Abstract
BackgroundNeonatal mortality comprises an increasing proportion of childhood deaths in the developing world. Essential newborn care practices as recommended by the WHO may improve neonatal outcomes in resource limited settings. Our objective was to pilot a Helping Babies Breathe and Essential Care for Every Baby (HBB and ECEB) implementation package using HBB-ECEB training combined with supportive supervision in rural Nicaragua.MethodsWe employed an HBB-ECEB implementation package in El Ayote and Santo Domingo, two rural municipalities in Nicaragua and used a pre- and post- data collection design for comparison. Following a period of pre-intervention data collection (June–August 2015), care providers were trained in HBB and ECEB using a train-the- trainer model. An external supportive supervisor monitored processes of care and collected data. Data on newborn care processes and short-term outcomes such as hypothermia were collected from facility medical records and analyzed using standard run charts. Home visits were used to determine breastfeeding rates at 7, 30 and 60 days.ResultsThere were 480 institutional births during the study period (June 2015–June 2016). Following the HBB-ECEB implementation package, cord care improved (pre-intervention median 66%; post-intervention shift to ≥85%) and early skin-to-skin care improved (pre-intervention median 0%; post-intervention shift to ≥56%, with a high of 92% in June 2016). Rates of administration of ophthalmic ointment and vitamin K were high pre-intervention (median 97%) and remained high. Early initiation of breastfeeding increased with a pre-intervention median of 25% and post-intervention shift to ≥28%, with a peak of 81% in June 2016. Exclusive breastfeeding rates increased short-term but were not significantly different by 60-days of life (9% pre-intervention versus 21% post-intervention).ConclusionsThe implementation of the HBB-ECEB programs combined with supportive supervision improved the quality of care for newborns in terms of cord care, early skin-to-skin care and early initiation of breastfeeding. The rates of administration of ophthalmic ointment and vitamin K were high pre- intervention and remained high afterwards. These findings show that HBB-ECEB programs implemented with supportive supervision can improve quality of care for newborns.
Highlights
Neonatal mortality comprises an increasing proportion of childhood deaths in the developing world
Our study demonstrates that Essential Newborn Care (ENC) practices can be improved in facilities in resource-poor communities using Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) with in-country supportive supervision
We describe an implementation strategy that may be a model for programs in other rural, resource-limited areas
Summary
Neonatal mortality comprises an increasing proportion of childhood deaths in the developing world. Essential newborn care practices as recommended by the WHO may improve neonatal outcomes in resource limited settings. In Nicaragua, the Neonatal mortality rate (NMR) has remained between 15 and 19 per 1,000 live births over the last decade [4] This rate compares favorably to the rate in many LICs and LMICs, significant disparities in newborn outcomes exist between rural and urban areas, and addressing these disparities is a national priority [4]. Evidence supports the effectiveness of more than 20 perinatal and newborn health practices to reduce neonatal mortality [6] Most of these practices are included in a bundle of care recommended by the World Health Organization (WHO), referred to as Essential Newborn Care (ENC) [7, 8]. Implementation of evidence based newborn care in these areas may improve with the use of educational programs that are simplified, adaptable to local environments, and deliverable using a train-the-trainer model
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