Abstract
BackgroundNeonatal mortality contributes to nearly half of child deaths globally and the majority of these deaths are preventable. Poor quality of care is a major driver of neonatal mortality in low- and middle-income countries. The All Babies Count (ABC) intervention was designed to reduce neonatal mortality through provision of equipment and supplies, training, mentorship, and data-driven quality improvement (QI) with peer-to-peer learning through learning collaborative sessions (LCS). We aim to describe the ABC scale-up in seven rural district hospitals from 2017 to 2019 focusing on the QI strategies implemented in hospital neonatal care units (NCUs) and the resultant neonatal care outcomes.MethodsA pre-post quasi experimental study was conducted in 7 rural hospitals in Rwanda in two phases. The baseline periods were April-June 2017 for Phase I and July-September 2017 for Phase II; with end-line data collected during the same periods in 2019. Data included facility audits of supplies and staffing, LCS surveys of QI skills, and reports of implemented QI change ideas. Data on NCU admissions and deaths were extracted from Health Management Information System (HMIS). Facility-reported change ideas were coded into common themes. Changes in post-post neonatal mortality were measured using Chi-squared tests.ResultsNCUs were run by a median of 1 nurse [interquartile range (IQR):1–2] at baseline and endline. Median NCU admissions increased from 121 [IQR: 77–155] to 137 [IQR: 79–184]. Availability of advanced equipment improved (syringe pumps: 57–100 %, vital sign monitors: 51–100 % and CPAP machine: 14–100 %). There were significant improvements in QI skills among NCU staff. All 7 NCUs (100 %) addressed non-adherence to protocol as a priority gap, 5 NCUs (86 %) also improved communication with families. NCU case fatality rate declined from 12.4 to 7.8 % (p = 0.001).ConclusionsThe ABC package of interventions combining the provision of essential equipment to NCU, clinical training and strong mentorship, QI coaching, and the LCS approach for peer-to-peer learning was associated with significant neonatal mortality reduction and services utilization in the intervention hospitals.
Highlights
Neonatal mortality contributes to nearly half of child deaths globally and the majority of these deaths are preventable
Globally, four million neonatal deaths are registered annually, representing nearly half of under-five child mortality [1]. 73 % of neonatal deaths occur in the first week of life, especially during the first 24 hours after delivery [1]. 98 % of all neonatal deaths occur in low- and middle-income countries (LMICs), and 77 % of those in Asia and Sub-Saharan Africa [1]
Study setting The hospitals for implementation of All Babies Count (ABC) during scaleup were identified jointly by the Rwandan Ministry of Health (MOH) and Partners In Health/ Inshuti Mu Buzima (PIH/IMB) based on the following criteria: high neonatal mortality rate and no partner organizations to improve neonatal care in their areas
Summary
Neonatal mortality contributes to nearly half of child deaths globally and the majority of these deaths are preventable. Poor quality of care is a major driver of neonatal mortality in low- and middle-income countries. Scaling up evidence-based interventions for the management of small and sick newborns is one strategy which could reduce neonatal mortality by 30 % globally [3]. This requires the availability of inpatient specialized care for small and sick newborns, ideally in dedicated units with skilled staff, and there is significant potential for quality improvement (QI) interventions [9]
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