Early Essential Newborn Care Is Associated With Reduced Adverse Neonatal Outcomes in a Tertiary Hospital in Da Nang, Viet Nam: A Pre- Post- Intervention Study

BackgroundTo improve maternal and neonatal outcomes, Vietnam implemented early essential newborn care (EENC) using clinical coaching and quality improvement self-assessments in hospitals to introduce policy, practice and environmental changes. Da Nang Hospital for Women and Children began EENC with caesarean section births to inform development of national guidelines. This study compared newborn outcomes after caesarean sections pre/post-EENC introduction.MethodsMaternity records of all live in-born hospital caesarean births and separate case records of the subpopulation admitted to the neonatal intensive care unit (NICU) were reviewed pre-EENC (November 2013–October 2014) and post-EENC (November 2014–October 2015) implementation. NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics.FindingsA total of 16 927 newborns were delivered by caesarean section: 7928 (46.8%) pre-EENC and 8999 post-EENC (53.2%). Total NICU admissions decreased from 16.7% to 11.8% (relative risk 0.71; 95% CI 0.66 to 0.76) after introduction of EENC. Compared with the pre-EENC period, babies with hypothermia on admission to the NICU declined from 5.0% to 3.7% (relative risk 0.73; 95% CI 0.63 to 0.84) and cases of sepsis from 3.2% to 0.8% (relative risk 0.26; 95% CI 0.20 to 0.33) post-EENC implementation. While more than half of all newborns in the NICU were fed something other than breastmilk pre-EENC introduction, 85.8% were exclusively breast fed post-EENC (relative risk 1.86; 95% CI 1.75 to 1.98). Preterm newborns <2000 g receiving kangaroo mother care (KMC) increased from 50% to 67% (relative risk 1.33; 95% CI 1.12 to 1.59).ConclusionThe EENC quality improvement approach with caesarean section births was associated with reduced NICU admissions, admissions with hypothermia and sepsis, and increased rates of exclusive breast feeding and KMC in the NICU.

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Family-centered postnatal training and adherence to newborn care practices in district hospitals in two Indian states: A quasi-experimental intervention study

10.1101/2021.03.15.21252605 ◽

2021 ◽

Author(s):

Sehj Kashyap ◽

Amanda F Spielman ◽

Nikhil Ramnarayan ◽

Sahana SD ◽

Rashmi Pant ◽

...

Keyword(s):

Health Outcomes ◽

Intervention Study ◽

Intervention Group ◽

Newborn Care ◽

Post Intervention ◽

Indian States ◽

District Hospitals ◽

Quasi Experimental ◽

Care Practices ◽

Family Centered

Background and Objectives: Globally, 2.5 million newborns die within the first month of life annually. The majority of deaths occur in low- and middle-income countries (LMICs), and many of these deaths happen at home. The study assessed if the Care Companion Program (CCP) an in-hospital, skills-based training given to families improves post-discharge maternal and neonatal health outcomes. Methods: This quasi-experimental pre-post intervention study design compared self-reported behavior and health outcomes among families before and after the CCP intervention. Intention to treat analysis included families regardless of their exposure to the intervention. Mixed effects logistic regression model, adjusted for confounders, was fit for all observations. Effects were expressed as Relative Risks (RR) with 95% Confidence Intervals (CI). Results: At 2-weeks post-delivery, telephone surveys were conducted in the pre (n = 3510) and post-intervention (n = 1474) groups from 11 district hospitals in the states of Karnataka and Punjab. The practice of dry cord care improved significantly by 4%, (RR = 1.04, 95%CI [1.04,1.06]) and skin to skin care by 78% (RR=1.78, 95%CI [1.37,2.27]) in the post-intervention group as compared to pre-intervention group. Furthermore, newborn complications reduced by 16% (RR=0.84, 95%CI [0.76,0.91]), mother complications by 12% (RR=0.88, 95%CI [0.79,0.97]) and newborn readmissions by 56% (RR=0.44, 95%CI [0.31,0.61]). Outpatient visits increased by 27% (RR=1.27, 95%CI [1.10,1.46]). However, outcomes of breastfeeding, mothers diet, hand-hygiene, and process indicator of being instructed on warning signs were not different. Conclusion: Postnatal care should incorporate pre-discharge multi-pronged training of families to improve essential maternal and newborn care practices. The CCP model runs on a public-private partnership and is integrated into existing health systems. Our findings demonstrate that it is possible to improve outcomes through a family-centered approach in India. The CCP model can be integrated into formalised hospital processes to relieve overburdened healthcare systems in LMIC settings.

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Implementation of the Early Essential Newborn Care (EENC) on neonatal outcomes in west China: an observational study

The Lancet ◽

10.1016/s0140-6736(18)32683-7 ◽

2018 ◽

Vol 392 ◽

pp. S54 ◽

Cited By ~ 3

Author(s):

Wen Qu ◽

Qing Yue ◽

Yan Wang ◽

Jinliuxing Yang ◽

Xiaona Huang ◽

...

Keyword(s):

Observational Study ◽

Newborn Care ◽

Neonatal Outcomes ◽

Essential Newborn Care ◽

West China

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Clinical decision making in basic emergency obstetric and newborn care among nurses and midwives: the role of the safe delivery mhealth application_pre-post-intervention study (research protocol)

Informatics for Health and Social Care ◽

10.1080/17538157.2020.1869007 ◽

2021 ◽

pp. 1-11

Author(s):

Aurore Nishimwe ◽

Marc Nyssen ◽

Latifat Ibisomi ◽

Daphney Nozizwe Conco

Keyword(s):

Decision Making ◽

Intervention Study ◽

Clinical Decision Making ◽

Newborn Care ◽

Clinical Decision ◽

Research Protocol ◽

Post Intervention ◽

Safe Delivery ◽

Nurses And Midwives

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Compliance and Microbial Findings Among Intensive Care Unit (ICU) Health Care Workers in a Tertiary Hospital in Sudan: Pre- and Post-Intervention Study

Public Health - Open Journal ◽

10.17140/phoj-1-112 ◽

2016 ◽

Vol 1 (3) ◽

pp. 61-65

Author(s):

Ikhlas Mohamed Hamed Elyas ◽

◽

Abushadi Abdelfadeel Hassan ◽

Adel Abu Elmaali Elsiddig ◽

◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Health Care Workers ◽

Intervention Study ◽

Tertiary Hospital ◽

Post Intervention ◽

Care Workers

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Effectiveness of Early Essential Newborn Care Implementation In Four Provinces of Western China

10.21203/rs.3.rs-1091428/v1 ◽

2021 ◽

Author(s):

Chenran Wang ◽

Yun Lin ◽

Hanxiyue Zhang ◽

Ge Yang ◽

Kun Tang ◽

...

Keyword(s):

Intervention Group ◽

Newborn Care ◽

Western China ◽

World Health ◽

Health Concern ◽

Control Group ◽

Neonatal Health ◽

Post Intervention ◽

Essential Newborn Care ◽

Postpartum Mothers

Abstract Introduction: Neonatal survival remains a public health concern globally. Early Essential Newborn Care (EENC) recommended by World Health Organization is a package of cost-effective interventions to improve neonatal health and development outcomes. In this study we aimed to explore the effectiveness of EENC implementation in four provinces of western China.Methods: A pre- and post-intervention investigations were conducted in 4 selected EENC intervention counties and 4 control counties of four western provinces of China, during June to August 2017 and December 2020 to April 2021 respectively. A mixed quantitative and qualitative approach was used for data collection and analysis. Data on the coverage of EENC practices were collected through post-intervention face-to-face questionnaire interview with postpartum mothers before hospital discharge. Hospital-reported data on neonatal health outcomes were obtained through mail surveys in both investigations. We also performed semi-structured interviews with stakeholders of policymakers, health staff, and postpartum mothers to learn their perceived usefulness of EENC implementation. Results: 599 mother-newborn pairs in the intervention group and 699 pairs in the control group participated in the post-intervention survey. With the confounding factor of province being controlled for, proportions of newborns receiving any skin to skin contact (99.50% vs. 49.07%), exclusive breastfeeding before discharge (92.57% vs. 63.80%), no applied medicine to the umbilical cord (98.50% vs. 9.73%), routine eye care (93.16% vs. 8.73%), and vitamin K1 administration (98.33% vs. 88.98%) were higher in the intervention group compared with the control group (P<0.05). Lower incidences of neonatal diarrhea (0.07% vs. 0.22%) and eye infection (0.04% vs. 0.29%) were reported in the intervention group than the control group (P<0.05). The enhanced satisfaction of stakeholders primarily manifests in belief acknowledgement, policy promotion, emotional support, health improvement, widely-acknowledged sustainability, and work support. Conclusion: EEEC-recommended core practices have been successfully introduced in pilot hospitals. The efficacy of EENC implementation should be highly recognized to accelerate the progress towards its national rolling out.

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Health staff experiences with the implementation of early essential newborn care guidelines in Da Nang municipality and Quang Nam province in Viet Nam

BMC Health Services Research ◽

10.1186/s12913-020-05449-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Marianne S. Morseth ◽

Tuan T. Nguyen ◽

Malene Skui ◽

Laura Terragni ◽

Quang V. Ngo ◽

...

Keyword(s):

Newborn Care ◽

Health Staff ◽

Viet Nam ◽

Essential Newborn Care ◽

Care Guidelines ◽

Staff Experiences

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The Effect of a Decision-Support mHealth Application on Maternal and Neonatal Outcomes in Two District Hospitals in Rwanda: Quasi-Experimental Study

10.21203/rs.3.rs-79352/v1 ◽

2020 ◽

Author(s):

Aurore Nishimwe ◽

Latifat Ibisomi ◽

Marc Nyssen ◽

Daphney Nozizwe Conco

Keyword(s):

Decision Support ◽

Post Partum ◽

Neonatal Resuscitation ◽

Newborn Care ◽

Neonatal Outcomes ◽

P Value ◽

Post Intervention ◽

District Hospitals ◽

Quasi Experimental ◽

Maternal And Neonatal Outcomes

Abstract Background: Globally, mobile health (mHealth) applications are known for their potential to improve healthcare providers’ access to relevant and reliable health information. Besides, electronic decision support tools, such as the Safe Delivery mHealth Application (SDA), help to reduce clinical errors and to ensure quality care at the point of service delivery. The current study assessed the effects of the SDA on basic emergency obstetric and newborn care (BEmONC) outcomes for the most frequent complications in Rwanda; post-partum haemorrhage (PPH) and newborn asphyxia and its complications.Methods: The study adopted a quasi-experimental design. A pre-intervention record review of the BEmONC outcomes: Apgar score and PPH progressions, was conducted. The intervention took place in two district hospitals in Rwanda and entails the implementation of the SDA for six months. Six months’ post-intervention, the effect of the SDA on BEmONC outcomes was evaluated. The study included 327 participants (114 cases of PPH and 213 cases of neonatal complications). The analysis compared the outcome variables between the baseline and the endline data. Fisher’s exact test was used to compare the proportions and test between-group differences and significance level set at p<0.05. Results: Unstable newborn outcome following neonatal resuscitation was recorded in 61.90% and 27.59% newborns cases at baseline and endline respectively, P-value = 0.000. Unstable maternal outcome following PPH management was recorded in 19.40 % and 6.38% maternal cases at baseline and endline respectively, P-value = 0.048. There was a significant association between the SDA intervention and newborns’ and maternal’ outcomes following neonatal resuscitation and PPH management, 6 months after baseline.Conclusion: The use of the SDA supported nurses and midwives in the management of PPH and neonatal resuscitation thus improved maternal and neonatal outcomes after 6 months of the SDA intervention.

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The Effect of a Decision-Support mHealth Application on Maternal and Neonatal Outcomes in Two District Hospitals in Rwanda: Quasi-Experimental Study

10.21203/rs.3.rs-62197/v1 ◽

2020 ◽

Author(s):

Aurore NISHIMWE ◽

Latifat IBISOMI ◽

Marc NYSSEN ◽

Daphney NOZIZWE CONCO

Keyword(s):

Decision Support ◽

Post Partum ◽

Neonatal Resuscitation ◽

Newborn Care ◽

Neonatal Outcomes ◽

P Value ◽

Post Intervention ◽

District Hospitals ◽

Quasi Experimental ◽

Maternal And Neonatal Outcomes

Abstract Background: Globally, mobile health (mHealth) applications are known for their potential to improve healthcare providers’ access to relevant and reliable health information. Besides, electronic decision support tools, such as the Safe Delivery mHealth Application (SDA), help to reduce clinical errors and to ensure quality care at the point of service delivery. The current study assessed the effects of the SDA on basic emergency obstetric and newborn care (BEmONC) outcomes for the most frequent complications in Rwanda; post-partum haemorrhage (PPH) and newborn asphyxia and its complications.Methods: The study adopted a quasi-experimental design. A pre-intervention record review of the BEmONC outcomes: Apgar score and PPH progressions, was conducted. The intervention took place in two district hospitals in Rwanda and entails the implementation of the SDA for six months. Six months’ post-intervention, the effect of the SDA on BEmONC outcomes was evaluated. The study included 327 participants (114 cases of PPH and 213 cases of neonatal complications). The analysis compared the outcome variables between the baseline and the endline data. Fisher’s exact test was used to compare the proportions and test between-group differences and significance level set at p<0.05. Results: Unstable newborn outcome following neonatal resuscitation was recorded in 61.90% and 27.59% newborns cases at baseline and endline respectively, P-value = 0.000. Unstable maternal outcome following PPH management was recorded in 19.40 % and 6.38% maternal cases at baseline and endline respectively, P-value = 0.048. There was a significant association between the SDA intervention and newborns’ and maternal’ outcomes following neonatal resuscitation and PPH management, 6 months after baseline.Conclusion: The use of the SDA supported nurses and midwives in the management of PPH and neonatal resuscitation thus improved maternal and neonatal outcomes after 6 months of the SDA intervention.

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