Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania.

Christina Lulu Makene,Patience Ugwi,Brett D Nelson,Marya Plotkin,Dunstan Bishanga,Sheena Currie,Henry Louis,Kiholeth Winani

doi:10.1186/s12884-014-0381-3

Abstract

BackgroundEvery year, more than a million of the world’s newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. Simple interventions to improve the quality of essential newborn care in health facilities – for example, improving steps to help newborns breathe at birth – have demonstrated up to 47% reduction in newborn mortality in health facilities in Tanzania. We conducted an evaluation of the effects of a large-scale maternal-newborn quality improvement intervention in Tanzania that assessed the quality of provision of essential newborn care and newborn resuscitation.MethodsCross-sectional health facility surveys were conducted pre-intervention (2010) and post intervention (2012) in 52 health facilities in the program implementation area. Essential newborn care provided by health care providers immediately following birth was observed for 489 newborns in 2010 and 560 in 2012; actual management of newborns with trouble breathing were observed in 2010 (n = 18) and 2012 (n = 40). Assessments of health worker knowledge were conducted with case studies (2010, n = 206; 2012, n = 217) and a simulated resuscitation using a newborn mannequin (2010, n = 299; 2012, n = 213). Facility audits assessed facility readiness for essential newborn care.ResultsIndex scores for quality of observed essential newborn care showed significant overall improvement following the quality-of-care intervention, from 39% to 73% (p <0.0001). Health worker knowledge using a case study significantly improved as well, from 23% to 41% (p <0.0001) but skills in resuscitation using a newborn mannequin were persistently low. Availability of essential newborn care supplies, which was high at baseline in the regional hospitals, improved at the lower-level health facilities.ConclusionsWithin two years, the quality improvement program was successful in raising the quality of essential newborn care services in the program facilities. Some gaps in newborn care were persistent, notably practical skills in newborn resuscitation. Continued investment in life-saving improvements to newborn care through the health services is a priority for reduction of newborn mortality in Tanzania.

Highlights

Every year, more than a million of the world’s newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period
Significant progress has been made over the past two decades in child survival, less progress is evident in reducing newborn mortality, especially in sub-Saharan Africa
Helping newborns survive their first day is a priority in the work of the Tanzanian Ministry of Health and Social Welfare (MOHSW) and of other key partners working to accelerate progress toward Millennium Development Goal (MDG) 4 for child survival [6]

Summary

Introduction

More than a million of the world’s newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. In Tanzania, infant mortality (deaths in the first year of life) has seen dramatic reduction in the past 13 years, falling from 71/1,000 to 51/1,000 live births, but neonatal mortality has remained more constant in the same period, from 30/1000 to 26/1,000 [5]. Helping newborns survive their first day is a priority in the work of the Tanzanian Ministry of Health and Social Welfare (MOHSW) and of other key partners working to accelerate progress toward Millennium Development Goal (MDG) 4 for child survival [6]

Methods

Results

Conclusion