Emergency Neonatal Care Research Articles

GIANT OMPHALOCELE ABOUT A CASE

We report the case of a giant omphalocele 10 cm in diameter diagnosed by ultrasound in the obstetric emergency department in a patient with a full-term pregnancy in labor, in whom an emergency cesarean section was indicated with fetal extraction, performance of emergency neonatal care, coverage of the omphalocele with non-adherent wet compresses and management by the pediatric surgeon with the result of uncomplicated operative sequelae without complications.

Smartphone apps hold promise for neonatal emergency care in low-resource settings.

Many countries risk failing the Sustainable Development Goal to reduce neonatal mortality to 12 in 1000 live births before 2030, necessitating intervention. This scoping review assesses available evidence from studies implementing smartphone application-based education and clinical decision support in neonatal emergency care in low- and middle-income countries and describes applied assessment tools to highlight gaps in the current literature. A systematic search on 28 March 2024 of PubMed, Web of Science, and EMBASE identified original research papers published in peer-reviewed journals after 2014 in English. The evaluation was based on Kirkpatrick's framework. In total, 20 studies assessing eight different smartphone applications were included. Participants found applications acceptable and feasible in 11 of 14 studies. Knowledge and/or skills were improved in 11 of 12 studies. Behaviour was assessed in 10 studies by tracking app usage. Patient outcome was assessed in four studies, focusing on perinatal mortality, Basic Newborn Care outcomes and correct assessment of newborns. Data from included studies further strengthens hope that smartphone applications can improve neonatal mortality rates in low- and middle-income countries. However, further research into the effectiveness of these applications is warranted. This review highlights gaps in the current literature and provides guidance for future trials.

Parental perceptions of informed consent in a study of tracheal intubations in neonatal intensive care.

Obtaining informed consent in neonatal emergency research is challenging. The aim of this study was to assess parental perceptions of informed consent following participation in a clinical trial in neonatal emergency care. This was a supplementary analysis of a randomised controlled trial comparing video and direct laryngoscopy for neonatal endotracheal intubation in the delivery room and neonatal intensive care unit. After obtaining informed consent for the clinical trial, parents were asked to answer a series of self-administered questions about their perceptions of clinical trial participation and the consent process. Informed consent had been given either before birth, after birth but before inclusion in the trial, or after inclusion in the trial. We received responses from 33 mothers and 27 fathers (n = 60) of the 63 preterm and term infants who participated in the study. Fifty-three (89.8%, n = 59) parents agreed that infants should participate in clinical trials, and 51 (85%, n = 60) parents agreed that parents should be asked for informed consent. Fifty-three (89.8%, n = 59) parents felt that their infant's participation in this particular trial would be beneficial. Fifty-two (86.7%, n = 60) parents felt that the informed consent process was satisfactory. One parent (100%, n = 1) approached before birth, 23 parents (82.1%, n = 28) approached after birth but before enrolment and 26 (83.9%, n = 31) parents approached after enrolment were satisfied with the timing of the consent process. Eight (13.3%, n = 60) parents felt some pressure to provide informed consent. Of these, two (25%) were approached before enrolment and six (75%) were approached after enrolment. Parents valued their infant's participation in an emergency neonatal clinical trial and considered it important to be asked for consent. In this study, it seemed less important whether consent was obtained before or after the intervention. Future studies may need to investigate which form of consent is most acceptable to parents for the individual study in question.

Supporting Acute Neonatal and Paediatric Care Quality in Nepal

The RCPCH Global Health programme has been working for over 20 years in many middle- and low-income countries to help improve the quality of child health worldwide. In 2021, RCPCH Global launched a new programme in Nepal working in partnership with Nepal Paediatric Society (NEPAS) the Nepal Ministry of Health and United Nations International Children’s Emergency Fund (UNICEF). This report outlines the component of the programs and highlights the success in improving neonatal and paediatric emergency care.

Does Facilitative Supervision Made Difference in PHC Readiness to Provide Emergency Maternal and Newborn Care: an Operational Research at Primary Health Centre of Ende District, Eastern Indonesia

Purpose: Government of Indonesia (GOI) has commitment to ensure that basic obstetric and newborn care is provided as to standard of care, through a pilot project of facilitative supervision conducted at 5 Primary Health Centre (PHC) of Ende district, in a series of combined online and onsite supervision during a period of 7 months, ended in December 2021. This operational research examined PHC’ readiness in providing emergency obstetric and newborn care, comparing intervened and control PHC.
 Methods: This present study used quasi experimental method, with Post-test Only Control Group design. Intervention of facilitative supervision only provided in one group, and assessment conducted in those 2 groups, comparing results between those groups. Unit analysis was PHC, 2 PHCs selected as intervened PHC, and 2 PHCs as control. Data were collected through direct observation using check list, assessment of patient’s records, and interview with several health workers.
 Results: In this operational study we compared the service coverage and readiness in providing emergency obstetric neonatal care, between PHC that received and not received intensive facilitative supervision in the previous 7 months. PHC in urban area handling very few obstetric complications but referred more cases to District Hospital (>90). However, intervened PHC provide obstetric complication care two times higher (8.33%) than control PHC (4.17%). Both intervened and control PHC in rural area, provide far more obstetric complication care (>60%) compared to those in urban area, with the coverage of referral case around 30-35% from total obstetric complication cases. Intervened PHC in rural area managing all neonatal complication cases, and shows the lowest percentage of neonatal death (1,2%) compare to other PHCs. Control PHC in rural area also managed 88.89% of neonatal complication cases, but has the highest percentage of neonatal death (4.17%). The significant difference between intervened and control PHC in the input side, lies in the availability of emergency team which should be minimal of 3 health workers consist of doctor, midwife and nurse; and availability of neonatal emergency kit. In the process side, the difference between intervened and control PHC is more obvious in rural area, the main difference lies in the unavailability of algorithm and SOP for post-partum bleeding, pre/eclampsia, and neonatal resuscitation at control PHC
 Conclusions: There is difference in the readiness of providing emergency maternal neonatal between intervened and control PHC only in rural area, indicate by higher compliance level value in the intervened PHC (77.14%) compared to control PHC (40%). The difference in the quality of care only obvious in rural area and in emergency neonatal care, indicate by 3,5x lower percentage of neonatal death in intervened PHC compared to the control PHC

Machine Learning Techniques in Adaptive and Personalized Systems for Health and Wellness

Traditional health systems mostly rely on rules created by experts to offer adaptive interventions to patients. However, with recent advances in artificial intelligence (AI) and machine learning (ML) techniques, health-related systems are becoming more sophisticated with higher accuracy in providing more personalized interventions or treatments to individual patients. In this paper, we present an extensive literature review to explore the current trends in ML-based adaptive systems for health and well-being. We conduct a systematic search for articles published between January 2011 and April 2022 and selected 87 articles that met our inclusion criteria for review. The selected articles target 18 health and wellness domains including disease management, assistive healthcare, medical diagnosis, mental health, physical activity, dietary management, health monitoring, substance use, smoking cessation, homeopathy remedy finding, patient privacy, mobile health (mHealth) apps finder, clinician knowledge representation for neonatal emergency care, dental and oral health, medication management, disease surveillance, medical specialty recommendation, and health awareness. Our review focuses on five key areas across the target domains: data collection strategies, model development process, ML techniques utilized, model evaluation techniques, as well as adaptive or personalization strategies for health and wellness interventions. We also identified various technical and methodological challenges including data volume constraints, data quality issues, data diversity or variability issues, infrastructure-related issues, and suitability of interventions which offer directions for future work in this area. Finally, we offer recommendations for tackling these challenges, leveraging on technological advances such as multimodality, Cloud technology, online learning, edge computing, automatic re-calibration, Bluetooth auto-reconnection, feedback pipeline, federated learning, explainable AI, and co-creation of health and wellness interventions.

Supporting a review of the benefits package of the National Health Insurance Scheme in Ghana

BackgroundAlthough Ghana is lauded for its National Health Insurance Scheme (NHIS), concerns exist about the scheme’s functioning and sustainability. An often-cited issue—contributing to the scheme’s decreasing membership, long-standing financial deficit, and frequent out-of-pocket payments among members—is the large benefits package (BP). While, on paper, the BP covers over 95% of the conditions occurring in Ghana, its design was not informed by any budget analysis, nor any systematic prioritization of interventions. This paper aims to provide evidence-based input into ongoing discussions regarding a review of the NHIS benefits package.MethodsAn existing analytic framework is used to calculate net health benefit (NHB) for a range of interventions in order to assess their cost-effectiveness and enable the prioritization of ‘best buys’. The framework is expanded upon by incorporating concerns for financial protection, and practical feasibility, as well as the political economy challenges of disinvesting in currently funded activities. Five different options for the benefits package, each based on policy discourse in Ghana’s health sector, are presented and evaluated.ResultsImplementing all interventions for which data was available to 100% of the population in need was estimated to cost GH₵4323 million (US$994 million), while the available NHIS budget was only GH₵970 million (US$223 million). Options for the benefits package that focussed on cost-effectiveness and primary care provision achieved the best health outcomes, while options reflecting the status quo and allowing for co-payments included a higher number of healthcare interventions. Apart from the package option focussing on primary care, all packages were faced with physician shortages.ConclusionsCurrent funding to the NHIS is insufficient to provide the historical benefits package, which promises to cover over 95% of disease conditions occurring in Ghana, to the total population. Shifting the NHIS focus from intervention coverage to population coverage is likely to lead to better health outcomes. A primary care package may be most feasible in the short-term, though additional physicians should be trained to provide higher-level care that is highly cost-effective, such as emergency neonatal care.

Analisis Implementasi Program Ponek Di Rsud Sleman Melalui Pendekatan Model Van Meter Van Horn

Background: The maternal mortality rate, newborns in Sleman Regency is quite high. The death rate can be prevented by implementing the Emergency Neonatal Care (EmNC) program. RSUD Sleman is a 24-hour EmNC hospital, has been running the program since 2012.Objectives: To find out the EmNC program at RSUD Sleman through the Van Meter Van Horn model approach to see the implementation performance on aspects: standards, targets, and policy objectives; resource; communication between units, organizational character; attitude of the implementers.Method: Research with a mix method approach. Quantitative data were collected through questionnaires, and qualitative data through in-depth interviews with key informants: the person in charge of the program, doctors, nurses, midwives, and management leaders. Data analysis using qualitative descriptive analysis techniques.Results and Discussion: Aspects of standards, goals, policy objectives of the EmNC program, resources, inter-organizational communication are included in the good category. On the aspect of organizational characteristics, and the attitude of the implementers in the sufficient category.Conclusion: The performance of the implementation of the EmNC program policy at RSUD Sleman from the aspect of standards, goals, objectives, and resources, communication between organizations is categorized as good, but the aspects of organizational characteristics and attitude of the implementers are categorized as adequate.Keywords: emergency; obstetrics; neonates; service; vanmeter van horn.

Geographical accessibility of emergency neonatal care services in Ethiopia: analysis using the 2016 Ethiopian Emergency Obstetric and Neonatal Care Survey

IntroductionAccess to emergency neonatal health services has not been explored widely in the Ethiopian context. Accessibility to health services is a function of the distribution and location of services, including...

A Literature Review of Research on Korean Child Nursing Simulation Practice Education

Purpose : This is a descriptive research to analyze research trends related to child nursing simulation practice education in korea within past 11 years. Methods : A review was done using domestic databases including RISS, KISS, DBpia, and KERIS. 16 papers were analyzed by general characteristics, key variables on reflection, and its findings. Results : 12.5% of the cases, the biggest portion, was on the variables including care for pediatric patient with asthma, neonatal emergency care, simulation-based orientation program before pediatric clinical practice while 6.3% of the sample cases was with the variables for asthma and type 1 diabetes module, children with fever in emergency units, neonatal care, optimizing clinical practice in maternal and child nursing, respiratory distress syndrome in neonatal intensive care units, pediatric nursing, pediatric medication, pediatric medication nursing education for gastroenteritis, standardized child care education, simulation practice for hand-off education. Conclusion : It is believed that it can be available for the basic data for the development of education on simulation practice of children s nursing in korea and also for revitalizing the nursing practice using this research outcome.

Interprofessional collaboration practices enhance the achievement of comprehensive obstetric and neonatal emergency care program indicators in hospitals

Interprofessional collaboration practices enhance the achievement of comprehensive obstetric and neonatal emergency care program indicators in hospitals

Comprehending the lack of access to maternal and neonatal emergency care: Designing solutions based on a space-time approach.

The objective of this study was to better understand how the lack of emergency child and obstetric care can be related to maternal and neonatal mortality levels. We performed spatiotemporal geospatial analyses using data from Brazilian municipalities. An emergency service accessibility index was derived using the two-step floating catchment area (2SFCA) for 951 hospitals. Mortality data from 2000 to 2015 was used to characterize space-time trends. The data was overlapped using a spatial clusters analysis to identify regions with lack of emergency access and high mortality trends. From 2000 to 2015 Brazil the overall neonatal mortality rate varied from 11,42 to 11,71 by 1000 live births. The maternal mortality presented a slightly decrease from 2,98 to 2,88 by 100 thousand inhabitants. For neonatal mortality the Northeast and North regions presented the highest percentage of up trending. For maternal mortality the North region exhibited the higher volume of up trending. The accessibility index obtained highlighted large portions of the rural areas of the country without any coverage of obstetric or neonatal beds. The analyses highlighted regions with problems of mortality and access to maternal and newborn emergency services. This sequence of steps can be applied to other low and medium income countries as health situation analysis tool. Low and middle income countries have greater disparities in access to emergency child and obstetric care. There is a lack of approaches capable to support analysis considering a spatiotemporal perspective for emergency care. Studies using Geographic Information System analysis for maternal and child care, are increasing in frequency. This approach can identify emergency child and obstetric care saturated or deprived regions. The sequence of steps designed here can help researchers, and policy makers to better design strategies aiming to improve emergency child and obstetric care.

Evaluation of Adaptive Feedback in a Smartphone-Based Serious Game on Health Care Providers' Knowledge Gain in Neonatal Emergency Care: Protocol for a Randomized Controlled Trial.

BackgroundAlthough smartphone-based clinical training to support emergency care training is more affordable than traditional avenues of training, it is still in its infancy and remains poorly implemented. In addition, its current implementations tend to be invariant to the evolving learning needs of the intended users. In resource-limited settings, the use of such platforms coupled with serious-gaming approaches remain largely unexplored and underdeveloped, even though they offer promise in terms of addressing the health workforce skill imbalance and lack of training opportunities associated with the high neonatal mortality rates in these settings.ObjectiveThis randomized controlled study aims to assess the effectiveness of offering adaptive versus standard feedback through a smartphone-based serious game on health care providers’ knowledge gain on the management of a neonatal medical emergency.MethodsThe study is aimed at health care workers (physicians, nurses, and clinical officers) who provide bedside neonatal care in low-income settings. We will use data captured through an Android smartphone-based serious-game app that will be downloaded to personal phones belonging to the study participants. The intervention will be adaptive feedback provided within the app. The data captured will include the level of feedback provided to participants as they learn to use the mobile app, and performance data from attempts made during the assessment questions on interactive tasks participants perform as they progress through the app on emergency neonatal care delivery. The primary endpoint will be the first two complete rounds of learning within the app, from which the individuals’ “learning gains” and Morris G intervention effect size will be computed. To minimize bias, participants will be assigned to an experimental or a control group by a within-app random generator, and this process will be concealed to both the study participants and the investigators until the primary endpoint is reached.ResultsThis project was funded in November 2016. It has been approved by the Central University Research Ethics Committee of the University of Oxford and the Scientific and Ethics Review Unit of the Kenya Medical Research Institute. Recruitment and data collection began from February 2019 and will continue up to July 31, 2019. As of July 18, 2019, we enrolled 541 participants, of whom 238 reached the primary endpoint, with a further 19 qualitative interviews conducted to support evaluation. Full analysis will be conducted once we reach the end of the study recruitment period.ConclusionsThis study will be used to explore the effectiveness of adaptive feedback in a smartphone-based serious game on health care providers in a low-income setting. This aspect of medical education is a largely unexplored topic in this context. In this randomized experiment, the risk of performance bias across arms is moderate, given that the active ingredient of the intervention (ie, knowledge) is a latent trait that is difficult to comprehensively control for in a real-world setting. However, the influence of any resulting bias that has the ability to alter the results will be assessed using alternative methods such as qualitative interviews.Trial RegistrationPan African Clinical Trials Registry PACTR201901783811130; https://pactr.samrc.ac.za/TrialDisplay. aspx?TrialID=5836International Registered Report Identifier (IRRID)PRR1-10.2196/13034

Hubungan Motivasi Mahasiswa Pada Praktek Laboratorium Asuhan Kegawatdaruratan Maternal dan Neonatal (KGD) dengan Hasil Belajar Asuhan Kegawatdaruratan Maternal dan Neonatal (KGD) Pada Mahasiswa Semester IV Di Akademi Kebidanan Ibt.isam Aulia Kisaran Tahu

Abstract
 learnig outcomes are to find out the extent to with students have been able to learn from certain subjects by conducting evaluations ,competencies in the form knowledge ,skill,and attitude periodically in the form of midterm formative, semester. the study aims to determaine the relationship of students motivation in laboratory practices with learning outcomes of maternal and neonatal emergency care ( KGD ) in semester IV students .this type of research is a descriptive analytic study using cross sectional design . the population was fourth semester students of ibtisam aulia midwifery kisaran 2018/2019 school year which consisted of 1 class totaling 25 peoples.the sample in this study is the total population data analysis was univariate ,analysis and bivariete analysis with chi square test. the results showed that there was a significant relationship between motivation in KGD laboratory practices and KGD care learning outcomes .its recommended to increase guidance on improving maternal and neonatal emergency care learning outcomes ( KGD ) 
 

Barriers and facilitators to the provision of optimal obstetric and neonatal emergency care and to the implementation of simulation-enhanced mentorship in primary care facilities in Bihar, India: a qualitative study

BackgroundGlobally, an estimated 275,000 maternal deaths, 2.7 million neonatal deaths, and 2.6 million third trimester stillbirths occurred in 2015. Major improvements could be achieved by providing effective care in low- and middle-income countries, where the majority of these deaths occur. Mentoring programs have become a popular modality to improve knowledge and skills among providers in low-resource settings. Thus, a detailed understanding of interrelated factors affecting care provision and mentorship is necessary both to improve the quality of care and to maximize the impact of mentoring programs.MethodsIn partnership with the Government of Bihar, CARE India and PRONTO International implemented simulation-enhanced mentoring in 320 primary health clinics (PHC) across the state of Bihar, India from 2015 to 2017, within the context of the AMANAT mobile nurse mentoring program. Between June and August 2016, we conducted semi-structured interviews with 20 AMANAT nurse mentors to explore barriers and facilitators to optimal care provision and to implementation of simulation-enhanced mentorship in PHCs in Bihar. Data were analyzed using the thematic content approach.ResultsMentors identified numerous factors affecting care provision and mentorship, many of which were interdependent. Such barriers included human resource shortages, nurse-nurse hierarchy, distance between labor and training rooms, cultural norms, and low skill level and resistance to change among mentees. In contrast, physical resource shortages, doctor-nurse hierarchy, corruption, and violence against providers posed barriers to care provision alone. Facilitators included improved skills and confidence among providers, inclusion of doctors in training, increased training frequency, establishment of strong mentor-mentee relationships, administrative support, and nursing supervision and feedback.ConclusionsThis study has identified many interrelated factors affecting care provision and mentorship in Bihar. The mentoring program was not designed to address several barriers, including resource shortages, facility infrastructure, corruption, and cultural norms. These require government support, community awareness, and other systemic changes. Programs may be adapted to address some barriers beyond knowledge and skill deficiencies, notably hierarchy, violence against providers, and certain cultural taboos. An in-depth understanding of barriers and facilitators is essential to enable the design of targeted interventions to improve maternal and neonatal survival in Bihar and related contexts.

IMPROVEMENT OF SOFT SKILLS THROUGH COOPERATIVE LEARNING METHOD (JIGSAW) IN COURSES OF MIDWIFERY CARE EMERGENCY ON MATERNAL AND NEONATAL

Being a professional midwife in the future is not enough to have good hard skills, but also a good soft skill, and for students to have good soft skills, a proper learning method is required, and the lecturer has an important role in determining the learning method. The purpose of this research is to know the method of learning that can improve students’ soft skills on Maternal and Neonatal Emergency Care. The method in this research is Classroom Action Research which measure soft skills of students DIII midwifery. The attributed used soft skills consisted of 15 items. The population of this research is the students of DIII Midwifery of PEMKAB Jombang Institute of Health Science semester IV who follow the Subject of care of Midwifery Emergency Maternal and Neonatal care, which are number 43 respondents. Sampling used is total sampling Method of data collection in this research is lecturers apply three kinds of learning method in 3 times meeting: conventional method, Case Based learning and Cooperative Learning (Jigsaw).The results of this study shows that the case-based learning method is better than the conventional method in improving the soft skills of DIII Midwifery students., cooperative learning (jigsaw) is better than conventional methods in improving the soft skills of DIII midwifery students. There is no significant difference between case based learning method and cooperative learning method (jigsaw).Thus cooperative learning is an appropriate method for midwives students because it is proven to improve students’ soft skills.

FREQUENCY AND CAUSES OF PERINATAL MORTALITY IN A TERTIARY CARE HOSPITAL IN PESHAWAR, PAKISTAN

Background: Perinatal mortality rate indicates quality of care provided during pregnancy and delivery to the mother and to the neonate in its early neonatal period. The objective of this study was to determine the frequency and causes of perinatal mortality in a tertiary care hospital in Peshawar, Pakistan. Materials & Methods: This cross-sectional study was conducted at Department of Gynaecology & Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from 1st January 2016 to 31st December 2016. The inclusion criteria was all singleton gestation with gestational age of at least 24 weeks presenting with perinatal mortality. Data was collected for the following variables; age groups (up to 20 years, 21-30 years, 31-40 years and > 40 years), booking status (yes/ no), period of gestation (24-31+6, 32-36+6, 37-39+6 and > 40 weeks), Foetal weight ( 3.5 kg) and cause of perinatal mortality. Results: Out of 4508 deliveries there were 288 perinatal deaths, including 228 stillbirths and 60 neonatal deaths, so perinatal mortality rate was 63.8/1000 births. 90.28% women were unbooked. Most common cause was hypertensive disorders of pregnancy (27.78%) followed by antepartum haemorrhage (25.71%) and then mechanical causes (13.88%). Congenital anomalies comprised 11.8% cases, neonatal problems 10.07% and maternal medical disorders for 4.16% cases. Cause of 4.16% cases remained unexplained. Conclusion: Appropriate strategies like control of identifiable causes, proper antenatal and postnatal care, healthy delivery practices and availability of emergency neonatal care facilities can bring down perinatal mortality rates.

Implementation strategies for health systems in low-income countries: an overview of systematic reviews.

BackgroundA key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low‐income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision‐makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness.ObjectivesTo provide an overview of the available evidence from up‐to‐date systematic reviews about the effects of implementation strategies for health systems in low‐income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview.MethodsWe searched Health Systems Evidence in November 2010 and PDQ‐Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well‐conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low‐income countries.Main resultsWe identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high‐income countries. There were no studies from low‐income countries in eight reviews.Implementation strategies addressed in the reviews were grouped into four categories – strategies targeting:1. healthcare organisations (e.g. strategies to change organisational culture; 1 review);2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews);3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews);4. healthcare recipients (e.g. medication adherence; 15 reviews).Overall, we found the following interventions to have desirable effects on at least one outcome with moderate‐ or high‐certainty evidence and no moderate‐ or high‐certainty evidence of undesirable effects.1.Strategies targeted at healthcare workers: educational meetings, nutrition training of health workers, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions.2.Strategies targeted at healthcare workers for specific types of problems: training healthcare workers to be more patient‐centred in clinical consultations, use of birth kits, strategies such as clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings, and in‐service neonatal emergency care training.3. Strategies targeted at healthcare recipients: mass media interventions to increase uptake of HIV testing; intensive self‐management and adherence, intensive disease management programmes to improve health literacy; behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy; a one time incentive to start or continue tuberculosis prophylaxis; default reminders for patients being treated for active tuberculosis; use of sectioned polythene bags for adherence to malaria medication; community‐based health education, and reminders and recall strategies to increase vaccination uptake; interventions to increase uptake of cervical screening (invitations, education, counselling, access to health promotion nurse and intensive recruitment); health insurance information and application support.Authors' conclusionsReliable systematic reviews have evaluated a wide range of strategies for implementing evidence‐based interventions in low‐income countries. Most of the available evidence is focused on strategies targeted at healthcare workers and healthcare recipients and relates to process‐based outcomes. Evidence of the effects of strategies targeting healthcare organisations is scarce.

Analysis of Basic Emergency Obstetric and Neonatal Care (PONED) Services in Baso Public Health Center, Indonesia: Recommendations from Qualitative Interviews

One of the main indicators of the health status of a country is the Maternal Mortality Rate (MMR). In order to improve the MMR in Indonesia, the government has made a number of primary health centers (PHC) capable of providing basic obstetric and neonatal emergency care (PONED) services. The aim of this research is to learn how well PONED services have been implemented at the Baso PHC in Agam Regency as of 2015. We used a qualitative approach, with in-depth interviews and observations from June-August 2015. Ten respondents participated in the in-depth interviews, and observations were made about the infrastructure. The validity of the data is based on the standard of credibility, transferability, dependability, and confirmability of the content of the interviews. The analysis shows that there are still some obstacles in PONED PHC implementation, including the lack of human resources at the PHC and insufficient facilities, funding, and oversight, which causes many cases that should be handled by a PONED team to be referred to the hospital. Suggestions are provided to help improve policies and ultimately patient care.

Impact Evaluation of PRONTO Mexico: A Simulation-Based Program in Obstetric and Neonatal Emergencies and Team Training.

Most maternal deaths in Mexico occur within health facilities, often attributable to suboptimal care and lack of access to emergency services. Improving obstetric and neonatal emergency care can improve health outcomes. We evaluated the impact of PRONTO, a simulation-based low-cost obstetric and neonatal emergency and team training program on patient outcomes. We conducted a pair-matched hospital-based trial in Mexico from 2010 to 2013 with 24 public hospitals. Obstetric and neonatal care providers participated in PRONTO trainings at intervention hospitals. Control hospitals received no intervention. Outcome measures included hospital-based neonatal mortality, maternal complications, and cesarean delivery. We fitted mixed-effects negative binomial regression models to estimate incidence rate ratios and 95% confidence intervals using a difference-in-differences approach, cumulatively, and at follow-up intervals measured at 4, 8, and 12 months. There was a significant estimated impact of PRONTO on the incidence of cesarean sections in intervention hospitals relative to controls adjusting for baseline differences during all 12 months cumulative of follow-up (21% decrease, P = 0.005) and in intervals measured at 4 (16% decrease, P = 0.02), 8 (20% decrease, P = 0.004), and 12 months' (20% decrease, P = 0.003) follow-up. We found no statistically significant impact of the intervention on the incidence of maternal complications. A significant impact of a 40% reduction in neonatal mortality adjusting for baseline differences was apparent at 8 months postintervention but not at 4 or 12 months. PRONTO reduced the incidence of cesarean delivery and may improve neonatal mortality, although the effect on the latter might not be sustainable. Further study is warranted to confirm whether obstetric and neonatal emergency simulation and team training can have lasting results on patient outcomes.