a source of asram, as well as a reliance upon them to cure asram; 3) there are rural/urban differences in perceptions of asram; and 4) asram may serve as a mechanism of social control for pregnant women and new mothers. Local beliefs and practices must be better understood and incorporated into health education campaigns if neonatal mortality is to be reduced in Ghana.

Keywords

Neonatal mortalityDeveloping countrySub-Saharan Africa
Type
Research Article
Information
Journal of Biosocial Science , Volume 53 , Issue 4 , July 2021 , pp. 497 - 507
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akseer, N, Lawn, JE, Keenan, W, Konstantopoulos, A, Cooper, P, Ismail, Z et al. (2015) Ending preventable newborn deaths in a generation. International Journal of Gynaecology and Obstetrics 131(Supplement 1), S43–S48. doi: 10.1016/j.ijgo.2015.03.017 CrossRefGoogle Scholar
Annan, NA and Asiedu, Y (2018) Predictors of neonatal deaths in Ashanti Region of Ghana: a cross-sectional study. Advances in Public Health, Article ID 9020914, doi: https://doi.org/10.1155/2018/9020914.CrossRefGoogle Scholar
Attride-Stirling, J (2001) Thematic networks: an analytic tool for qualitative research. Qualitative Research 1(3), 385–405.CrossRefGoogle Scholar
Bell, AJ, Arku, Z, Bakari, A, Oppong, SA, Youngblood, J, Adanu, RM and Moyer, CA (2020) ‘This sickness is not hospital sickness’: a qualitative study of the evil eye as a source of neonatal illness in Ghana. Journal of Biosocial Science 52(2), 159–167.CrossRefGoogle Scholar
Bhutta, ZA, Das, JK, Bahl, R, Lawn, JE, Salam, RA, Paul, VK et al. (2014) Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 384(9940), 347–370.CrossRefGoogle ScholarPubMed
Dako-Gyeke, P, Aikins, M, Aryeetey, R, McCough, L and Adongo, PB (2013) The influence of socio-cultural interpretations of pregnancy threats on health-seeking behavior among pregnant women in urban Accra, Ghana. BMC Pregnancy Childbirth 13(211), doi: 10.1186/1471-2393-13-211 CrossRefGoogle ScholarPubMed
Dickson, KE, Simen-Kapeu, A, Kinney, MV, Huicho, L, Vesel, L, Lackritz, E et al. (2014) Every newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. The Lancet 384(9941), 438–454.CrossRefGoogle ScholarPubMed
Engmann, C, Adongo, P, Aborigo, RA, Gupta, M, Logonia, G, Affah, G et al. (2013) Infant illness spanning the antenatal to early neonatal continuum in rural northern Ghana: local perceptions, beliefs and practices. Journal of Perinatology 33(6), 476–481.CrossRefGoogle ScholarPubMed
Geerlings, E, Kaselitz, E, Aborigo, RA, Williams, J, Youngblood, J, Avrakotos, A et al. (2019) “I am still confused as to what caused the problem”: perceptions of mothers on communication regarding newborn illness and death in Northern Ghana. Global Public Health 14(12), 1784–1792.CrossRefGoogle ScholarPubMed
Ghana Statistical Service, Ghana Health Service and DHS Program (2014) Ghana Demographic Health Survey. URL: http://dhsprogram.com/publications/publication-fr307-dhs-finalreports.cfm Google Scholar
Hill, E, Hess, R, Aborigo, R, Adongo, P, Hodgson, A, Engmann, C and Moyer, CA (2014) “I don’t know anything about their culture”: the disconnect between allopathic and traditional maternity care providers in rural northern Ghana. African Journal of Reproductive Health 18(2), 36–45.Google ScholarPubMed
Kumar, V, Shearer, JC, Kumar, A and Darmstadt, GL (2009) Neonatal hypothermia in low resource settings: a review. Journal of Perinatology 29(6), 401–412.CrossRefGoogle ScholarPubMed
Lawn, JE, Cousens, S, Zupan, J and Lancet Neonatal Survival Steering Committee (2005) 4 million neonatal deaths: When? Where? Why? The Lancet 365(9462), 891–900.CrossRefGoogle ScholarPubMed
Mohan, P, Iyengar, SD, Agarwal, K, Martines, JC and Sen, K (2008) Care-seeking practices in rural Rajasthan: barriers and facilitating factors. Journal of Perinatology 28(Supplement 2), S31–S37.CrossRefGoogle ScholarPubMed
Moyer, CA, Aborigo, RA, Kaselitz, EB, Gupta, ML, Oduro, A and Williams, J (2016) PREventing Maternal And Neonatal Deaths (PREMAND): a study protocol for examining social and cultural factors contributing to infant and maternal deaths and near-misses in rural northern Ghana. Reproductive Health 13, 20.CrossRefGoogle ScholarPubMed
Mrisho, M, Obrist, B, Schellenberg, JA, Haws, RA, Mushi, AK, Mshinda, H et al. (2009) The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania. BMC Pregnancy Childbirth 9, 10.CrossRefGoogle Scholar
Mrisho, M, Schellenberg, JA, Mushi, AK, Obrist, B, Mshinda, H, Tanner, M and Schellenberg, D (2008) Understanding home-based neonatal care practice in rural southern Tanzania. Transactions of the Royal Society of Medicine and Tropical Hygiene 102(7), 669–678.CrossRefGoogle ScholarPubMed
Okyere, E, Tawiah-Agyemang, C, Manu, A, Deganus, S, Kirkwood, B and Hill, Z (2010) Newborn care: the effect of a traditional illness, asram, in Ghana. Annals of Tropical Paediatrics 30(4), 321–328.CrossRefGoogle ScholarPubMed
Olusanya, BO, Ogunlesi, TA and Slusher, TM (2014) Why is kernicterus still a major cause of death and disability in low-income and middle-income countries? Archives of Disease in Childhood 99(12), 1117–1121.CrossRefGoogle Scholar
Oppong, S, Bakari, A, Bell, AJ, Bockarie, Y, Adu, J, Turpin, CA et al. (2019) Incidence, causes, and correlates of maternal near-miss morbidity in southern Ghana: a multi-centre cross-sectional study. British Journal of Obstetrics and Gynaecology 126(6), 755–762.CrossRefGoogle ScholarPubMed
Owusu, BA, Lim, A, Makaje, N, Wobil, P and SameAe, A (2018) Neonatal mortality at the neonatal unit: the situation at a teaching hospital in Ghana. African Health Science 18(2), 369–377.Google Scholar
Thairu, L and Pelto, G (2008) Newborn care practices in Pemba Island (Tanzania) and their implications for newborn health and survival. Maternal and Child Nutrition 4(3), 194–208.CrossRefGoogle ScholarPubMed
Tuncalp, O, Hindin, MJ, Adu-Bonsaffoh, K and Adanu, R (2012) Listening to women’s voices: the quality of care of women experiencing severe maternal morbidity, in Accra, Ghana. PLoS One 7(8), e44536.CrossRefGoogle ScholarPubMed
Winch, PJ, Alam, MA, Akther, A, Afroz, D, Ali, NA, Ellis, AA et al. (2005) Local understandings of vulnerability and protection during the neonatal period in Sylhet District, Bangladesh: a qualitative study. The Lancet 366(9484), 478–485.CrossRefGoogle ScholarPubMed
World Bank (2019) Mortality Rate, Neonatal (per 1,000 live births). URL: https://data.worldbank.org/indicator/SH.DYN.NMRT (accessed 25th April 2020).Google Scholar