Abstract
BackgroundIntrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Multidimensional care for asphyxia must be implemented to ensure timely and effective care of newborns. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. Our objective was to assess the impact of SMI on neonatal asphyxia care in health centers and hospitals in the region.MethodsA pre-post design. Two hundred forty-eight cases of asphyxia were randomly selected from medical records at baseline (2011–2013) and at second-phase follow-up (2017–2018) in Mexico (state of Chiapas), Honduras, Nicaragua, and Guatemala as part of the SMI Initiative evaluation. A facility survey was conducted to assess quality of health care and the management of asphyxia. The primary outcome was coverage of multidimensional care for the management of asphyxia, consisting of a skilled provider presence at birth, immediate assessment, initial stabilization, and appropriate resuscitation measures of the newborn. Data were analyzed using multivariable logistic regression.ResultsManagement of asphyxia improved significantly after SMI. Proper care of asphyxia in intervention areas was better (OR = 2.4; 95% CI = 1.3–4.6) compared to baseline. Additionally, multidimensional care was significantly higher in Honduras (OR = 4.0; 95% CI = 1.4–12.0) than in Mexico. Of the four multidimensional care components, resuscitation showed the greatest progress by follow-up (65.7%) compared to baseline (38.7%).ConclusionSMI improved the care for neonatal asphyxia management across all levels of health care in all countries. Our findings show that proper training and adequate supplies can improve health outcomes in low-income communities. SMI provides a model for improving health care in other settings.
Highlights
Intrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica
Revised by WHO, UNICEF, and UNFPA in 2009, the Emergency Obstetric and Newborn Care (EmONC) guidelines [6] focus on quality of care for labor and delivery
The objective of this study is to evaluate clinical performance of asphyxia management in low-resource Mesoamerican hospitals by examining multidimensional care coverage and quality of care before and after implementation of Salud Mesoamérica Initiative (SMI)
Summary
Intrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. The EmONC services call for nine essential signal functions, of which basic newborn resuscitation is a required function regardless of facility type To address this performance gap in hospitals, combined rather than single interventions must be implemented, monitored, and evaluated to ensure effective and timely care for newborns. The ministries of health set forth country-led performance indicators and associated incentivized target goals that were monitored by SMI [9]. These performance indicators, or interventions, sought to integrate maternal and child services across the health system, rather than in silos. Asphyxia care interventions were measured alongside maternal targets during labor and delivery, as well as antenatal, postpartum, and older child health goals [10]
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