Factors Associated with Delayed Presentation of Sick Neonates at a Nigerian Tertiary Facility

Background: Neonatal mortality is a high-priority public health concern in Nigeria, with delayed initiation of adequate health care for sick neonates contributing to unfavourable outcomes. This indicates the urgent need to address the barriers to timely access to healthcare for neonates in desperate situations. Objectives: To determine the factors associated with the delay in presentation of sick neonates at the University College Hospital, Ibadan. Methods: A sequential-exploratory mixed-method approach was used. Data were collected using a semi-structured questionnaire adapted from the Healthcare-Seeking Behaviour and Patient Satisfaction Questionnaire. Qualitative interviews with caregivers of neonates were analysed using thematic analysis. Results: Of the 312 neonates, 151(48.4%) had delay in presentation (DIP) while 63(20.0%) had delayed health seeking. The mean delay in presentation and delayed health-seeking was 46±86hrs and 33±73hrs, respectively. The reasons for DIP were predominantly previous treatment (48; 31.8%), lack of awareness in the mother (46; 30.5%), and thoughts that the illness would resolve (33; 21.9%). The reasons for DHS included the belief that illness would resolve (22; 8.6%), lack of maternal awareness (20; 7.8%), and cost (10; 3.9%). In multivariate analysis, age <7 days was a predictor of both DIP and DHS (AOR:0.316, CI:0.19-0.52) and (AOR:0.285, CI:0.15-0.53), respectively. Prematurity protected against DIP (AOR:0.437, 95%CI: 0.26-0.72) but increased the likelihood of DHS (AOR:2.794, CI:1.36-5.73). Conclusion: Delay in healthcare seeking among caregivers of neonates remains high. Efforts to improve caregivers' knowledge of neonatal illnesses should be promoted to enhance neonatal care.