Context
Neonatal infection prevention in Ghana is a critical public health priority, as neonatal infections are a major contributor to under-five mortality. The national neonatal mortality rate is estimated at 22.8 per 1,000 live births, far above the Sustainable Development Goals target of 12 per 1,000. Furthermore, neonatal infections account for 60% of neonatal intensive care unit (NICU) admissions, with case-fatality rates of 9-13.5%. Moreover, hand hygiene compliance before patient contact in NICUs is just about 16%, largely due to low awareness, behavioural barriers, inadequate supply of IPC materials, and poor antiseptic quality. Healthcare workers often skip hand hygiene between patients, inconsistently use personal protective equipment, and prioritise visible tidiness over adherence to protocols. Mothers of admitted neonates receive little IPC education, while poor environmental cleaning and use of sub-standard disinfectants heighten healthcare associated infections risks. Existing AMS efforts are limited by occasional non-adherence to neonatal guidelines, weak laboratory data systems, resource gaps, frequent staff transfers that disrupt continuity and weak diagnostic capacity.
Problem
Limited infection prevention and control (IPC) practices such as inconsistent hand hygiene, inadequate water supply, insufficient cleaning of medical equipment and the healthcare environment, have been linked to healthcare-associated infections among neonates. Compounding this problem is poor antibiotic prescribing and weak diagnostic stewardship, leading to delayed case detection, poor treatment outcomes, and increasing antimicrobial resistance (AMR), which require contextually designed and functional antimicrobial stewardship (AMS) and IPC strategies to address these.
Project overview
This project aims to reduce the incidence of neonatal infections, including those caused by drug-resistant pathogens and also improve health outcomes with rational antibiotic use for neonatal infections, in four hospitals in the Volta Region of Ghana. Using an implementation research approach, the project team will employ a before and after study design over a three-year period. Interventions will focus on strengthening IPC and AMS. The team will also implement behavioural change interventions targeting healthcare workers and mothers in the neonatal intensive care units (NICU) and maternity wards. To ensure long-term sustainability and to inform national scale-up, the project will assess the cost inputs and cost-effectiveness of the interventions. Findings will provide evidence to strengthen policy on neonatal infection prevention and management in the Volta Region, with potential for broader application across Ghana.
Intended outcomes
- Reduce neonatal infections, including drug-resistant infections by 20% in the NICU and maternity wards of four hospitals in the Volta Region of Ghana
- Improve rational antibiotic use and neonatal health outcomes amongst HCWs and mothers through strengthening IPC and AMS in the NICU and maternity wards of four hospitals in the Volta Region of Ghana
- National IPC policy and prescribing guideline revisions incorporate evidence generated from the project.
