Cultural Beliefs and Health-Seeking Practices Among Postnatal Mothers in Ghana,Bono East Region,Regarding Newborn Danger Signs

Research Design

The study adopted a qualitative approach using the exploratory descriptive research design (Elhami & Khoshnevisan, 2022). The study design was ideal because it provided a flexible and efficient method for interacting with participants about their experiences. This was done by relying on their own words and experiences with regard to beliefs and practices on newborn danger signs.

Study Setting

The research was carried out at the Holy Family Hospital, in Techiman within the Bono East region of Ghana. The Bono East region is one of the 16 regions of Ghana and the hospital serves as the only referral center for Newborn cases in the Bono East region. It also has the largest Neonatal Intensive Care Unit (NICU) in the region where all manner of specialist services are provided. The Holy Family Hospital is the largest amongst five hospitals in the municipality and the main referral point for other hospitals and health facilities within the municipality and region.

Research Question

The study was guided by the research question below:

In what ways do cultural beliefs and practices influence health-seeking behaviors of postnatal mothers regarding newborn danger signs?

Population and Sampling

The study initially recruited 20 participants who met the inclusion criteria through a purposive sampling technique (Campbell et al., 2020). Participants were recruited from the postnatal wards and NICU of the Holy Family Hospital in the Bono East Region which was known to the researchers. There was however no threat to power balance between the researchers and participants as the researchers had no prior contact with participants before data collection. However, data saturation was obtained by the fifteenth participant as no new information was identified to address our study's aims (Braun & Clarke, 2021a). The remaining postnatal mothers were discharged with an explanation from the principal researcher. The inclusion criteria for the study were postnatal mothers whose newborns had an ailment, which caused them to return to the hospital on admission to either the NICU or postnatal ward. However postnatal mothers who had an ailment and had newborns on admission were excluded from the study. Postnatal mothers with ailments were identified through their documented diagnosis at the postnatal wards where they were admitted. The participants were subsequently counseled with the rational for their exclusion from the study clearly explained, while reassurance was provided regarding continuity of care for both mothers and their babies.

Data Collection

Participants who met the inclusion criteria were interviewed face to face using a semistructured interview guide attached as Supplemental Appendix 1. The semistructured interview guide was developed through review of in-depth literature based on the objectives of the study. The guide covered key areas such as beliefs and practices as well as participants health seeking behavior toward the beliefs. The interviews were conducted by the principal researcher who had no prior contact with participants before the interviews were conducted. The principal researcher conducted the interviews due to her knowledge in midwifery and qualitative research. The entire process of data collection lasted from February to April 2024. The research instrument was piloted on two postnatal mothers who were not included in the study by the principal investigator before the commencement of the interview. This was done to ensure that the interview guide was suitable for the target participants. After the piloting, further review was done by all researchers to ensure accuracy of the interview guide. Research participants were identified with the help of the midwifery managers at the various wards. The aims, methods, advantages, and the potential risk of the study were explained to participants in the native language for easy understanding by the ward managers. Those who met the inclusion criteria were referred to the principal researcher for further engagements for the interview. Participants were assured of Privacy, anonymity and confidentiality during data collection to gain their trust and confidence in the study. Voluntary participation was also ensured, and the participants were informed about their right to participate in or withdraw from the interview, with the assurance that their decision will not impact the care provided to their babies at the facility. A quiet office was obtained at the hospital at convenience after their consent was sought and each interview lasted between 40 and 60 min per participant which was audio recorded. Field dairy was kept during data collection process by the principal researcher to record nonverbal cues from participants to ensure rich data. In order to familiarize with the data obtained, audio recordings were made available to all researchers.

Data Analysis

Data were analyzed concurrently with data collection using Braun and Clarke (2021a) thematic analysis approach. Themes were derived deductively with the aid of the data collection tool (semistructured interview guide, Supplemental Appendix 1). All interviews were transcribed verbatim, and each transcript was independently reviewed by two researchers to ensure thorough understanding of the content. However, some interviews which were conducted in Twi were translated into English by the principal researcher who is well vexed with the twi language as part of her primary spoken languages. Words without English translation were replaced with words closer in meaning. Initial codes were generated capturing significant features and patterns across datasets. These codes were then reviewed by all researchers across the entire dataset before progressing to the formation of themes and subthemes. Any discrepancies in coding or interpretation were further discussed among researchers to arrive at consensus. Upon confirmation by all authors the generated themes and subthemes were refined. Final report of findings was produced based on the themes and subthemes after further confirmation.

Methodological Rigor (Trustworthiness)

The authors adopted the Guba (1981) criteria to ensure trustworthiness of the study. These criteria, credibility, transferability, dependability, and confirmability, are essential for establishing rigor in qualitative research.

Credibility was maintained through sustained engagement with participants throughout the data collection process. Additionally, regular debriefing sessions by authors was ensured to discuss the research methodology and the data collection procedures.

Transferability was achieved through an in-depth description of the study design, participant selection, and data collection methods. Data saturation was also ensured to obtain rich data to aid transferability. Through an audit trail and construction of appropriate interview guide using probing questions dependability was ensured. To ensure confirmability, the authors ensured that findings obtained from the data collection were a true representation of data obtained from participants by making sure to carefully confirm findings.

Triangulation refers to the use of multiple methods, data sources, theories, or investigators to enhance the credibility, validity, and richness of a study's findings by establishing identifiable patterns (Stahl & King, 2020). Triangulation was carried out using participants’ primary data sources (such as in-depth interviews) and field notes which was obtained during data collection. These provided an insight into the subjective experiences, beliefs, and practices of the participants in the study.

Ethical Consideration

The study was approved by Institutional Review Board of the Christian Health Association of Ghana (CHAG) with IRB number CHAG-IRB02082023. The research department of Holy Family Hospital granted the approval to recruit postnatal mothers from the NICU and postnatal ward. The study's objectives, benefits, potential risks, and rewards were explained in detail to participants to obtain their consent. Verbal and written consent was obtained from participants before the commencement of the interview after assuring them of anonymity and confidentiality. Participants were informed about their right to participate in or withdraw from the interview, with the assurance that their decision will not impact the care provided to their babies at the facility. The study ensured anonymity by assigning participants with the pseudonyms “DS.”

Organization of Themes

Two major themes and 5 subthemes emerged from the study from the analysis of data using the Braun and Clarke (2021a) approach. This is described in Table 2.

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Table 2.

Summary of Themes and Subthemes.

Themes	Subthemes
Beliefs on Newborn Danger Signs	Spiritual causes Attitude towards beliefs
Practices on management of newborn danger signs	Cultural remedies Alternative remedies Reason for choice of remedy

Spiritual Causes

The findings from the current study revealed the profound influence of cultural and spiritual beliefs on the health-seeking practices among postnatal mothers. Spiritual interpretation to newborn illness, such as the belief that conditions like jaundice, sepsis, and diarrhea have spiritual origins were prevalent among participants. The findings also revealed that, newborn illnesses can be caused by spiritual forces such as “evil eyes or spirits.” This is consistent with findings from various studies across different cultural environments. For instance, a study by Jahan and Islam (2022) in Bangladesh demonstrated that, new mothers and their babies who are considered vulnerable to evil spirits and evil eyes are made to stay inside to avoid contracting illness from evil spirits. Similarly, Rent et al. (2022) revealed that, in Ghana, healthcare providers described an ancient cultural belief where “evil eye” was seen as the cause of newborn illness and that, traditional healers or herbalists were seen to be better equipped to treat such conditions than the health practitioners. The phenomenon of “evil eyes” as a source of newborn illness in Ghana has been documented by Bell et al. (2020).

In Africa belief system in the supernatural elements are often considered as underlying causes of health issues in infants. Similar beliefs are also identified across regions in Ghana. Such spiritual perspectives can lead to a preference for nonmedical remedies and reliance on traditional healers rather than seeking orthodox medical care. This can delay seeking timely medical interventions thereby exacerbating the severity of newborn conditions. A similar belief system in line with the current study was identified by Joshi et al. (2023) in India where newborn illness was attributed to evil eye and various measures were used to cast off the evil eye from the baby.

Contrasting evidence from studies in other settings demonstrates the inconsistencies in the influence of spiritual beliefs on health seeking practices. Abate et al. (2022) and Sivalogan et al. (2023) revealed that even though traditional beliefs were identified as the cause of illness, it did not hinder health seeking for medical interventions as majority of participants sought medical interventions while few sought alternative treatment for their newborns. Similarly, the current findings contrast with a study by Tette et al. (2020) in Ghana where most caregivers avoided the use of home remedies before seeking professional care. Only a small number administered some form of home treatment including paracetamol before seeking care, even though they were aware of traditional beliefs. Mothers were likely to recognize danger signs as medical conditions requiring immediate hospital management rather than attributing to spiritual causes.

These contrasting findings suggest that, the influence of spiritual beliefs on health seeking practices can vary essentially depending on the effectiveness of health education programs and accessibility of health services. In areas where mothers had great exposure to health education and access to healthcare, spiritual beliefs may have less effect on newborn illness and heath seeking practices. Therefore health providers should collaborate with traditional healers and community leaders to enable an effective strategy to bridge the gap between traditional beliefs and modern healthcare practices.

Attitude Toward Beliefs

In examining the attitude of postnatal mothers toward traditional beliefs regarding newborn danger signs, it is important to recognize the different emotional responses and their impact on health seeking practices. The influence of social networks particularly family and community members played a vital role in shaping mother's attitudes and health-seeking behaviors. The study revealed that, the advice and pressure from elders and peers compelled mothers to adhere to traditional beliefs and practices even when they harbored doubts. The study suggests a response of negative attitude towards these beliefs based on attitudes of hesitation and desperation when confronted with traditional beliefs about newborn danger signs. Similar attitudes were reported in a study by Abdullah et al. (2021) in Bangladesh, where caregivers showed initial doubt toward traditional practices but further relied on advice from traditional healers before considering hospital care. Studies by Ani-Amponsah et al. (2023) and Kanton et al. (2023) revealed that, when it came to cultural beliefs and practices to newborn care, some participants indicated having no choice but to follow the family which they were married, though they were not happy with the treatment of choice for the neonates.

Unlike the findings of this study, findings from Ramamonjinirina et al. (2022) which contradict the finding indicated that majority of mothers sought hospital care as their first option when faced with newborn danger signs even when traditional beliefs existed. This suggests a more positive attitude toward medical care in their study area, promoting better health outcomes. The findings of the study suggest that, social approval and fear of social repercussions can override personal beliefs when seeking care for newborn danger signs.

Cultural Remedies

Cultural diversity is associated with different beliefs and practices which influence utilization of healthcare in the treatment of various conditions and disorders of the newborn in many settings of the world (Adongo et al., 2024).

One interesting key finding of this study is the strong preference for cultural remedies among participants over modern medicine. This was based on the belief that newborn illness had spiritual causes and thus, requires cultural remedies instead of modern treatment. Participants frequently cited local herbs and specific practices, such as chameleon bracelet to ward off evil spirits, use of fresh tomatoes for skin infections and application of local gin for conditions like measles as quicker and more effective remedies than hospital interventions. These findings are consistent with Rent et al. (2022) in Ghana who found cultural remedies such as tying of chameleon amulet to ward off evil spirits causing newborn infections. Similar study in Ghana by Kanton et al. (2023) also revealed the preference of home remedies using traditional herbs by caregivers as a preferred care seeking practice for newborn ailments. The findings from the study suggest a preference for cultural remedies based on spiritual beliefs for newborn illness to be predominant in most regions of Ghana. However, a previous study in India by Joshi et al. (2023) revealed similar findings to that of the current study where spiritual remedies such as spiritual incantations, oil for massaging the body, application of holy flame and giving holy water were considered effective for speedy recovery of newborn illness by warding off evil spirits from the baby. Similarly, a study in Ethiopia by Aynalem et al. (2023) also revealed that, reliance on traditional healers, attributing newborn illnesses to supernatural causes grounded in cultural beliefs, hindered prompt medical care for neonatal danger signs. Cultural remedies often hold deep significance within communities and are integrated into daily practices and beliefs. The perceived effectiveness of these remedies significantly suggest its continued use by mothers instead of seeking care for newborn ailments. These remedies may offer familiar and accessible alternative to modern medicine. Also remedies such as herbs and tomatoes are locally available resources. This further enhances the appeal of these remedies thereby making them not only culturally acceptable but also practical in everyday life in communities.

However, a previous study by Adongo et al. (2024) contradicts these findings as the use of modern medicine and health facilities were considered the preferred choice for most participants compared to traditional healers and herbal medicine. Similarly, studies by Cáceres et al. (2023) and Odwe et al. (2020) also revealed that, in the phase of traditional beliefs as the cause of newborn illness, most participants did not consider it as a barrier to seeking modern medical interventions for their newborn illness which is not in agreement with the findings of the current study. This indicates a shift in some areas toward modern medical care, even while cultural practices remain influential.

While the current findings reveal the efficacy and acceptance of cultural remedies by most communities, it also raises concerns about the potential risk of neglecting modern medical care particularly for serious newborn conditions that may require professional interventions. Balancing the need for traditional and modern healthcare approaches could lead to proper maternal and newborn health outcomes. This can be achieved by stakeholders in healthcare acknowledging cultural beliefs and finding ways to incorporate them into healthcare strategies. This can enhance trust and cooperation with the communities where such practices are predominant.

Alternative Remedies

Alternative remedies were also found to play a significant role in health-seeking practices among postnatal mothers. The study revealed that, health seeking behaviors are often influenced by cultural beliefs, maternal personal experiences with treatment regimen as well as access to health resources. The study also found a poor connection between the use of traditional remedies and modern health care practices. While some participants expressed a preference for herbal remedies, there was a notable reliance on hospital care when these herbal remedies fail. This reliance on traditional medicine aligns with findings from Kanton et al. (2023) who noted the use of herbal treatment and pharmaceutical medicine as the first line of action before turning to hospital interventions when herbal treatments failed. Similarly, a study in India by Joshi et al. (2023), demonstrated a reliance on home remedies as a first line of treatment by mothers before seeking medical care when symptoms worsen. Consistent with the current findings is a previous study by Rent et al. (2022) in Ghana, where health providers identified families to have consulted spiritual healers first and only sought care at the hospital when spiritual remedies failed.

This preference for alternative remedies is often driven by factors such as accessibility, cost, and cultural beliefs as well as knowledge on the severity of conditions. Many mothers may choose herbal treatments due to their familiarity and perceived safety. However, this approach suggests a delay in health seeking for appropriate medical interventions which may lead to increase in newborn mortality.

In contrast, a study conducted by Adongo et al. (2024) revealed an overall high patronage of health facilities as a first line of treatment as compared to traditional healers and home remedies. The outcome of the current findings is also contrary to the findings from Madagascar by Ramamonjinirina et al. (2022) who found majority of participants who experience neonatal danger signs to have sought care from health personnel immediately without considering other remedies.

The positive health-seeking practices of the participants were attributed to increase awareness of danger signs during pregnancy and postpartum periods as well as the educational level of women and their spouse.

Reasons for Choice of Remedy

The reasons behind the choice of remedies were also found to be influential in shaping health-seeking practices among postnatal mothers. Financial constraints were identified as a reason for opting for nonmedical remedies, while a lack of trust in the efficacy of treatments influenced the choice of hospital care. These findings are supported by Adongo et al. (2024), Dizoagl et al. (2025) and Yeboah et al. (2025) who identified efficacy of treatment and attitudes of health personal as barriers to the choice of remedy for newborn care in Ghana. A previous study by Kanton et al. (2023) in Ghana, in alignment with this study discovered that, few participants identified financial constraints as influencing the reason for their choice of health-seeking practice. Abdullah et al. (2021) posits that, inadequate knowledge of danger signs, perceived cultural beliefs, treatment cost and transport expenses as well as lack of decision making power by mothers are reasons for choice of remedy and health seeking among mothers in Bangladesh. Understanding these factors equips healthcare providers to effectively address barriers to healthcare accessibility. These findings emphasize the need for culturally tailored health education initiatives that integrate respect for traditional beliefs while promoting evidenced based neonatal care practices.