Diagnostic, Management Capacity and Outcomes for Neonates with Sepsis in Rural Health Facilities of Northern Ghana: A Mixed Method Assessment

Aim: The study assessed diagnostic and management competences of rural healthcare providers for neonatal sepsis and related system challenges in health facilities of Gushegu and Nkwanta South districts of Ghana.
Methodology: A convergent mixed-methods design, inspired by the Health Systems Framework and Three Delays Model, was employed. Ten facilities each in Gushegu and Nkwanta South, were selected by stratified sampling. Quantitative data came from 322 neonatal registers, while qualitative data were from health staff and caregiver interviews. Data reliability was ensured through standardization of tools, training, and triangulation. SPSS and NVivo were used to analyze the data by combining descriptive statistics, logistic regression and thematic coding which revealed systemic delays and care deficiencies.
Findings: Most of 322 neonates studied were female(58%), with 70% of caregivers on >GHS 500 monthly income. In Gushegu, only 43% had formal education, and used travel times longer than two hours. The facilities had no CRP and blood culture testing. In Gushegu, recovery rates were 52% and 64% in Nkwanta South; mortality rates were 20% and 14%, respectively. Late presentation (>48 hours) tripled adverse outcomes (OR = 2.8); delayed antibiotics (>6 hours) quadrupled mortality risk (OR = 3.9); delayed referrals (>12 hours) doubled it (OR = 2.1). Only 31% of health workers had recent training.
Conclusions: The study established clinical, and infrastructural, as systemic challenges for the care of neontates with sepsis. Tiered multi-faceted interventions—community education, standardisation of protocols, training, diagnostics, and referral upgrades—are recommended to reduce mortality and improve neonatal health outcomes in rural areas.

Neonatal sepsis, Rural healthcare, Northern Ghana, Clinical outcomes

1. Abadi, M. . (2023). Role of Culture on Leadership and Governance in Saudi Arabia. International Journal of Leadership and Governance, 3(1), 24–35. https://doi.org/10.47604/ijlg.1926 [Google Scholar] [Crossref]

2. Afeke, I., Hirose, M., Amegan-Aho, K. H., Haertel, C., Becker, M., Moustafa, A., Schilf, P., Badr, M. T., Mensah, G. L., Mbroh, H. K., Rupp, J., & Ibrahim, S. (2021). Neonatal and young infant sepsis in a regional hospital in Ghana. Open Journal of Pediatrics, 11(2), 281–300. https://doi.org/10.4236/ojped.2021.112027 [Google Scholar] [Crossref]

3. Bengtsson, M. (2022). Ensuring trustworthiness in qualitative research. Nursing Open, 9(1), 112–118. https://doi.org/10.1002/nop2.1049 [Google Scholar] [Crossref]

4. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa [Google Scholar] [Crossref]

5. Braun, V., & Clarke, V. (2022). Thematic analysis: A practical guide. Sage Publications. [Google Scholar] [Crossref]

6. Bouncken, R. B., Czakon, W., & Schmitt, F. (2025). Purposeful sampling and saturation in qualitative research methodologies: Recommendations and review. Review of Managerial Science. https://doi.org/10.1007/s11846-025-00881-2 [Google Scholar] [Crossref]

7. Camara, S., Diallo, M., & Kone, A. (2024). Infection control and neonatal outcomes in rural West African clinics: A cross-sectional study. African Journal of Health Systems, 9(1), 22–34. [Google Scholar] [Crossref]

8. Craymah, J. P., Tuoyire, D. A., Adjei-Ofori, P., Ekor, O. E., Ninson, P. A., & Ewusi, M. H. K. A. (2024). Neonatal sepsis in a tertiary health facility in Cape Coast, Ghana. PLOS ONE, 19(5), e0302533. https://doi.org/10.1371/journal.pone.0302533 [Google Scholar] [Crossref]

9. Creswell, J. W., & Hirose, M. (2023). Mixed methods inquiry: Advances in design and integration. Sage Publications. [Google Scholar] [Crossref]

10. Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). Sage Publications. [Google Scholar] [Crossref]

11. Creswell, J. W., & Plano Clark, V. L. (2021). Designing and conducting mixed methods research (3rd ed.). Sage Publications. [Google Scholar] [Crossref]

12. Enyew, E. F., Getnet, M., Gebiru, A. M., & Dessie, G. (2025). Individual and community level determinants of neonatal mortality in Sub-Saharan Africa: Findings from recent demographic and health survey data. Italian Journal of Pediatrics, 51(1), 144. https://doi.org/10.1186/s13052-025-01997-7 [Google Scholar] [Crossref]

13. Ghana Health Service. (2022). Annual report on maternal and neonatal health. Accra: Ministry of Health. [Google Scholar] [Crossref]

14. Ghana Health Service. (2023). Annual health sector performance report. Accra: GHS. [Google Scholar] [Crossref]

15. Ghana Health Service. (2023). Annual health sector performance report: Northern Region. Tamale: GHS. [Google Scholar] [Crossref]

16. Ghana Statistical Service. (2021). 2021 Population and Housing Census: District analytical reports. Accra: GSS. [Google Scholar] [Crossref]

17. Ghana Statistical Service. (2021). 2021 Population and Housing Census: Population of regions and districts (Vol. 3A). Accra: GSS. [Google Scholar] [Crossref]

18. Ghana Statistical Service. (2023). District population projections. Accra: GSS. [Google Scholar] [Crossref]

19. Gilson, L. (2012). Health policy and systems research: A methodology reader. Alliance for Health Policy and Systems Research, WHO. [Google Scholar] [Crossref]

20. Konlan, K. D., Nukpezah, R. N., & Doat, A. R. (2024). Nurses' experiences in neonatal sepsis prevention and management: A qualitative cross-sectional study at selected hospitals in a metropolitan area. BMC Health Services Research, 24(1), 1298. https://doi.org/10.1186/s12913-024-11811-5 [Google Scholar] [Crossref]

21. Korstjens, I., & Moser, A. (2022). Series: Practical guidance to qualitative research. Part 6: Longitudinal qualitative and mixed-methods approaches for longitudinal and complex health themes in primary care research. European Journal of General Practice, 28(1), 118–124. https://doi.org/10.1080/13814788.2022.2053106 [Google Scholar] [Crossref]

22. Ministry of Health, Ghana. (2025). National Health Quality Strategy 2024–2030. https://www.moh.gov.gh/wp-content/uploads/2025/05/National-Health-Quality-Strategy-2024-2030.pdf [Google Scholar] [Crossref]

23. Moser, A., & Korstjens, I. (2023). Series: Practical guidance to qualitative research. Part 7: Qualitative evidence synthesis for emerging themes in primary care research: Scoping review, meta-ethnography and rapid realist review. European Journal of General Practice, 29(1). https://doi.org/10.1080/13814788.2023.2274467 [Google Scholar] [Crossref]

24. Mustapha, S. S., Zaidu, A. M., Azaria, N. T., Aliyu, S., & Abdulkadir, I. (2024). Neonatal sepsis—a peek into our findings in Northwest Nigeria: A prospective study. Egyptian Pediatric Association Gazette, 72, Article 53. https://doi.org/10.1186/s43054-024-00294-y [Google Scholar] [Crossref]

25. Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed-method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y [Google Scholar] [Crossref]

26. Rosa-Mangeret, F., Dupuis, M., Dewez, J. E., Muhe, L. M., Wagner, N., & Pfister, R. E. (2024). Challenges and opportunities in neonatal sepsis management: Insights from a survey among clinicians in 25 Sub-Saharan African countries. BMJ Paediatrics Open, 8(1), e002398. https://doi.org/10.1136/bmjpo-2023-002398 [Google Scholar] [Crossref]

27. Tafesse, N., Samuel, A., Geta, A., & others. (2022). Clinical ethical practice and associated factors in healthcare facilities in Ethiopia: A cross-sectional study. BMC Medical Ethics, 23(61). https://doi.org/10.1186/s12910-022-00800-0 [Google Scholar] [Crossref]

28. Traoré, F. B., Coulibaly, F., & Sow, M. (2024). Risk factors for neonatal sepsis in sub-Saharan Africa: A meta-analysis. Frontiers in Public Health, 12, 105–117. https://doi.org/10.3389/fpubh.2024.1272193 [Google Scholar] [Crossref]

29. UNICEF. (2021). Levels and trends in child mortality: Report 2021. https://data.unicef.org/resources/levels-and-trends-in-child-mortality/ [Google Scholar] [Crossref]

30. UNICEF. (2023). State of the world’s children: For every child, health. New York: United Nations Children’s Fund. [Google Scholar] [Crossref]

31. UNICEF. (2024). Neonatal survival estimates and projections. New York: UNICEF. [Google Scholar] [Crossref]

32. WHO. (2022). Improving neonatal outcomes in low-resource settings: A roadmap for action. Geneva: World Health Organization. [Google Scholar] [Crossref]

33. World Health Organization. (2022). Newborn health: Sepsis and infections. https://www.who.int/news-room/fact-sheets/detail/newborn-health [Google Scholar] [Crossref]

34. Wondifraw, E. B., Wudu, M. A., Tefera, B. D., & Wondie, K. Y. (2025). The burden of neonatal sepsis and its risk factors in Africa: A systematic review and meta-analysis. BMC Public Health, 25, Article 847. https://doi.org/10.1186/s12889-025-22076-w [Google Scholar] [Crossref]

35. Wondifraw, Z., Alemu, T., & Dagne, H. (2025). Prevalence and determinants of neonatal sepsis in Africa: A systematic review and meta-analysis. BMC Public Health, 25(1), 210–225. [Google Scholar] [Crossref]

36. Wudu, T., Gebrehiwot, H., & Assefa, D. (2025). Supply chain failures and neonatal mortality in rural health centers: Evidence from northern Ethiopia. Global Health Research and Policy, 10(2), 88–97. [Google Scholar] [Crossref]

• Tribal Child Nutrition and Health in District of Sundargarh: A Public Health Review of ICDS Intervention
• Knowledge, Attitudes and Practices Towards Prostate Cancer Screening Amongst Men Aged 40-60 Years in The Buea Health District: A Cross-Sectional Study
• Compliance with JCI Protocols: A Focus on Employee Safety
• Influence and Involvement of Teachers in Menstrual Hygiene Management of Female Secondary School Students in Kogi State, Nigeria
• A Critical Evaluation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bihar