Neonatal Intensive Care in a Karen Refugee Camp: A 4 Year Descriptive Study

Claudia Turner,Germana Bancone,Paul Turner,Naw Aye Mya Thein,Nicholas J White,Rose Mcgready,Verena Carrara,François Nosten,Naw Chit Mo Mo Win,Tobias R Kollmann

doi:10.1371/journal.pone.0072721

Claudia Turner, Germana Bancone + Show 8 more

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https://doi.org/10.1371/journal.pone.0072721

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Abstract

BackgroundA third of all deaths in children aged <5 years occur in the neonatal period. Neonatal intensive care is often considered too complex and expensive to be implemented in resource poor settings. Consequently the reductions that have been made in infant mortality in the poorest countries have not been made in the neonatal period. This manuscript describes the activities surrounding the introduction of special care baby unit (SCBU) in a refugee setting and the resulting population impact.MethodsA SCBU was developed in Maela refugee camp on the Thailand-Myanmar border. This unit comprised of a dedicated area, basic equipment, drugs and staff training. Training was built around neonatal guidelines, comprising six clinical steps: recognition, resuscitation, examination, supportive medical care, specialised medical care, and counselling of parents with sick newborns.ResultsFrom January 2008 until December 2011, 952 infants were admitted to SCBU. The main admission diagnoses were early onset neonatal sepsis, jaundice and prematurity. Early prematurity (<34 weeks) carried the highest risk of mortality (OR 9.5, 95% CI 5.4–16.5, p<0.001). There was a significant decrease in mortality from 19.3% (2008) to 4.8% (2011) among the infants admitted for prematurity (p=0.03). The neonatal mortality in Maela camp as a whole declined by 51% from 21.8 to 10.7 deaths per 1000 live births over the corresponding period (p=0.04). Staff expressed more confidence in their ability to take care of neonates and there was a more positive attitude towards premature infants.ConclusionNeonatal mortality can be reduced in a resource poor setting by introduction of a simple low cost unit specialising in care of sick neonates and run by local health workers following adequate training. Training in recognition and provision of simple interventions at a high standard can increase staff confidence and reduce fatalistic attitudes towards premature neonates.

Highlights

Each year over three million neonates die
The commonest causes of death are due to the complications of preterm delivery, complications arising at the time of birth and from neonatal sepsis [1]
The following analysis takes into account only those infants ≥ 28weeks and those infants born to mothers following ANC in Maela camp (n=923)

Summary

Introduction

Each year over three million neonates die. The commonest causes of death are due to the complications of preterm delivery, complications arising at the time of birth and from neonatal sepsis [1]. As 2015 approaches, strides have been made in working toward the fourth millennium development goal, the two thirds reduction in childhood mortality [4] This reduction has occurred mostly in children outside of the neonatal period [5]. The reductions that have been made in infant mortality in the poorest countries have not been made in the neonatal period This manuscript describes the activities surrounding the introduction of special care baby unit (SCBU) in a refugee setting and the resulting population impact. Conclusion: Neonatal mortality can be reduced in a resource poor setting by introduction of a simple low cost unit specialising in care of sick neonates and run by local health workers following adequate training. Training in recognition and provision of simple interventions at a high standard can increase staff confidence and reduce fatalistic attitudes towards premature neonates

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