Enweronu-Laryea Christabel C, Nsiah-Boateng Eric, Andoh Hilary D, Frimpong-Barfi Audrey, Asenso-Boadi Francis M, Aikins Moses
Department of Child Health, University of Ghana School of Medicine and Dentistry, Ghana.
School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
Ghana Med J. 2019 Dec;53(4):256-266. doi: 10.4314/gmj.v53i4.2.
Neonatal mortality has been decreasing slowly in Ghana despite investments in maternal-newborn services. Although community-based interventions are effective in reducing newborn deaths, hospital-based services provide better health outcomes.
To examine the process and cost of hospital-based services for perinatal asphyxia and low birth weight/preterm at a district and a regional level referral hospital in Ghana.
A cross-sectional study was conducted at 2 hospitals in Greater Accra Region during May-July 2016. Term infants with perinatal asphyxia and low birth weight/preterm infants referred for special care within 24hours after birth were eligible. Time-driven activity-based costing (TDABC) approach was used to examine the process and cost of all activities in the full cycle of care from admission until discharge or death. Costs were analysed from health provider's perspective.
Sixty-two newborns (perinatal asphyxia 27, low-birth-weight/preterm 35) were enrolled. Cost of care was proportionately related to length-of-stay. Personnel costs constituted over 95% of direct costs, and all resources including personnel, equipment and supplies were overstretched.
TDABC analysis revealed gaps in the organization, process and financing of neonatal services that undermined the quality of care for hospitalized newborns. The study provides baseline cost data for future cost-effectiveness studies on neonatal services in Ghana.
Authors received no external funding for the study.
尽管加纳在孕产妇-新生儿服务方面投入了资金，但新生儿死亡率仍在缓慢下降。虽然基于社区的干预措施在减少新生儿死亡方面有效，但基于医院的服务能提供更好的健康结果。
在加纳的一家区级和一家区域级转诊医院，研究基于医院的围产期窒息及低出生体重/早产服务的过程和成本。
2016年5月至7月在大阿克拉地区的2家医院进行了一项横断面研究。纳入出生后24小时内转诊接受特殊护理的围产期窒息足月儿和低出生体重/早产儿。采用时间驱动作业成本法（TDABC）来研究从入院到出院或死亡的整个护理周期中所有活动的过程和成本。从医疗服务提供者的角度分析成本。
共纳入62名新生儿（围产期窒息27名，低出生体重/早产35名）。护理成本与住院时间成比例相关。人员成本占直接成本的95%以上，包括人员、设备和物资在内的所有资源都过度紧张。
TDABC分析揭示了新生儿服务在组织、流程和资金方面的差距，这些差距损害了住院新生儿的护理质量。该研究为加纳未来新生儿服务的成本效益研究提供了基线成本数据。
作者未获得该研究的外部资金。
