Abstract
BackgroundAs more high-risk newborns survive the neonatal period, they remain at significant medical, nutritional, and developmental risk. However, no follow-up system for early intervention exists in most developing countries. In 2014, a novel Pediatric Development Clinic (PDC) was implemented to provide comprehensive follow-up to at-risk under-five children, led by nurses and social workers in a district hospital and surrounding health centers in rural Rwanda.MethodsAt each PDC visit, children undergo clinical/nutritional assessment and caregivers participate in counseling sessions. Social assessments identify families needing additional social support. Developmental assessment is completed using Ages and Stages Questionnaires. A retrospective medical record review was conducted to evaluate the first 24 months of PDC implementation for patients enrolled between April 2014–December 2015 in rural Rwanda. Demographic and clinical characteristics of patients and their caregivers were described using frequencies and proportions. Completion of different core components of PDC visits were compared overtime using Fisher’s Exact test and p-values calculated using trend analysis.Results426 patients enrolled at 5 PDC sites. 54% were female, 44% were neonates and 35% were under 6 months at enrollment. Most frequent referral reasons were prematurity/low birth weight (63%) and hypoxic-ischemic encephalopathy (34%). In 24 months, 2787 PDC visits were conducted. Nurses consistently completed anthropometric measurements (age, weight, height) at all visits. Some visit components were inconsistently recorded, including adjusted age (p = 0.003), interval growth, danger sign assessment, and feeding difficulties (p < 0.001). Completion of other visit components, such as child development counseling and play/stimulation activities, were low but improved with time (p < 0.001).ConclusionsIt is feasible to implement PDCs with non-specialized providers in rural settings as we were able to enroll a diverse group of high-risk infants. We are seeing an improvement in services offered at PDCs over time and continuous quality improvement efforts are underway to strengthen current gaps. Future studies looking at the outcomes of the children benefiting from the PDC program are underway.
Highlights
As more high-risk newborns survive the neonatal period, they remain at significant medical, nutritional, and developmental risk
It is feasible to implement Pediatric Development Clinic (PDC) with non-specialized providers in rural settings as we were able to enroll a diverse group of high-risk infants
We are seeing an improvement in services offered at PDCs over time and continuous quality improvement efforts are underway to strengthen current gaps
Summary
As more high-risk newborns survive the neonatal period, they remain at significant medical, nutritional, and developmental risk. Global advances have been made over the past decade to improve neonatal care and the burden of neonatal mortality and morbidity in low and middle-income countries [1] with prematurity as the leading cause of death among children under 5 years of age [2]. In high-income countries, longitudinal follow-up of these children is integrated into routine pediatric care and is typically conducted by specialists [12]. In sub-Saharan Africa, there are very few interventions to support early childhood development and the majority are generalized, community-based programs [13, 14] that do not meet the unique needs of high-risk infants. To our knowledge there are no early childhood development interventions integrated into routine primary care for at-risk children in low-income countries without access to pediatricians and subspecialists, especially in sub-Saharan Africa
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