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

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.