‘Asram' is not for hospital’: Perceptions and management of newborn illnesses in two urban slums in Accra, Ghana

Background: Neonatal mortality remains a significant public health challenge globally, and Ghana is no exception. In Ghana, neonatal deaths accounts for 61% of infant deaths and 43% of under-five deaths. While the illnesses that affect neonates and contribute to neonatal mortality are widely known, and interventions for managing these illnesses exist, it is not clear how these illnesses are perceived and managed in many local communities including urban slums in Ghana. This paper explored the illnesses affecting neonates and their perceptions and management in two urban slums in Accra, Ghana. Methods: This qualitative study forms part of a concurrent mixed methods cross-sectional study that was conducted in two large urban slums (Ashaiman and Sodom and Gomorrah) in Accra. The qualitative component of the study involved 14 focus groups discussions and 13 in- depth interviews with purposively sampled mothers, traditional birth attendants, caregivers, community leaders and health workers at national and sub national level. Interviews were tape-recorded, transcribed and analyzed thematically using NVivo 12 Pro. Results: Several common newborn illnesses were reported including diarrhoea, fever, cough, acute respiratory infections, neonatal jaundice, and rashes. There were also other locally themed newborn illnesses including “tomatoes”, “asram”, “obopremu”, “obobre” “bosu -bosu”. Most locally themed illnesses were generally perceived as caused by evil spirits and therefore “not for hospital”. Rather, these illnesses are managed by pastors, mallams, herbalists through exorcism and herbal concoctions. Key barriers to newborn care in the slums include inadequate infrastructure, lack of newborn resuscitation equipment, poor provider skills and competencies, and negative attitude of health service providers. Conclusion: The main illnesses affecting newborns in the slums are diarrhoea, fever, cough, acute respiratory infections, “asram”, “obobre” neonatal jaundice, rashes, “tomatoes” and “bosu-bosu”. The key barriers to newborn care included cost, waiting time, distance and negative attitude of health care providers. Importantly, the findings suggested that how people in urban spaces perceive the cause of their newborn illness determined the nature and type of treatment. It is critical therefore that targeted health educational interventions are designed and implemented in these urban slums to address misconceptions and improve care for newborns.