Neonatal resuscitation in low-resource settings: What, who, and how to overcome challenges to scale up?

Abstract Our purpose was to explore whether private–public partnerships (PPPs) can serve as a model for access to high-cost care in low-resource settings by examining a unique PPP providing haemodialysis services in a remote setting, investigating challenges and enablers. The study setting is a 500-bed teaching hospital serving a catchment population of 8 million in Northern Ethiopia. Based on local data collection, observation and in-depth interviews, we identified the impetus for the PPP, described the partnership agreement, reported outcomes after 6 years of activity and examined challenges that have arisen since the programme’s inception, including funding sustainability. The PPP was established in 2013 based on a decision by local leadership that treatment of patients with acute kidney injury (AKI) is a necessity rather than a luxury. A private partner was sought who could ensure service delivery as well as a reliable supply of consumables. The hospital contributions included infrastructure, personnel and sharing of maintenance costs. The partnership has facilitated uninterrupted haemodialysis service to 101 patients with AKI and 202 with chronic kidney disease. The former (>50% cured) were mainly supported by charitable donations procured by the hospital’s leadership, while the latter were self-funded. The local university and community contributed to the charity. Utilization has increased yearly. Funding and logistical issues remain. In conclusion, this PPP enabled access to previously unavailable lifesaving care in Northern Ethiopia and could serve as a model for potential scale-up for haemodialysis provision in particular, and more broadly, high-cost care in low-resource settings. An ethical commitment to provide the service, combined with ongoing administrative and community involvement has contributed to its sustained success. Lack of affordability for most patients requiring chronic haemodialysis and reliance on charitable donations for treatment of patients with AKI pose challenges to long-term sustainability.

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Detecting tuberculosis: rapid tools but slow progress

Public Health Action ◽

10.5588/pha.19.0013 ◽

2019 ◽

Vol 9 (3) ◽

pp. 80-83

Author(s):

K. England ◽

T. Masini ◽

E. Fajardo

Keyword(s):

Point Of Care ◽

Scale Up ◽

Critical Issue ◽

World Health ◽

High Turnover ◽

Low Resource Settings ◽

Laboratory Staff ◽

Low Resource ◽

Point Of Care Test ◽

Health Organization

The World Health Organization (WHO) currently recommends Xpert® MTB/RIF as the initial test for all people with presumptive tuberculosis (TB). A number of challenges have been reported, however, in using this technology, particularly in low-resource settings. Here we examine these challenges, and provide our perspective of the barriers to Xpert scale-up as assessed through a survey in 16 TB burden countries in which the Médecins Sans Frontières is present. We observed that the key barriers to scale-up include a lack of policy adoption and implementation of WHO recommendations for the use of Xpert, resulting from high costs, poor sensitisation of clinical staff and a high turnover of trained laboratory staff; insufficient service and maintenance provision provided by the manufacturer; and inadequate resources for sustainability and expansion. Funding is a critical issue as countries begin to transition out of support from the Global Fund. While it is clear that there is still an urgent need for research into and development of a rapid, affordable point-of-care test for TB that is truly adapted for use in low-resource settings, countries in the meantime need to develop functional and sustainable Xpert networks in order to close the existing diagnostic gap.

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Neonatal resuscitation in low resource settings: Challenges to implementation at a district hospital level in Tanzania

Annals of Global Health ◽

10.1016/j.aogh.2016.04.399 ◽

2016 ◽

Vol 82 (3) ◽

pp. 515

Author(s):

M. Mitchell ◽

D. Mohammed ◽

A. Lehman ◽

E. Mahmoud ◽

C. Bweri

Keyword(s):

District Hospital ◽

Neonatal Resuscitation ◽

Hospital Level ◽

Low Resource Settings ◽

Low Resource

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Obstetric care in low-resource settings: What, who, and how to overcome challenges to scale up?

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2009.07.017 ◽

2009 ◽

Vol 107 (Supplement) ◽

pp. S21-S45 ◽

Cited By ~ 105

Author(s):

G. Justus Hofmeyr ◽

Rachel A. Haws ◽

Staffan Bergström ◽

Anne CC Lee ◽

Pius Okong ◽

...

Keyword(s):

Scale Up ◽

Obstetric Care ◽

Low Resource Settings ◽

Low Resource

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Disinfection of Neonatal Resuscitation Equipment in Low-Resource Settings: The Importance, the Reality, and Considerations for the Future

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18137065 ◽

2021 ◽

Vol 18 (13) ◽

pp. 7065

Author(s):

Anne M. White ◽

Dominic Mutai ◽

David Cheruiyot ◽

Amy R. L. Rule ◽

Joel E. Mortensen ◽

...

Keyword(s):

Gold Standard ◽

Best Practice ◽

Neonatal Resuscitation ◽

Clean Water ◽

Low Resource Settings ◽

Neonatal Deaths ◽

Low Resource ◽

Resource Limited ◽

High Level ◽

Ongoing Concern

Preventable neonatal deaths due to prematurity, perinatal events, and infections are the leading causes of under-five mortality. The vast majority of these deaths are in resource-limited areas. Deaths due to infection have been associated with lack of access to clean water, overcrowded nurseries, and improper disinfection (reprocessing) of equipment, including vital resuscitation equipment. Reprocessing has recently come to heightened attention, with the COVID-19 pandemic bringing this issue to the forefront across all economic levels; however, it is particularly challenging in low-resource settings. In 2015, Eslami et al. published a letter to the editor in Resuscitation, highlighting concerns about the disinfection of equipment being used to resuscitate newborns in Kenya. To address the issue of improper disinfection, the global health nongovernment organization PATH gathered a group of experts and, due to lack of best-practice evidence, published guidelines with recommendations for reprocessing of neonatal resuscitation equipment in low-resource areas. The guidelines follow the gold-standard principle of high-level disinfection; however, there is ongoing concern that the complexity of the guideline would make feasibility and sustainability difficult in the settings for which it was designed. Observations from hospitals in Kenya and Malawi reinforce this concern. The purpose of this review is to discuss why proper disinfection of equipment is important, why this is challenging in low-resource settings, and suggestions for solutions to move forward.

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Adapted Helping Babies Breathe approach to neonatal resuscitation in Haiti: a retrospective cohort study

BMC Pediatrics ◽

10.1186/s12887-021-02987-4 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Shannon Findlay ◽

Morgan Swanson ◽

Christian Junker ◽

Mitchell Kinkor ◽

Karisa K. Harland ◽

...

Keyword(s):

Community Health ◽

Neonatal Mortality ◽

Health Workers ◽

Neonatal Resuscitation ◽

Neonatal Health ◽

Low Resource Settings ◽

Low Resource ◽

Helping Babies Breathe ◽

Community Health Initiative

Abstract Background Helping Babies Breathe (HBB) is an American Academy of Pediatrics neonatal resuscitation program designed to reduce neonatal mortality in low resource settings. The 2017 neonatal mortality rate in Haiti was 28 per 1000 live births and an estimated 85 % of Haitian women deliver at home. Given this, the Community Health Initiative implemented an adapted HBB (aHBB) in Haiti to evaluate neonatal mortality. Methods Community Health Workers taught an aHBB program to laypeople, which didn’t include bag-valve-mask ventilation. Follow-up after delivery assessed for maternal and neonatal mortality and health. Results Analysis included 536 births of which 84.3 % (n=452) were attended by someone trained in aHBB. The odds of neonatal mortality was not significantly different among the two groups (aOR=0.48 [0.16-1.44]). Composite outcome of neonatal health as reported by the mother (subjective morbidity and mortality) was significantly lower in aHBB attended births (aOR=0.31 [0.14-0.70]). Conclusion This analysis of the aHBB program indicates that community training to laypersons in low resource settings may reduce neonatal ill-health but not neonatal mortality. This study is likely underpowered to find a difference in neonatal mortality. Further work is needed to evaluate which components of the aHBB program are instrumental in improving neonatal health.

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Optimizing integrated imaging service delivery by tier in low-resource health systems

Insights into Imaging ◽

10.1186/s13244-021-01073-8 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Kristen DeStigter ◽

Kara-Lee Pool ◽

Abimbola Leslie ◽

Sarwat Hussain ◽

Bien Soo Tan ◽

...

Keyword(s):

Service Delivery ◽

Health System ◽

Low Income ◽

Care Delivery ◽

Scale Up ◽

Health Coverage ◽

Low Resource Settings ◽

Low Resource ◽

Low Middle Income Countries ◽

Budgetary Decisions

AbstractAccess to imaging diagnostics has been shown to result in accurate treatment, management, and optimal outcomes. Particularly in low-income and low-middle-income countries (LICs, LMICs), access is limited due to a lack of adequate resources. To achieve Sustainable Development Goal (SDG) 3, access to imaging services is critical at every tier of the health system. Optimizing imaging services in low-resource settings is best accomplished by prescriptive, integrated, and coordinated tiered service delivery that takes contextual factors into consideration. To our knowledge, this is the first recommendation for optimized, specific imaging care delivery by tier. A model for tier-based essential imaging services informs and guides policymakers as they set priorities and make budgetary decisions. In this paper, we recommend a framework for tiered imaging services essential to reduce the global burden of disease and attain universal health coverage (UHC). A lack of access to basic imaging services, even at the lowest tier of the health system, can no longer be justified by cost. Worldwide, affordable modalities of modern ultrasound and X-ray are becoming an accessible mainstay for the investigation of common conditions such as pregnancy, pneumonia, and fractures, and are safely performed and interpreted by qualified professionals. Finally, given the vast gap in access to imaging resources between LMICs and high-income countries (HICs), a scale-up of tiered imaging services in low-resource settings has the potential to reduce health disparities between, and within countries. As the access to appropriately integrated imaging services improves, UHC may be achieved.

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Obstetrics and Gynaecology

Global Anaesthesia ◽

10.1093/med/9780198809821.003.0008 ◽

2020 ◽

pp. 157-196

Author(s):

Rachel Collis ◽

Rebecca Jones ◽

Sarah O’Neill

Keyword(s):

Caesarean Section ◽

Neonatal Resuscitation ◽

Pregnant Patient ◽

Practical Advice ◽

Low Resource Settings ◽

Obstetric Anaesthesia ◽

Low Resource ◽

Obstetrics And Gynaecology ◽

Obstetric Haemorrhage ◽

Obstetric Surgery

In low-resource settings, obstetrics and gynaecology frequently forms a large part of the anaesthetist’s workload. The chapter serves both as an aide-memoire for those who are not regular practitioners in obstetric anaesthesia and as a guide to adapting your practice in low-resource settings. It contains practical advice on analgesia in labour and anaesthesia for Caesarean section, including spinal, general anaesthesia, and local anaesthesia techniques. It contains advice on drug alternatives in the absence of commonly used obstetric drugs, e.g. spinal bupivacaine. There are also sections on management of pre-eclampsia and obstetric haemorrhage, both of which are commonly encountered in low-resource settings. Neonatal resuscitation and non-obstetric surgery in the pregnant patient are also covered.

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Decision making and situational awareness in neonatal resuscitation in low resource settings

Resuscitation ◽

10.1016/j.resuscitation.2018.10.034 ◽

2019 ◽

Vol 134 ◽

pp. 41-48 ◽

Cited By ~ 6

Author(s):

Maria Elena Cavicchiolo ◽

Francesco Cavallin ◽

Alex Staffler ◽

Damiano Pizzol ◽

Eduardo Matediana ◽

...

Keyword(s):

Decision Making ◽

Situational Awareness ◽

Neonatal Resuscitation ◽

Low Resource Settings ◽

Low Resource

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Helping Babies Breathe and its effects on intrapartum-related stillbirths and neonatal mortality in low-resource settings: a systematic review

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-316319 ◽

2019 ◽

pp. archdischild-2018-316319 ◽

Cited By ~ 1

Author(s):

Jorien M D Versantvoort ◽

Mirjam Y Kleinhout ◽

Henrietta D L Ockhuijsen ◽

Kitty Bloemenkamp ◽

Willem B de Vries ◽

...

Keyword(s):

Systematic Review ◽

Neonatal Mortality ◽

Data Extraction ◽

Neonatal Resuscitation ◽

Eligibility Criteria ◽

Low Resource Settings ◽

Low Resource ◽

Helping Babies Breathe ◽

Simulation Based ◽

Registration Number

BackgroundAn important factor in worldwide neonatal mortality is the deficiency in neonatal resuscitation skills among trained professionals. ‘Helping Babies Breathe’ (HBB) is a simulation-based training course designed to train healthcare professionals in the initial steps of neonatal resuscitation in low-resource areas. The aim of this systematic review is to provide an overview of the available evidence regarding intrapartum-related stillbirths and neonatal mortality related to the HBB training and resuscitation method.Data sourcesCochrane, CINAHL, Embase, PubMed and Scopus.Study eligibility criteriaConducted in low-resource settings focusing on the effects of HBB on intrapartum-related stillbirths and neonatal mortality.Study appraisalIncluded studies were reviewed independently by two researchers in terms of methodological quality.Data extractionData were extracted by two independent reviewers and crosschecked by one additional reviewer.ResultsSeven studies were included in this systematic review; the selected studies included a total of 230.797 neonates. Significant decreases were found after the implementation of HBB in one of two studies describing perinatal mortality (n=25 108, rate ratio (RR) 0.75; p<0.001), four out of six studies related to intrapartum-related stillbirths (n=125.720, RR 0.31–0.76), in four out of five studies focusing on 1 day neonatal mortality (n=111.289, RR 0.37–0.67), and one out of three studies regarding 7 day neonatal mortality (n=4.390, RR 0.32). No changes were seen in late neonatal mortality after HBB training and resuscitation method.LimitationsIncluded studies in were predominantly of moderate quality, therefore no strong recommendations can be made.Conclusions and implications of key findingsDue to the heterogeneous quality of the studies, this systematic review showed moderate evidence for a decrease in intrapartum-related stillbirth and 1-day neonatal mortality rate after implementing the ‘Helping Babies Breathe’ training and resuscitation method. Further research is required to address the effects of simulation-based team training on morbidity and mortality beyond the initial neonatal period.PROSPERO registration numberCRD42018081141.

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