1642 Barriers to achieving quality neonatal care in low resource settings: perspectives from a unique panel of neonatal health experts

Abstract Objective To explore the gaps in knowledge and practice in neonatal thermal care among healthcare workers in low-resource settings. Methods We conducted a 2-round, web-based survey of a purposive and snowball sample of healthcare workers in neonatal care in low-resource settings globally. The questionnaire was developed using themes of neonatal thermal care extracted from existing neonatal care guidelines, including WHO’s. The survey asked multiple-choice questions, supplemented by open-ended questions to capture first hand insights and information on neonatal thermal care. Results of the survey were analysed using Microsoft Excel. Data was collated and summarized using descriptive measures. Results Almost all participants acknowledged the importance of all the WHO warm chain elements, however, fewer participants responded positively regarding the practice of this warm chain. Only 56% of the participants acknowledged the usefulness of checking the peripheral temperature by hand-touch. The usefulness of the core temperature was valued higher than that of the peripheral temperature as an indicator of cold stress, with 70% and 58% agreement, respectively. Opinions diverged regarding the peripheral temperatures, including apparent inaccuracy compared to rectal or axillary temperature. Preferences on rewarming strategies widely differed among participants and so did the availability of warming equipment in their institutions. Conclusions We identified the general acknowledgment of the importance of the WHO warm chain but also its limited practice. We also identified that an inadequate understanding of cold stress underestimates the potential benefits of peripheral temperatures and leads to missed opportunities for timely prevention of hypothermia. Furthermore, lack of consistent guidance on equipment for rewarming hypothermic neonates hampers recovery.

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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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Devising a comprehensive strategy to improve the neonatal health and survival rates in low-resource settings

Annals of Tropical Medicine and Public Health ◽

10.4103/1755-6783.193949 ◽

2016 ◽

Vol 9 (6) ◽

pp. 414

Author(s):

SaurabhRamBihariLal Shrivastava ◽

PrateekSaurabh Shrivastava ◽

Jegadeesh Ramasamy

Keyword(s):

Survival Rates ◽

Neonatal Health ◽

Comprehensive Strategy ◽

Low Resource Settings ◽

Low Resource

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Staged implementation of a two-tiered hospital-based neonatal care package in a resource-limited setting in Eastern Uganda

BMJ Global Health ◽

10.1136/bmjgh-2017-000586 ◽

2018 ◽

Vol 3 (1) ◽

pp. e000586 ◽

Cited By ~ 7

Author(s):

Kathy Burgoine ◽

Juliet Ikiror ◽

Sylivia Akol ◽

Margaret Kakai ◽

Sara Talyewoya ◽

...

Keyword(s):

Neonatal Mortality ◽

Low Income ◽

Low Cost ◽

Neonatal Care ◽

Health Facilities ◽

Low Income Countries ◽

Low Resource Settings ◽

Low Resource ◽

Care Package ◽

Eastern Uganda

Neonatal mortality remains a major global challenge. Most neonatal deaths occur in low-income countries, but it is estimated that over two-thirds of these deaths could be prevented if achievable interventions are scaled up. To date, initiatives have focused on community and obstetric interventions, and there has been limited simultaneous drive to improve neonatal care in the health facilities where the sick neonates are being referred. Few data exist on the process of implementing of neonatal care packages and their impact. Evidence-based guidelines for neonatal care in health facilities in low-resource settings and direction on how to achieve these standards of neonatal care are therefore urgently needed. We used the WHO-Recommended Quality of Care Framework to build a strategy for quality improvement of neonatal care in a busy government hospital in Eastern Uganda. Twelve key interventions were designed to improve infrastructure, equipment, protocols and training to provide two levels of neonatal care. We implemented this low-cost, hospital-based neonatal care package over an 18-month period. This data-driven analysis paper illustrates how simple changes in practice, provision of basic equipment and protocols, ongoing training and dedicated neonatal staff can reduce neonatal mortality substantially even without specialist equipment. Neonatal mortality decreased from 48% to 40% (P=0.25) after level 1 care was implemented and dropped further to 21% (P<0.01) with level 2 care. In our experience, a dramatic impact on neonatal mortality can be made through modest and cost-effective interventions. We recommend that stakeholders seeking to improve neonatal care in low-resource settings adopt a similar approach.

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