Assessment of Availability of Human Resource and Services for Newborn Care in Primary Health Care Facilities in Jos North Local Government Area of Plateau State, Nigeria

Background: The majority of neonatal deaths occur in low and middle-income countries. Availability of qualified human resources along with maternal and child health services are essential to curb these deaths. The study objective was to determine the availability of human resources and services for newborn care in Primary Health Care facilities in Jos North Local Government Area. Methods: This was a descriptive cross-sectional study conducted in Primary Health Care facilities offering immediate newborn care. A stratified sampling technique was used to select 67 and 60 healthcare workers in 30 public and 30 private facilities respectively. A structured questionnaire was used to collect data and SPSS version 23 was used for data analysis. Results: The majority, 85(66.9%) of the healthcare workers were Community Health Extension Workers. There were 16(12.6%) midwives and 1(0.8%) medical doctors. In-service training on newborn care had been received by 69(54.3%) respondents, while 22(17.3%) respondents had received training on essential newborn care. Only twenty (33.3%) facilities discharge mother and newborn 24 hours after normal delivery. Postnatal services provided included early initiation of breastfeeding by 116(91.3%) respondents. Preventive services included chlorhexidine cord care given by 86(67.7%) respondents while 27(21.3%) and 26(20.5%) gave erythromycin/ tetracycline eye prophylaxis and vitamin k1 respectively. Conclusion: Community Health Extension Workers were the major human resource for immediate newborn care; further research to determine their knowledge and skills are needed. The preventive neonatal services were few. More preventive care and 24-hour postnatal care are advocated as strategies to improve newborn outcomes.

Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study

Background Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. “Every Newborn Birth Indicators Research Tracking in Hospitals” (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF. Methods The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women’s exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording. Results Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8–21.0). Survey-reported (53.2, 95% CI 39.4–66.8) and register-recorded results (85.9, 95% CI 58.1–99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5–93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3–73.5%) and drying (7.3–29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5–3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting. Conclusions Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.

Reliability of maternal recall of delivery and immediate newborn care indicators in Sarlahi, Nepal

Background The intrapartum period is a time of high mortality risk for newborns and mothers. Numerous interventions exist to minimize risk during this period. Data on intervention coverage are needed for health system improvement. Maternal report of intrapartum interventions through surveys is the primary source of coverage data, but they may be invalid or unreliable. Methods We assessed the reliability of maternal report of delivery and immediate newborn care for a sample of home and health facility births in Sarlahi, Nepal. Mothers were visited as soon as possible following delivery (< 72 h) and asked to report circumstances of labor and delivery. A subset was revisited 1–24 months after delivery and asked to recall interventions received using standard household survey questions. We assessed the reliability of each indicator by comparing what mothers reported immediately after delivery against what they reported at the follow-up survey. We assessed potential variation in reliability of maternal report by characteristics of the mother, birth event, or intervention prevalence. Results One thousand five hundred two mother/child pairs were included in the reliability study, with approximately half of births occurring at home. A higher proportion of women who delivered in facilities reported “don’t know” when asked to recall specific interventions both initially and at follow-up. Most indicators had high observed percent agreement, but kappa values were below 0.4, indicating agreement was primarily due to chance. Only “received any injection during delivery” demonstrated high reliability among all births (kappa: 0.737). The reliability of maternal report was typically lower among women who delivered at a facility. There was no difference in reliability based on time since birth of the follow-up interview. We observed over-reporting of interventions at follow-up that were more common in the population and under-reporting of less common interventions. Conclusions This study reinforces previous findings that mothers are unable to report reliably on many interventions within the peripartum period. Household surveys which rely on maternal report, therefore, may not be an appropriate method for collecting data on coverage of many interventions during the peripartum period. This is particularly true among facility births, where many interventions may occur without the mother’s full knowledge.

Reliability of maternal recall of delivery and immediate newborn care indicators in Sarlahi, Nepal

Background: The intrapartum period is a time of high mortality risk for newborns and mothers. Numerous interventions exist to minimize risk during this period. Data on intervention coverage are needed for health system improvement. Maternal report of intrapartum interventions through surveys is the primary source of coverage data, but they may be invalid or unreliable. Methods: We assessed the reliability of maternal report of delivery and immediate newborn care for a sample of home and health facility births in Sarlahi, Nepal. Mothers were visited as soon as possible following delivery (<72 hours) and asked to report circumstances of labor and delivery. A subset was revisited 1-24 months after delivery and asked to recall interventions received using standard household survey questions. We assessed the reliability of each indicator by comparing what mothers reported immediately after delivery against what they reported at the follow-up survey. We assessed potential variation in reliability of maternal report by characteristics of the mother, birth event, or intervention prevalence.Results: 1502 mother/child pairs were included in the reliability study, with approximately half of births occurring at home. A higher proportion of women who delivered in facilities reported “don’t know” when asked to recall specific interventions both initially and at follow-up. Most indicators had high observed percent agreement, but kappa values were below 0.4, indicating agreement was primarily due to chance. Only “received any injection during delivery” demonstrated high reliability among all births (kappa: 0.737). The reliability of maternal report was typically lower among women who delivered at a facility. There was no difference in reliability based on time since birth of the follow-up interview. We observed over-reporting of interventions at follow-up that were more common in the population and under-reporting of less common interventions.Conclusions: This study reinforces previous findings that mothers are unable to report reliably on many interventions within the peripartum period effectively. Household surveys which rely on maternal report, therefore, may not be an appropriate method for collecting data on coverage of many interventions during the peripartum period. This is particularly true among facility births, where many interventions may occur without the mother’s full knowledge.

Helping Babies Survive: Lessons Learned From Global Trainers

BACKGROUND: The Helping Babies Survive (HBS) suite of programs was launched in 2010 as an evidence-based educational package to train health care workers in low- and middle-income countries in neonatal resuscitation, immediate newborn care, and complications of prematurity. To date, there has been no purposeful examination of lessons learned from HBS trainers. Our intent with this study is to gather that data from the field. METHODS: To estimate the total global reach of the HBS program, we obtained equipment distribution data from Laerdal and HBS material download data from the HBS Web site as of March 2020. To understand the lessons learned from HBS trainers, we examined comments from trainers who recorded their trainings on the HBS Web site, and other first-hand accounts. RESULTS: More than 1 million pieces of equipment (simulators, flip charts, provider guides, and action plans) have been distributed worldwide. HBS materials have been downloaded from the Web site &gt;130 000 times and have now been translated into 27 languages. HBS equipment and training has reached an estimated 850 000 providers in 158 countries. Qualitative analysis revealed 3 major themes critical to building successful and sustainable HBS programs: support, planning and local context, and subthemes for each. CONCLUSIONS: Lessons learned from experienced trainers represent a vital distillation of first-hand experience into widely applicable knowledge to be used to reduce potential failures and achieve desired outcomes. Findings from this study offer further guidance on best practices for implementing and sustaining HBS programs and provide insight into challenges and successes experienced by HBS trainers.

Immediate Newborn Care and Associated Outcomes in the Delivery Room: An Observational Study in Rwanda

Background Neonatal mortality is a worldwide concern, especially in sub-Sahara Africa. Millions of newborn deaths could be prevented with quality care at birth. Objective To identify immediate newborn care provided by birth attendants and associated outcomes in the delivery room of a district hospital in Kabgayi, Rwanda. Methods This study used a descriptive cross-sectional design and convenience sampling strategy. The sample of 171 newborns and birth attendants were observed in the delivery room using a standardized checklist during April and May 2019. Descriptive statistics were used to analyze data. Results The majority (65.5%) of newborns were female, and at term (93.6%). The majority had mouth and nose cleared (60%), dried thoroughly (75.4%), wet cloth removed (57.3%), delayed umbilical cord clamping (67.3%), and immediate skin-to-skin contact (67.3%). Limited interventions included APGAR evaluation (28%) and breastfeeding within the first hour (36.6%). The majority of 135(78.9%) were stable, and none died. Conclusion The majority of the study population was stable, though all newborns did not benefit from standard immediate newborn care. To reduce neonatal mortality and morbidity in Rwanda, we need to redouble efforts to strengthen the quality of immediate newborn care. Future research is needed to identify effective training to improve newborn outcomes at birth. Rwanda J Med Health Sci 2020;3(2):238-249