scholarly journals Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Karen Zamboni ◽  
Samiksha Singh ◽  
Mukta Tyagi ◽  
Zelee Hill ◽  
Claudia Hanson ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Neonatal Mortality ◽  
Process Evaluation ◽  
Andhra Pradesh ◽  
Newborn Care ◽  
Mechanisms Of Change ◽  
Evidence Based ◽  
Programme Implementation ◽  
Quasi Experimental ◽  
Care Practices

Abstract Background Improving quality of care is a key priority to reduce neonatal mortality and stillbirths. The Safe Care, Saving Lives programme aimed to improve care in newborn care units and labour wards of 60 public and private hospitals in Telangana and Andhra Pradesh, India, using a collaborative quality improvement approach. Our external evaluation of this programme aimed to evaluate programme effects on implementation of maternal and newborn care practices, and impact on stillbirths, 7- and 28-day neonatal mortality rate in labour wards and neonatal care units. We also aimed to evaluate programme implementation and mechanisms of change. Methods We used a quasi-experimental plausibility design with a nested process evaluation. We evaluated effects on stillbirths, mortality and secondary outcomes relating to adherence to 20 evidence-based intrapartum and newborn care practices, comparing survey data from 29 hospitals receiving the intervention to 31 hospitals expected to receive the intervention later, using a difference-in-difference analysis. We analysed programme implementation data and conducted 42 semi-structured interviews in four case studies to describe implementation and address four theory-driven questions to explain the quantitative results. Results Only 7 of the 29 intervention hospitals were engaged in the intervention for its entire duration. There was no evidence of an effect of the intervention on stillbirths [DiD − 1.3 percentage points, 95% CI − 2.6–0.1], on neonatal mortality at age 7 days [DiD − 1.6, 95% CI − 9–6.2] or 28 days [DiD − 3.0, 95% CI − 12.9—6.9] or on adherence to target evidence-based intrapartum and newborn care practices. The process evaluation identified challenges in engaging leaders; challenges in developing capacity for quality improvement; and challenges in activating mechanisms of change at the unit level, rather than for a few individuals, and in sustaining these through the creation of new social norms. Conclusion Despite careful planning and substantial resources, the intervention was not feasible for implementation on a large scale. Greater focus is required on strategies to engage leadership. Quality improvement may need to be accompanied by clinical training. Further research is also needed on quality improvement using a health systems perspective.

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

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.

scholarly journals Newborn Care Practices by the Mother / Care Givers’ and Their Knowledge about Signs of Sickness of Neonates

2012 ◽  
Vol 35 (3) ◽  
pp. 90-96 ◽  
Author(s):  
Md Mahbubul Hoque ◽  
Mohammad Faizul Haque Khan ◽  
Jotsna Ara Begum ◽  
MAK Azad Chowdhury ◽  
Lars Ake Persson
Keyword(s):  
Neonatal Mortality ◽  
Newborn Care ◽  
Cost Effective ◽  
Home Delivery ◽  
Prelacteal Feeding ◽  
Cross Sectional ◽  
Institutional Deliveries ◽  
Home Deliveries ◽  
Care Practices ◽  
At Home

Background: Despite proven cost effective intervention, there has been little change in neonatal mortality. In Bangladesh neonatal mortality accounts for two third of infants death. About 90% deliveries take place in home and majority of neonatal death are taking place within 7 days of birth. Information about reasons for delivering at home and newborn care practices will be useful to undertake simple intervention measures by policy makers.Aims and objective: To see the knowledge, perception and behaviour of mothers towards their normal and sick newborn.Methods: A cross sectional study was carried out in Dhaka Shishu Hospital from June to November, 2007. A semistructured, pretested questionnaire was used to interview mothers attending inpatient (IPD) and outpatient department (OPD) of hospital.Results: A total 198 mothers were interviewed. Home deliveries were 35.5% and Institutional were 64.5%. Among the Institutional deliveries 35% (44 out of 127) were planned and tried first at home, but when failed mothers were taken to hospital. Majority (86%) of home deliveries were conducted by Dai/relatives. Umbilical cord was cut with new/boiled blade in 85% of home deliveries and household knife was used in 4% cases. Birth place were not at all heated in all home deliveries. In 32 % of home deliveries babies were given bath within 1 hour of birth and it was 15% in case of hospital deliveries. Forty-eight percent babies of home deliveries were wrapped within 10 minutes. Prelacteal feed was given in 51% of home deliveries in comparison to 23% of institutional deliveries. The rate of initiation of breast feeding within one hour of birth was 52% in home and 35% in institutional deliveries. In all cases breast milk was given within 48 hours. Main reasons cited for delivering at home were preference (43%) and fear about hospital (39%). In case of educated (graduate) mothers 72% deliveries took place at hospital. Less feeding (56%), vomiting (42%), less movement (32%), fever (29%) and cough (27%) could be recognized by mothers as signs of sickness.Conclusion: Home deliveries and poor newborn care practices are commonly found in this study. Traditional birth attendants should be adequately trained as they are conducting majority of home deliveries. Female education is very important to reduce home delivery as it is seen that deliveries of educated mothers are taking place in hospital. High risk traditional newborn care practices like delayed wrapping, early bathing, use of oil in umbilical stump and prelacteal feeding need to be addressed. This study also found that knowledge to identify sickness in newborn is still poor.DOI: http://dx.doi.org/10.3329/bjch.v35i3.10497  Bangladesh J Child Health 2011; Vol 35 (3): 90-96

scholarly journals Assessing the changes in childbirth care practices and neonatal outcomes in Western China: pre-comparison and post-comparison study on early essential newborn care interventions

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041829
Author(s):  
Wen Qu ◽  
Qing Yue ◽  
Yan Wang ◽  
Jin Liuxing Yang ◽  
Xi Jin ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Neonatal Mortality ◽  
Breast Feeding ◽  
Newborn Care ◽  
Western China ◽  
Comparison Study ◽  
Essential Newborn Care ◽  
Breastfeeding Rate ◽  
Care Practices ◽  
Childbirth Care

ObjectiveTo explore the changes in childbirth care practices and health outcomes of newborns after the introduction of early essential newborn care (EENC).DesignA pre-comparison and post-comparison study.SettingThe study was conducted in December 2016 and December 2018 in 18 counties in four western provinces of China.Participants46 hospitals that provide delivery services participated in the study.InterventionsEENC practices were introduced and implemented in the 46 hospitals.Outcome measuresThe changes of hospital indicators such as incidence of birth asphyxia and neonatal mortality were compared in 2016 and 2018. EENC coverage indicators, such as skin-to-skin (STS) contact, and time of first breast feeding were also compared before and after the intervention via interview with 524 randomly selected postpartum mothers (320 in 2016 and 204 in 2018).Results54 335 newborns were delivered in the pre-EENC period (2016) and 58 057 delivered in the post-EENC period (2018). According to hospital records, the proportion of newborns receiving immediate STS contact increased from 32.6% to 51.2% (Risk Ratio (RR)=1.57,95% CI 1.55 to 1.59) and the percentage of newborns receiving prolonged STS contact for more than 90 min increased from 8.1% to 26.8% (RR=3.31, 95% CI 3.21 to 3.41). No statistically significant changes were found in neonatal mortality, although slight decreases in birth asphyxiate and neonatal intensive care unit admission rates were detected. Among the mothers interviewed, the proportion of newborns receiving immediate STS contact increased from 34.6% to 80.0% (RR=2.31, 95% CI 1.69 to 3.17). The exclusive breastfeeding rate increased from 43% to 73.4% (RR=1.71, 95% CI 1.43 to 2.04). The average length of the first breast feeding increased from 15.8 min to 17.1 min.ConclusionsThe introduction of EENC has yielded significant improvements in newborn care services at the pilot hospitals, including enhanced maternal and newborn care practices, improved STS contact quality and early breastfeeding performance. Further studies are needed to evaluate the long-term impact of EENC on newborn health outcomes.

scholarly journals Just-in-time postnatal education programees to improve newborn care practices: needs and opportunities in low-resource settings

2020 ◽  
Vol 5 (7) ◽  
pp. e002660
Author(s):  
Laura Subramanian ◽  
Seema Murthy ◽  
Prasad Bogam ◽  
Shirley D Yan ◽  
Megan Marx Delaney ◽  
...  
Keyword(s):  
Survey Data ◽  
Newborn Care ◽  
Just In Time ◽  
Evidence Based ◽  
Care Seeking ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Education Model ◽  
Care Practices

Worldwide, many newborns die in the first month of life, with most deaths happening in low/middle-income countries (LMICs). Families’ use of evidence-based newborn care practices in the home and timely care-seeking for illness can save newborn lives. Postnatal education is an important investment to improve families’ use of evidence-based newborn care practices, yet there are gaps in the literature on postnatal education programees that have been evaluated to date. Recent findings from a 13 000+ person survey in 3 states in India show opportunities for improvement in postnatal education for mothers and families and their use of newborn care practices in the home. Our survey data and the literature suggest the need to incorporate the following strategies into future postnatal education programming: implement structured predischarge education with postdischarge reinforcement, using a multipronged teaching approach to reach whole families with education on multiple newborn care practices. Researchers need to conduct robust evaluation on postnatal education models incorporating these programee elements in the LMIC context, as well as explore whether this type of education model can work for other health areas that are critical for families to survive and thrive.

Cost-effectiveness of the Yashoda Programme

2017 ◽  
Vol 19 (2) ◽  
pp. 255-263 ◽  
Author(s):  
Somen Saha ◽  
Beena Varghese
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Neonatal Mortality ◽  
Intervention Group ◽  
Newborn Care ◽  
Additional Cost ◽  
Potential Cost ◽  
Neonatal Deaths ◽  
District Hospitals ◽  
Care Practices

Background: Under the Norway-India Partnership Initiative (NIPI), a pilot programme was launched in 2008 to improve the quality of institutional maternal and neonatal care through Yashodas or birth companions. Yashodas were placed at higher-level healthcare facilities across select districts of India to support mother and newborn. This article presents the additional cost of the Yashoda programme from a government perspective and models the potential cost-effectiveness of the Yashoda intervention in averting neonatal deaths. Methods: We estimated the additional costs of the Yashoda programme (2011–2012) using an activity-based costing approach from a provider perspective. Effectiveness measure was estimated as the difference in the average rate of receipt of counselling (for mothers who delivered at district hospitals) between intervention and comparison districts. The potential impact of the Yashoda programme on neonatal mortality was modelled from secondary data assuming a 30 per cent reduction in neonatal mortality among those who received counselling and practiced safe newborn care practices. Results: The additional cost of Yashoda intervention was US$26,350 per year or US$0.83 per live birth. Eighty-four per cent of mothers in the intervention group received essential postpartum newborn care counselling at the facility compared to 62 per cent of mothers in the comparison groups. Through potential change in newborn care practices, the Yashoda intervention was estimated to avert 45 neonatal deaths for a hypothetical cohort of 100,000 mothers who delivered at district hospitals. The incremental cost of the Yashoda intervention was US$1,832 per neonatal death averted or US$29 per life year saved (LYS). Sensitivity analysis showed the incremental cost per LYS of the Yashoda intervention varied between US$14 and US$59. Conclusion: This study concludes that the Yashoda intervention, when scaled up at high delivery load facilities, is a very cost-effective intervention to save newborn lives.

scholarly journals Community And Individual Factors Associated With Maternal And Neonatal Care Practices In Low Resource Settings. A Case Of Zimbabwe

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
E. Chiwawa ◽  
M. Mhlanga ◽  
A. Munodawafa ◽  
F. Mukora-Mutseyekwa
Keyword(s):  
Neonatal Mortality ◽  
Health Facility ◽  
Breast Feeding ◽  
Newborn Care ◽  
Neonatal Care ◽  
Care Seeking ◽  
District Health ◽  
Live Births ◽  
Factors Associated ◽  
Care Practices

Neonatal mortality has been increasing in Zimbabwe from 20/1,000 live births between 2000 and 2004 to 29 /1,000 live births between 2010 and 2014.Suboptimal newborn care practices are the predisposing factors to neonatal mortality. In Manicaland Province, care seeking behaviours for fever which is the main symptom of majority of infections in children and knowledge levels of danger signs that should cause the mother to take a child immediately to a health facility remains unacceptably lower than the national averages. A cross sectional descriptive and analytic design was carried out to explore the factors associated with the practice of the recommended newborn care practices by women of child bearing age in Mutare District. Health facilities were purposively sampled and participants were systematically sampled. Structured interviews were used to collect data which was analysed in Epi-Info version 7.2. Descriptive and multivariate analysis was performed on data collected from 349 participants. Practice of the five assessed recommended newborn care practices was high. Exclusive breast feeding (62%), early initiation of Breast feeding (74%), good code care (73%), care seeking for neonatal illness within 24hrs of onset of fever (82%) and keeping baby warm was at 58%. Statistically significant independent factors associated with the recommended newborn care practices were post-natal stay for more than 72 hours at the clinic (AOR=0.56; 95%CI: 0.12-0.87, p=0.000), and delivery at the health facility (AOR=0.43; 95%CI: 0.21-0.77; p=0.000). Cultural practices that impact negatively on neonatal care in Mutare district include; asking for permission to seek treatment for the child when ill, feeding the baby immediately after delivery and applying substances and mixed traditional herbs on the cord stump of the newborn. Improving newborn care outcomes require approaches addressing demand and supply factors to reach communities with correct information on good newborn care.

scholarly journals Evaluation of a maternal, neonatal and child health intervention package in a rural district of Pakistan: a quasi-experimental study

2019 ◽  
Vol 6 (11) ◽  
pp. 4682
Author(s):  
Muhammad Atif Habib ◽  
Kirsten I. Black ◽  
Camille Raynes Greenow ◽  
Mushtaq Mirani ◽  
Sajid Muhammad ◽  
...  
Keyword(s):  
Child Health ◽  
Neonatal Mortality ◽  
Continuum Of Care ◽  
Health Intervention ◽  
Intervention Package ◽  
Local Evidence ◽  
Quasi Experimental ◽  
Care Practices ◽  
And Child Health ◽  
Child Health Intervention

Background: Pakistan is among the countries which have the highest maternal, neonatal and child mortality rates. Immediate efforts are required to enable Pakistan to achieve the health related sustainable development goals. The continuum of care interventions can substantially reduce the mortality burden, however local evidence to implement them is lacking in Pakistan. We implemented the maternal, neonatal and child health intervention package comprised of health facility strengthening, capacity building, continuum of care interventions and community mobilization and evaluated its effectiveness on maternal, neonatal and child health care practices and neonatal mortality.Methods: The intervention package was delivered through existing public health system in a rural district of Pakistan. We used a quasi-experimental design to assess the impact of interventions. Baseline and end line surveys were conducted and neonatal mortality was considered as the primary outcome measure. Data were analysed using bivariate and difference and difference analysis techniques.Results: We found a reduced risk of neonatal mortality (RR 0.704; 95% CI 0.557-0.889; p=0.0033), in intervention areas compared to control area. For secondary outcomes; including mortality for infants and under five children, antenatal care, skilled birth attendance, institutional deliveries, postnatal care, delayed bathing, inappropriate cord care practices, birth asphyxia, exclusive breastfeeding and immunization a significant difference (p<0.001) was observed in the intervention area compared to control area.Conclusions: This study provides local evidence from Pakistan that effective methods for delivering MNCH interventions within the existing health infrastructure can improve the MNCH outcomes especially in the rural areas.

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