scholarly journals Strategies to sustain a quality improvement initiative in neonatal resuscitation

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Carlien Van Heerden ◽  
Carin Maree ◽  
Elsie S. Janse van Rensburg
Keyword(s):  
Quality Improvement ◽  
Neonatal Mortality ◽  
District Hospital ◽  
Neonatal Resuscitation ◽  
World Health ◽  
Quality Improvement Initiative ◽  
Neonatal Deaths ◽  
Early Neonatal Mortality ◽  
District Hospitals ◽  
Resuscitation Training

Background: Many neonatal deaths can be prevented globally through effective resuscitation. South Africa (SA) committed towards attaining the Millennium Development Goal 4 (MDG4) set by the World Health Organization (WHO). However, SA’s district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes associated with patient-related, administrative and health care provider factors contribute to neonatal mortality. A quality improvement initiative in neonatal resuscitation could contribute towards decreasing neonatal mortality, thereby contributing towards the attainment of the MDG4.Aim: The aim of this study was, (1) to explore and describe the existing situation regarding neonatal resuscitation in a district hospital, (2) to develop strategies to sustain a neonatal resuscitation quality improvement initiative and (3) to decrease neonatal mortality. Changes that occurred and the sustainability of strategies were evaluated.Setting: A maternity section of a district hospital in South Africa.Methods: The National Health Service (NHS) Sustainability Model formed the theoretical framework for the study. The Problem Resolving Action Research model was applied and the study was conducted in three cycles. Purposive sampling was used for the quantitative and qualitative aspects of data collection. Data was analysed accordingly.Results: The findings indicated that the strategies formulated and implemented to address factors related to neonatal resuscitation (training, equipment and stock, staff shortages, staff attitude, neonatal transport and protocols) had probable sustainability and contributed towards a reduction in neonatal mortality in the setting.Conclusion: These strategies had the probability of sustainability and could potentially improve neonatal outcomes and reduce neonatal mortality to contribute toward South Africa’s drive to attain the MDG4.

scholarly journals Designing and evaluating a novel mobile application for Helping Babies Breathe skills retention in Uganda: comparative study protocol

2019 ◽  
Vol 3 (1) ◽  
pp. e000561 ◽  
Author(s):  
Hasan Shamsh Merali ◽  
Natalie Hoi-Man Chan ◽  
Niraj Mistry ◽  
Ryan Kealey ◽  
Douglas Campbell ◽  
...  
Keyword(s):  
Comparative Study ◽  
Mobile Application ◽  
Neonatal Resuscitation ◽  
Training Programme ◽  
Second Phase ◽  
Early Neonatal Mortality ◽  
Helping Babies Breathe ◽  
Skills Retention ◽  
District Hospitals ◽  
Resuscitation Training

IntroductionOver 600 000 newborns die each year of intrapartum-related events, many of which are preventable in the presence of skilled birth attendants. Helping Babies Breathe (HBB) is a neonatal resuscitation training programme designed for low-resource settings that can reduce both early neonatal mortality and stillbirths. However, as in other similar educational programmes, knowledge and skill retention deteriorate over time. This trend may be counteracted by strategies such as regular simulated exercises. In this study, a mobile application (app) ‘HBB Prompt’ will be developed to assist providers in retaining HBB knowledge and skills.Methods and analysisThis is a comparative study in Uganda with two phases: an app development phase and an assessment phase. In the first phase, HBB trainers and providers will explore barriers and facilitators to enhance learning and maintenance of HBB skills and knowledge through focus group discussions (FGDs). The FGDs are designed with a human factors perspective, enabling collection of relevant data for the prototype version of HBB Prompt. The app will then undergo usability and feasibility testing through FGDs and simulations. In the second phase, a minimum of 10 healthcare workers from two district hospitals will receive HBB training. Only the intervention hospital will have access to HBB Prompt. All participants will be asked to practise HBB skills every shift and record this in a logbook. In the intervention site, app usage data will also be collected. The primary outcome will be comparing skills retention 12 months after training, as determined by Objective Structured Clinical Examination B scores.Ethics and disseminationThis study received ethics approval from The Hospital for Sick Children and Mbarara University of Science and Technology. The authors plan to publish all relevant findings from this study in peer-reviewed journals.Trial registration numberNCT03577054

scholarly journals A Neonatal Resuscitation Curriculum in Malawi, Africa: Did It Change In-Hospital Mortality?

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Michael K. Hole ◽  
Keely Olmsted ◽  
Athanase Kiromera ◽  
Lisa Chamberlain
Keyword(s):  
Hospital Mortality ◽  
Neonatal Mortality ◽  
Neonatal Resuscitation ◽  
Secondary Data ◽  
Hospital Staff ◽  
Short Term ◽  
Neonatal Deaths ◽  
Evaluation Strategies ◽  
Resuscitation Training ◽  
Longitudinal Relationships

Objective. The WHO estimates that 99% of the 3.8 million neonatal deaths occur in developing countries. Neonatal resuscitation training was implemented in Namitete, Malawi. The study's objective was to evaluate the training's impact on hospital staff and neonatal mortality rates.Study Design. Pre-/postcurricular surveys of trainee attitude, knowledge, and skills were analyzed. An observational, longitudinal study of secondary data assessed neonatal mortality.Result. All trainees' (n=18) outcomes improved, (P=0.02). Neonatal mortality did not change. There were 3449 births preintervention, 3515 postintervention. Neonatal mortality was 20.9 deaths per 1000 live births preintervention and 21.9/1000 postintervention, (P=0.86).Conclusion. Short-term pre-/postintervention evaluations frequently reveal positive results, as ours did. Short-term pre- and postintervention evaluations should be interpreted cautiously. Whenever possible, clinical outcomes such as in-hospital mortality should be additionally assessed. More rigorous evaluation strategies should be applied to training programs requiring longitudinal relationships with international community partners.

Reduction in Perinatal Mortality after Implementation of HBB Training at a District Hospital in Mali

2019 ◽  
Vol 66 (3) ◽  
pp. 315-321
Author(s):  
M Innerdal ◽  
I Simaga ◽  
H Diall ◽  
M Eielsen ◽  
S Niermeyer ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Neonatal Mortality ◽  
Perinatal Mortality ◽  
District Hospital ◽  
Neonatal Mortality Rate ◽  
Neonatal Deaths ◽  
Live Births ◽  
Early Neonatal Mortality ◽  
Helping Babies Breathe ◽  
Before And After

Abstract Background Mali has a high neonatal mortality rate of 38/1000 live births; in addition the fresh stillbirth rate (FSR) is 23/1000 births and of these one-third are caused by intrapartum events. Objectives The aims are to evaluate the effect of helping babies breathe (HBB) on mortality rate at a district hospital in Kati district, Mali. Methods HBB first edition was implemented in April 2016. One year later the birth attendants were trained in HBB second edition and started frequent repetition training. This is a before and after study comparing the perinatal mortality during the period before HBB training with the period after HBB training, the period after HBB first edition and the period after HBB second edition. Perinatal mortality is defined as FSR plus neonatal deaths in the first 24 h of life. Results There was a significant reduction in perinatal mortality rate (PMR) between the period before and after HBB training, from 21.7/1000 births to 6.0/1000 live births; RR 0.27, (95% CI 0.19–0.41; p < 0.0001). Very early neonatal mortality rate (24 h) decreased significantly from 6.3/1000 to 0.8/1000 live births; RR 0.12 (95% CI 0.05–0.33; p = 0.0006). FSR decreased from 15.7/1000 to 5.3/1000, RR 0.33 (95% CI 0.22–0.52; p < 0.0001). No further reduction occurred after introducing the HBB second edition. Conclusion HBB may be effective in a local first-level referral hospital in Mali.

scholarly journals Evaluating the effect of care around labor and delivery practices on early neonatal mortality in the Global Network’s Maternal and Newborn Health Registry

2020 ◽  
Vol 17 (S2) ◽  
Author(s):  
Archana B. Patel ◽  
Elizabeth M. Simmons ◽  
Sowmya R. Rao ◽  
Janet Moore ◽  
Tracy L. Nolen ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Neonatal Mortality ◽  
Composite Index ◽  
Newborn Health ◽  
World Health ◽  
Essential Newborn Care ◽  
Neonatal Deaths ◽  
Early Neonatal Mortality ◽  
Health Registry

Abstract Background Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation’s (UN’s) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization’s Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness. Methods Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD’s Global Network’s (GN) Maternal Newborn Health Registry (MNHR) between 2010 and 2013, were included. We evaluated if all 8 practices (Care around Delivery – CAD), combined as an index was associated with reduced early neonatal mortality rates (days 0–6 of life). Results A total of 150,848 live births were included in the analysis. The individual indicators varied across sites. All components were present in 19.9% births (range 0.4 to 31% across sites). Present indicators (8 components) were associated with reduced early neonatal mortality [adjusted RR (95% CI):0.81 (0.77, 0.85); p < 0.0001]. Despite an overall association between CAD and early neonatal mortality (RR < 1.0 for all early mortality): delivery by skilled birth attendant; presence of fetal heart and delayed bathing were associated with increased early neonatal mortality. Conclusions Present indicators (8 practices) of CAD were associated with a 19% reduction in the risk of neonatal death in the diverse health facilities where delivery occurred within the GN MNHR. These indicators could be monitored to identify facilities that need to improve compliance with ENC practices to reduce preventable neonatal deaths. Three of the 8 indicators were associated with increased neonatal mortality, due to baby being sick at birth. Although promising, this composite index needs refinement before use to monitor facility-based quality of care in association with early neonatal mortality. Trial registration The identifier of the Maternal Newborn Health Registry at ClinicalTrials.gov is NCT01073475.

scholarly journals Analysis of causes of early neonatal mortality during covid-19 pandemic in 2020 in Russia

2021 ◽  
Author(s):  
UN Tumanova ◽  
AI Schegolev ◽  
AA Chausov ◽  
MP Shuvalova
Keyword(s):  
Neonatal Mortality ◽  
Neonatal Death ◽  
Respiratory Diseases ◽  
Perinatal Death ◽  
Absolute Number ◽  
World Health ◽  
Neonatal Deaths ◽  
Early Neonatal Mortality ◽  
Federal Districts ◽  
Health Organization

In March 2020, the World Health Organization declared a COVID-19 pandemic. The aim of this study was to compare the causes of and statistics on neonatal mortality in Russia in the years 2020 and 2019 using the Rosstat A-5 forms that aggregate data from perinatal death certificates. In 2020, there was a 7.6% reduction in the absolute number of live births relative to 2019. In 2020, the early neonatal death rate (1.59‰) fell by 4.4% relative to 2019 (1.67‰). But neonatal death rates in the Southern and Far Eastern Federal Districts rose by 20.5% and 6.1%, respectively. Respiratory diseases were the most common cause of early neonatal mortality across Russia (37.3% and 40.2% relative to the total number of neonatal deaths in 2019 and 2020, respectively). Congenital sepsis accounted for 43.6% and 46.6% of neonatal deaths from infectious diseases and for 7.3% and 7.9% of all neonatal deaths reported in 2019 and 2020, respectively. There was an increase in the proportion of respiratory diseases among neonates, including congenital pneumonia and other respiratory conditions, and infections, including congenital sepsis, which reflects the direct and indirect effects of SARS-CoV-2 infection in pregnant women and neonates.

scholarly journals Revisiting: “A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: does helping babies breathe training save lives?”

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara Berkelhamer ◽  
Nalini Singhal
Keyword(s):  
Neonatal Mortality ◽  
Low Cost ◽  
Scale Up ◽  
Neonatal Resuscitation ◽  
Population Level ◽  
Helping Babies Breathe ◽  
Birth Attendants ◽  
Resuscitation Training ◽  
Facility Birth ◽  
The Impact

Abstract Background Helping Babies Breathe (HBB) is a low cost, skills-based neonatal resuscitation education program designed specifically for use in low resource settings. Studies from Tanzania, India and Nepal have demonstrated that HBB training results in decreased rates of fresh still birth and/or neonatal mortality. However, less is known regarding the impact of training on neonatal mortality at a population level. Bellad et al. utilized (BMC Pregnancy Childbirth. 2016;16 (1):222) utilized population based registries to evaluate outcomes before and after training of facility birth attendants. Their study entitled “A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: Does Helping Babies Breathe training save lives?” suggested facility based training was not associated with consistent improvements in neonatal mortality on a population level. Discussion Combining outcomes from three diverse settings may have under-estimated the impact of HBB training. We remain concerned that the modest benefits observed in the Kenyan site were lost with compiling of data. Summary The statement that HBB “was not associated with consistent improvements in mortality” may lead to the mistaken conclusion that improvements in neonatal mortality were not seen, when in fact, they were in selected cohorts. With numerous studies demonstrating potential for reduced neonatal mortality as a result of HBB training, we encourage interpretation of these findings in the context of local care.

Newborn Resuscitation Training Programmes Reduce Early Neonatal Mortality

Neonatology ◽  
2016 ◽  
Vol 110 (3) ◽  
pp. 210-224 ◽  
Author(s):  
Mohan Pammi ◽  
Eugene M. Dempsey ◽  
C. Anthony Ryan ◽  
Keith J. Barrington
Keyword(s):  
Neonatal Mortality ◽  
Newborn Resuscitation ◽  
Early Neonatal Mortality ◽  
Resuscitation Training ◽  
Training Programmes

scholarly journals Medical Abortion Versus Manual Vacuum Aspiration in a Hilly District Hospital of Eastern Nepal: A Comparative Study

2015 ◽  
Vol 11 (3) ◽  
pp. 206-209 ◽  
Author(s):  
OB Panta ◽  
D Bhattarai ◽  
N Parajuli
Keyword(s):  
District Hospital ◽  
Medical Abortion ◽  
First Trimester ◽  
Rural Setting ◽  
World Health ◽  
Medical Attention ◽  
Vacuum Aspiration ◽  
Contraception Use ◽  
District Hospitals ◽  
Manual Vacuum Aspiration

Backgroud Nepal government has approved medical abortion and manual vacuum aspiration for early first trimester pregnancy. Both the procedures have been approved by World Health Organization for use in early first trimester. Objectives The study aims to compare efficacy and safety of medical abortion with surgical abortion in a district hospital of rural eastern Nepal. Method An observational study conducted in district hospital, dhankuta from July 2010 to January 2011. Clients for abortion services were counseled about methods of abortion and were allowed to make decision on their own and classified as medical abortion group (N=48) (receiving 200milligram Mifepristone followed by 800 microgram misoprostol sublingually or vaginally on day two)and manual vacuum aspiration group (N=36). The two groups were compared for rate of complete abortion and other complications and contraception use after procedure. Results Rate of complete abortion was similar in both groups, 95.8% among medical abortion and 97.2% in manual vacuum aspiration. Moderate to severe expulsion bleeding was reported in 91.6% of cases after Medical Abortion but none required medical attention for hemorrhage. Condom was the most preferred contraceptive in medical abortion group and depo provera in manual vacuum aspiration group. Conclusion Medical method of abortion using mifepristone and misoprostol is equally safe and effective as manual vacuum aspiration in rural setting district hospitals of Nepal. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12505 Kathmandu Univ Med J 2013; 43(3):206-209

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.

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