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‘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
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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

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