Feeding Practices and Nutritional Outcomes in Neonates with Sepsis in Rural Health Facilities of Northern Ghana: A Mixed-Methods Analysis.

Authors

  • Mohammed Ali University of Brazil, Campinas.
  • Rashid Bawumia Ali University for Development Studies, Tamale-Ghana.
  • Barnabas Kwame Yeboah Africa Centres for Disease Prevention and Control, Ethiopia
  • Elizabeth Asor Mensah Nursing and Midwifery Training School -Teshie, Accra
  • Victor Nwadike University of Brazil, Campinas

DOI:

https://doi.org/10.47941/ijhmnp.3413

Keywords:

Neonatal Sepsis, Feeding Practices, Rural Ghana, Health Facilities

Abstract

Purpose: To study feeding habits, nutritional adequacy, and rehabilitation practices among septic neonates in rural Northern Ghana, identifying critical gaps in diagnosis, referral, and feeding guidelines that contribute to poor outcomes.

Methodology: A convergent mixed-methods design was employed in Gushegu and Nkwanta South. The study included 322 neonates diagnosed with sepsis, 20–25 caregivers, and 10–12 healthcare providers selected through multistage sampling. Quantitative data were analyzed using SPSS and STATA, while qualitative interviews were coded with NVivo. Ethical approval was obtained (GHS-ERC008/03/20), and rigorous measures were implemented to ensure data quality and protect participants’ rights.

Findings: Exclusive breastfeeding (EBF) was practiced in 58.1% of septic neonates, with slightly higher prevalence in Nkwanta South (59.6%) compared to Gushegu (56.6%). The mean age of admission was 6.4 days, and 59.0% experienced feeding delays exceeding 12 hours. Early EBF was associated with significant weight gain (18.4 ± 2.4 g/day), faster recovery (6.2 ± 1.2 days), and high tolerance (91.2%). Recovery odds ratios were higher in Nkwanta South (2.9) than Gushegu (2.6). Daily feeding frequency correlated positively with weight gain (r = 0.62), while delayed feeding was negatively associated with hospitalization duration (ρ = –0.47, p < 0.01).

Unique Contribution to Theory, Practice, and Policy: Early EBF enhances sepsis recovery in the newborns in low-income setting conditions defined by cultural factors, structural impediments and care practices. The study contributes to our understanding of theory by connecting feeding to recovery pathways, practice by focusing on caregiver knowledge and provider training, and policy by advocating for integrated protocols, more robust referral systems, and supervision practices to minimize neonatal death among the poor.

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Author Biographies

Mohammed Ali, University of Brazil, Campinas.

PhD Candidate, Graduate School

Rashid Bawumia Ali , University for Development Studies, Tamale-Ghana.

Senior Research Assistant, School of Nursing and Midwifery

Barnabas Kwame Yeboah, Africa Centres for Disease Prevention and Control, Ethiopia

Senior Community Health Specialist

Elizabeth Asor Mensah, Nursing and Midwifery Training School -Teshie, Accra

Deputy Chief Nursing Health Tutor

Victor Nwadike, University of Brazil, Campinas

Director of Studies

References

Abukari, Z., Mohammed, A., & Fuseini, A. G. (2021). Challenges in neonatal care delivery in Northern Ghana: A health systems perspective. Ghana Medical Journal, 55(2), 89–96.

Adedokun, S. T., Yaya, S., & Ahinkorah, B. O. (2022). Cultural beliefs and infant feeding practices in Ghana. BMC Public Health, 22(1), 112.

Adedokun, S. T., Yaya, S., & Olorunsaiye, C. Z. (2022). Cultural beliefs and breastfeeding practices in sub-Saharan Africa: A systematic review. International Breastfeeding Journal, 17(1), 1–12. https://doi.org/10.1186/s13006-022-00468-6

Adedokun, S. T., Yaya, S., & Uthman, O. A. (2022). Cultural beliefs and neonatal feeding practices in sub-Saharan Africa. BMC Public Health, 22(1), 1–10.

Afeke, I., Hirose, M., Amegan-Aho, K. H., Haertel, C., Becker, M., Moustafa, A., et al. (2021). Neonatal and young infant sepsis in a regional hospital in Ghana. Open Journal of Pediatrics, 11(3), 281–300. https://www.scirp.org/pdf/ojped_2021062115593595.pdf

Aguayo, V. M., Kahn, S., Ismael, C., & Mehta, S. (2007). Effect of early infant feeding practices on infection-specific neonatal mortality: An investigation of the causal links with observational data from rural Ghana. The American Journal of Clinical Nutrition, 86(4), 1126–1131. https://doi.org/10.1093/ajcn/86.4.1126

Agyekum, M. W., Codjoe, S. N. A., Dake, F. A. A., & Abu, M. (2022). Is infant birth weight and mothers’ perceived birth size associated with the practice of exclusive breastfeeding in Ghana? PLOS ONE, 17(5), e0267179. https://doi.org/10.1371/journal.pone.0267179

Akindolire, A., Talbert, A., & Sinha, I. (2020). Evidence that informs feeding practices in very low birthweight and very preterm infants in sub-Saharan Africa: An overview of systematic reviews. BMJ Paediatrics Open, 4(1), e000724. https://doi.org/10.1136/bmjpo-2020-000724

Amaniyo, L., Dektar, B., & Nakibuuka, V. (2025). Prevalence of sub-optimal feeding practices and associated factors in very low birth weight infants in Uganda. Frontiers in Pediatrics, 13, 1558163. https://doi.org/10.3389/fped.2025.1558163

Appiah, P. K., Amu, H., Osei, E., Konlan, K. D., Mumuni, I. H., & Verner, O. N. (2021). Breastfeeding and weaning practices among mothers in Ghana: A population-based cross-sectional study. PLOS ONE, 16(11), e0259442. https://doi.org/10.1371/journal.pone.0259442

Aryeetey, R. N., Lartey, A., & Brown, K. (2021). Barriers to optimal infant feeding practices in Ghana: A qualitative study. Maternal & Child Nutrition, 17(1), e13100.

Aryeetey, R. N. O., Adjuik, M., & Goh, H. (2021). Breastfeeding beliefs and practices among mothers in rural Ghana: A qualitative study. International Breastfeeding Journal, 16(1), 1–10. https://doi.org/10.1186/s13006-021-00384-2

Ali, M., Ali, R. B., & Nwadike, V. (2025). Predictive Influence of Neonatal APGAR Scores on Early Childhood Feeding Outcomes in Gushegu and Nkwanta South Districts of Ghana: A Prospective Cohort Study." Volume. 3 Issue. 11, November - 2025 International Journal of Modern Science and Research Technology (IJMSRT), www.ijmsrt.com. PP :- 170-180

Biks, G. A., Berhane, A., & Worku, A. (2021). Barriers to exclusive breastfeeding in Ethiopia: A qualitative study. International Breastfeeding Journal, 16(1), 1–9.

Braun, V., & Clarke, V. (2021). Thematic analysis: A practical guide. London: Sage Publications.

Champion, V. L., & Skinner, C. S. (2008). The health belief model. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (pp. 45–65). San Francisco: Jossey-Bass.

Creswell, J. W., & Plano Clark, V. L. (2022). Designing and conducting mixed methods research (4th ed.). Thousand Oaks: Sage Publications.

Edmond, K. M., Zandoh, C., Quigley, M. A., Amenga-Etego, S., Owusu-Agyei, S., & Kirkwood, B. R. (2006). Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics, 117(3), e380–e386. https://doi.org/10.1542/peds.2005-1496

Fetters, M. D., Curry, L. A., & Creswell, J. W. (2022). Achieving integration in mixed methods designs—principles and practices. Health Services Research, 57(1), 5–20. https://doi.org/10.1111/1475-6773.13957

Freysdottir, D. (2023). Early standardized enteral nutrition management of the preterm neonate: Clinical pathway. Johns Hopkins All Children’s Hospital. https://www.hopkinsmedicine.org/-/media/files/allchildrens/clinical-pathways/early-enteral-nutrition-6_14_23.pdf

Freysdottir, H. (2023). Enteral nutrition in neonatal sepsis: Clinical protocols and outcomes. Journal of Neonatal Care, 29(2), 145–158.

Ghana Health Service. (2023). District Health Information Management System II (DHIMS II) annual summary report. Accra: Ghana Health Service.

Ghana Statistical Service. (2022). Exclusive breastfeeding in Ghana: District-level analysis from GDHS and PHC. Accra: Ghana Statistical Service.

Ghana Statistical Service. (2023). Ghana Demographic and Health Survey 2022. Accra: Ghana Statistical Service. https://www.statsghana.gov.gh

Jiang, K., Zhang, Z., Huang, X., Hao, C., Huang, H., Liu, W., et al. (2025). Global, regional, and national incidence and mortality of neonatal sepsis and other neonatal infections, 1990–2021 and predictions to 2050. BMC Pediatrics, 25, 711. https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-025-06044-2

Khan, J., Vesel, L., Bahl, R., & Martines, J. (2022). Timing of breastfeeding initiation and its impact on neonatal mortality: A systematic review. The Lancet Global Health, 10(1), e61–e72. https://doi.org/10.1016/S2214-109X(21)00450-6

Mu, C., Liu, F., Tian, T., Feng, M., Dang, X., Xie, L., et al. (2025). Analysis of the global burden and key risk factors of neonatal sepsis and other neonatal infections in 204 countries and territories, 1990–2021. Frontiers in Medicine, 12, 1536948. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1536948/full

Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1), 1–13. https://doi.org/10.1177/1609406917733847

Ogbo, F. A., Page, A., Idoko, J., Claudio, F., Agho, K. E., & Eastwood, J. (2017). Barriers to exclusive breastfeeding in Nigeria: A population-based study. International Breastfeeding Journal, 12(1), 1–10. https://doi.org/10.1186/s13006-017-0117-0

Peters, D. H., El-Saharty, S., Siadat, B., Janovsky, K., & Vujicic, M. (2020). Improving health service delivery in developing countries: From evidence to action. Washington, DC: World Bank Publications.

Peters, D. H., Tran, N. T., & Adam, T. (2020). Implementation research in health: A practical guide. Geneva: World Health Organization. https://apps.who.int/iris/handle/10665/44365

Quitadamo, P., Palumbo, G., & Gatta, C. (2023). Nutritional support in neonatal sepsis: Evidence-based practices. Pediatric Nutrition Journal, 38(1), 33–42.

Quitadamo, P. A., Comegna, L., Zambianco, A., Palumbo, G., Gentile, M. A., & Mondelli, A. (2023). Impact of enteral nutrition on clinical outcomes in very low birth weight infants in the NICU: A single-center retrospective cohort study. Nutrients, 17(7), 1138. https://doi.org/10.3390/nu17071138

Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., … Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7

World Health Organization. (2020). Infant and young child feeding: Guiding principles for complementary feeding of the breastfed child. WHO. https://www.who.int/publications/i/item/9241593431

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Published

2026-01-02

How to Cite

Ali, M., Ali , R. B., Yeboah, B. K., Mensah, E. A., & Nwadike, V. (2026). Feeding Practices and Nutritional Outcomes in Neonates with Sepsis in Rural Health Facilities of Northern Ghana: A Mixed-Methods Analysis. International Journal of Health, Medicine and Nursing Practice, 9(1), 1–16. https://doi.org/10.47941/ijhmnp.3413

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