Neonatal Care Services Research Articles

Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective.

The population of infants at risk for retinopathy of prematurity (ROP) varies by world region; in countries with well developed neonatal intensive care services, the highest risk infants are those born at less than 28 weeks gestational age (GA) and less than 1kgat birth, while, in regions where many aspects of neonatal intensive and ophthalmological care are not routinely available, more mature infants up to 2000 g at birth and 37weeksGA are also at risk for severe ROP. Treatment options for both groups of patients include standard retinal laser photocoagulation or, more recently, intravitreal anti-VEGF drugs. In addition to detection and treatment of ROP, this review highlights new opportunities created by telemedicine, where screening and diagnosis of ROP in remote locations can be undertaken by non-ophthalmologists using digital fundus cameras. The ophthalmological care of the ROP infant is undertaken in the wider context of neonatal care and general wellbeing of the infant. Because of this context, this review takes a multi-disciplinary perspective with contributions from retinal vascular biologists, pediatric ophthalmologists, an epidemiologist and a neonatologist. This review highlights the latest insights regarding cellular and molecular mechanisms in the formation of the retinal vasculature in the human infant, pathogenesis of ROP, detection and treatment of severe ROP, the risks and benefits of anti-VEGF therapy, the identification of new therapies over the horizon, and the optimal neonatal care regimen for best ROP outcomes, and the benefits and pitfalls of telemedicine in the remote screening and diagnosis of ROP, all of which have the potential to improve ROP outcomes.

Ganaxolone: A New Treatment for Neonatal Seizures.

Neonatal seizures are amongst the most common neurologic conditions managed by a neonatal care service. Seizures can exacerbate existing brain injury, induce “de novo” injury, and are associated with neurodevelopmental disabilities in post-neonatal life. In this mini-review, we present evidence in support of the use of ganaxolone, a GABAA agonist neurosteroid, as a novel neonatal therapy. We discuss evidence that ganaxolone can provide both seizure control and neuroprotection with a high safety profile when administered early following birth-related hypoxia, and show evidence that it is likely to prevent or reduce the incidence of the enduring disabilities associated with preterm birth, cerebral palsy, and epilepsy. We suggest that ganaxolone is an ideal anti-seizure treatment because it can be safely used prospectively, with minimal or no adverse effects on the neonatal brain.

English

Health care seeking behaviour is any action undertaken by individuals who perceive to have a health problem or to be ill for finding an appropriate remedy. It involves recognition of symptoms, perceived nature of illness, followed initially by appropriate home care and monitoring. In Ethiopia, little is known about mother’s health care seeking behaviour on neonatal danger signs. Therefore, this study assessed the health care seeking behaviour on neonatal danger signs among mothers in Tenta district, Northeast Ethiopia. Community based cross-sectional study was conducted from October 23 to November 17, 2015. The study district was stratified into urban and rural kebeles. From each stratum, 1 out of 3 urban and 7 out of 25 rural kebeles were selected by simple random sampling technique. A total of 527 mothers were interviewed using structured and pre-tested questionnaire. The data were checked for missing values and outliers, and analysed using SPSS version 20.0. Logistic regression analyses were employed to see the association between dependent and independent variables. Mothers who sought medical care for neonatal danger signs were 167 (41.3%). Mothers’ secondary educational level (AOR=4.64, 95% CI=1.1-19.81), have given birth in health center (AOR=3.35, 95% CI=1.31-8.56), practicing optimal thermal care (AOR=2.52, 95% CI=1.08-5.85), and having higher decision-making abilities in seeking neonatal health care (AOR=11.28, 95% CI=4.36-29.22) were significant predictors of mother’s health seeking behaviour towards neonatal danger signs. Long distance of the residence from health facility, experiencing less serious neonatal danger signs, and beliefs that some danger signs were caused by evil spirits were the most common reasons cited by mothers who did not seek neonatal medical care. In this study, more than half of mother’s did not seek medical care for neonatal danger signs. Maternal education and improving their decision-making abilities, and promoting institutional delivery are the recommended interventions to improve mother’s health care seeking for neonatal illness. Health facilities should integrate essential neonatal care service during ANC and PNC follow up to improve the quality of health information about neonatal danger signs. At the community level, health extension workers should educate mothers about newborn care practices and neonatal danger signs. Key words: Mothers’ health care seeking behaviour, neonatal danger signs, Tenta district.

Clinical Evaluation of Invasive Home Mechanical Ventilation Dependent Pediatric Patients

Objectives: With the advancements in neonatal and pediatric intensive care services and technology, the number of children requiring long term mechanical ventilation support is increasing. Home mechanical ventilators enable discharge of patients with chronic respiratory failure from hospital and allows children to grow in natural environment. The objective of this study was to define clinical characteristics and follow up results of pediatric patients who are dependent on invasive home mechanical ventilation support. Methods: This retrospective study included a total of 61 patients discharged from pediatric intensive care unit while on mechanical ventilation (HMV). Results: The median age of patients was 8.5 (2 - 196) months with 60% of them being younger than 12 months. The decision for HMV was made after median 38 ± 37.2 days of mechanical ventilation in hospital. The most common reason of dependency on invasive HMV was found as central nervous system and neuromuscular diseases by 94%. The median duration of follow up was 11 months (4 days-7.5 years). HMV was no longer necessary in 12% of patients ventilated for neurological reasons and 50% for chronic pulmonary diseases. Anthropometric measures were observed to be improved in 69% of the patients. Mortality rate attributed to complications of tracheostomy was 15% and overall mortality was found as 46.7%. Conclusions: HMV enables ventilator dependent patients to be discharged and allows patients to develop and grow in their natural environment which helps them to catch up their growth potentials. The survival and quality of life (QoL) of these patients can be improved by family education and with the support by nutrition and care rehabilitation programs.

The effect of a clinical decision-making mHealth support system on maternal and neonatal mortality and morbidity in Ghana: study protocol for a cluster randomized controlled trial

BackgroundMobile health (mHealth) presents one of the potential solutions to maximize health worker impact and efficiency in an effort to reach the Sustainable Development Goals 3.1 and 3.2, particularly in sub-Saharan African countries. Poor-quality clinical decision-making is known to be associated with poor pregnancy and birth outcomes. This study aims to assess the effect of a clinical decision-making support system (CDMSS) directed at frontline health care providers on neonatal and maternal health outcomes.Methods/designA cluster randomized controlled trial will be conducted in 16 eligible districts (clusters) in the Eastern Region of Ghana to assess the effect of an mHealth CDMSS for maternal and neonatal health care services on maternal and neonatal outcomes. The CDMSS intervention consists of an Unstructured Supplementary Service Data (USSD)-based text messaging of standard emergency obstetric and neonatal protocols to providers on their request. The primary outcome of the intervention is the incidence of institutional neonatal mortality. Outcomes will be assessed through an analysis of data on maternal and neonatal morbidity and mortality extracted from the District Health Information Management System-2 (DHIMS-2) and health facility-based records. The quality of maternal and neonatal health care will be assessed in two purposively selected clusters from each study arm.DiscussionIn this trial the effect of a mobile CDMSS on institutional maternal and neonatal health outcomes will be evaluated to generate evidence-based recommendations for the use of mobile CDMSS in Ghana and other West African countries.Trial registrationClinicalTrials.gov, identifier: NCT02468310. Registered on 7 September 2015; Pan African Clinical Trials Registry, identifier: PACTR20151200109073. Registered on 9 December 2015 retrospectively from trial start date.

Reduction of Neonatal Mortality Requires Strengthening of the Health System: A Situational Analysis of Neonatal Care Services in Ballabgarh.

Planning a comprehensive program addressing neonatal mortality will require a detailed situational analysis of available neonatal-specific health infrastructure. We identified facilities providing essential and sick neonatal care (ENC, SNC) by a snowballing technique in Ballabgarh Block. These were assessed for infrastructure, human resource and equipment along with self-rated competency of the staff and compared with facility-based or population-based norms. A total of 35 facilities providing ENC and 10 facilities for SNC were identified. ENC services were largely in the public-sector domain (68.5% of births) and were well distributed in the block. SNC burden was largely being borne by the private sector (66% of admissions), which was urban-based. The private sector and nurses reported lower competency especially for SNC. Only 53.9% of government facilities and 17.5% of private facilities had a fully equipped newborn care corner. Serious efforts to reduce neonatal mortality would require major capacity strengthening of the health system, including that of the private sector.

A case control study investigating factors associated with high infant death in Saiha district of Mizoram, India bordering Myanmar

BackgroundInfant mortality has dropped considerably in India over the last 5 years. A sharp contrast to this decline in national average of infant mortality is the rate recorded during 2014–2015 from the southernmost district of Saiha, Mizoram having a common international border with Myanmar. As this district specific rate (113 per 1000 live births) is 3 times higher compared to the national and state average, the present investigation was carried out to identify associated factors.MethodsWe examined secondary data made available by the national health mission, consulted with local community members and generated primary data through interviews. A case-control study design was followed. Mothers, who delivered a child during 2013–2015 and subsequently lost them due to infant death, formed the case group and controls were selected from same neighborhood as with case-mothers. The mother and child tracking system maintained by the district specific national health mission office was used for recruiting cases and controls. A total of 195 mothers were interviewed; 66 of them belonged to ‘cases’ and 129 were ‘controls’.ResultsThe mean age of the respondents was 27 years (median 27; SD ± 5; minimum 17 & maximum 44). In uni-variate analyses ‘child delivery at home’, ‘low birth weight’, ‘non-attendance of school by mothers’, ‘completed standard of school education by mothers’, ‘both parents working’, ‘mothers receiving blood transfusion during last pregnancy’, and ‘fourth or more birth order during last pregnancy’ were associated with infant deaths. Intriguingly, the number of daily kuhva (raw areca nut) intake during last pregnancy was significantly higher among case-mothers compared to controls. In conditional logistic regression, ‘low birth weight’ (adjusted OR (AOR) 14.7; 95% CI 2.1–101.8; p = 0.006), and ‘consumption of 4 or more kuhva per day’ (AOR 8; 95% CI 1.9–34.3; p = 0.005) were independently associated with infant-death-experiences.ConclusionThe present investigation merits due attention from policy makers and health planners for immediate improvement in peri-natal and neonatal care services in the remote district of Saiha. Need for further research exploring socio-behavioural issues around areca nut consumption and effects of interventions to reduce areca nut intake on maternal and children health are underscored.

Availability, Coverage and Geographical Distribution of Emergency Obstetric and Neonatal Care Services in Tanzania Mainland

In order to assess the availability of Emergency Obstetric and Neonatal Care (EmONC) services in Tanzania Mainland, a Cross-sectional survey of a National sample of obstetric care facilities was conducted in 2015. We adapted the Averting Maternal Deaths and Disabilities (AMDD) tool and did spatial mapping using a calibrated Global Positioning System (GPS) Essential Software for Android and Arc Geographical Information System (GIS) software. Data were analysed using STATA, SPSS and Excel computer programs. Ethical approval was granted by the National Institute for Medical Research and the Ministry of Health, Community Development, Gender, Elderly and Children. We identified 5207 obstetric care facilities which is equivalent to 59.7 facilities per 500,000 population. We surveyed 2405 (46.2%) facilities of which 251 (10.4%) had provided all the 7 Basic Emergency Obstetric and Neonatal Care (BEmONC) in past 3 months. Among these, 130 had provided Comprehensive Emergency Obstetric and Neonatal Care (CEmONC). The UN benchmarks for BEmONC and CEmONC facility densities were attained or exceeded by 40% and 76% in all 25 regions respectively. EmONC facilities were dominated by hospitals and were clustered in cities and townships. In conclusions, the distribution of EmONC facilities in Tanzania Mainland is suboptimal in more than half of regions with clustering around cities and townships.

Assessing facility readiness to offer basic emergency obstetrics and neonatal care (BEmONC) services in health care facilities of west Pokot county, Kenya

Assessing facility readiness to offer basic emergency obstetrics and neonatal care (BEmONC) services in health care facilities of west Pokot county, Kenya

Emergency obstetric and neonatal care needs assessment: Results of the 2010 and 2014 surveys in Burkina Faso

ObjectiveTo analyze and compare the availability, utilization, and quality of services for maternal and neonatal health in 2010 and 2014 in Burkina Faso. MethodsA cross-sectional study of emergency obstetric and neonatal care services (EmONC) in all public and private health facilities in Burkina Faso in 2010 and a sample of 812 health facilities in 2014. The generic tools developed by the Averting Maternal Death and Disability (AMDD) program were used as the basic tools for evaluation. ResultsIn 2010, 25 health facilities were considered as EmONC health facilities and there were 23 in 2014. In 2010 and 2014, the proportion of births in EmONC health facilities was low (4.5%). The cesarean delivery rate also remained very low, at 0.9% in 2010 and 1.13% in 2014. The proportion of obstetric complications supported in health facilities was 12.3% in 2010 and 17.1% in 2014. The direct complication case fatality rate in EmONC health facilities was 1.6% in 2010 and 1.3% in 2014. ConclusionThe two surveys did not show a significant improvement in the availability, utilization, and quality of maternal and neonatal healthcare services between 2010 and 2014.

The mobile paediatric circulatory support unit

A mobile paediatric circulatory support unit has been set up within the paediatric and neonatal intensive care service at the Armand-Trousseau Hospital in Paris (AP-HP, 75). It is in place for situations of refractory respiratory and/or circulatory failure and can intervene in a radius of several hundred kilometres, in order to establish long-term extracorporeal circulation. In this delicate context, transporting children requires specific skills, coordination between all intervening parties and faultless organisation.

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.

Challenges and opportunities for neonatal respiratory support in Nigeria: a case for regionalisation of care

Background: Neonatal health appears not to have received the deserved attention in the context of the Child Survival Strategies and this must have contributed to the non-attainment of the MDG-4 in Nigeria. Neonatal mortality contributes 40% or more to the current rate of child deaths globally, with birth asphyxia, prematurity and its complications and severe infections as the leading causes. This emphasises the need to re-focus on neonatal health. Given the state of the economy in the low- and middle-income countries, Nigeria, like most of the other countries lack the resources required for efficient neonatal health care with minimal attention on the strategies needed to address the major causes of newborn death. Objectives: To assess the contemporary situation of neonatal care in Benin City, Nigeria and examine diverse approaches to be adopted to provide high level neonatal care services aimed at improving neonatal survival rates. Methods: The trends of neonatal morbidities and mortality over the period between 1974 and 2014 were studied by reviewing the hospital records covering admissions and weekly mortality records. The pattern of categories of babies and the causes of death were recorded. The information gathered identified the gaps in the management strategies for newborns over the years. Electronic databases such as the Medline and Pubmed were searched for relevant literatures published between 1960 and 2015 which might provide ideas required to fill the gaps. Results: In the 1974-1976 era, the major cause of neonatal mortality at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, was birth asphyxia with an attendant perinatal mortality of 80.9/1000 births. The decline in the perinatal mortality to 33.4/1000 births between 1976 and 1980 was linked to the introduction of delivery room resuscitation with a reciprocal decline in the incidence of birth asphyxia. Thereafter, neonatal mortality rate has continued to increase. This increase could be attributed to a three-fold rise in the proportion of very preterm admissions from 6.5% in 1985 to 19.3% in 2013. This population of babies is predisposed to Respiratory Distress Syndrome and respiratory failure. Neonatal intensive care did not include respiratory supports until very recently (2013) when the facilities were provided but at high cost to the patient and the health system. Conclusion: The strategies required to address reduction in neonatal mortality rates should necessarily include neonatal resuscitation and mechanical ventilation, all within the context of Neonatal Intensive Care. In order to provide the full range of neonatal intensive care services in a resource- constrained setting such as Benin City, Nigeria, regionalisation of care in a stepwise manner is recommended, both for improved medical outcomes and economic realities. Keywords: Challenges, Neonatal ventilatory support, Regionalisation of care

Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model.

BackgroundIn Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians.MethodsTen health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians), and forty-four nurse-midwives and clinical officers (associate clinicians) were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals.FindingsAfter launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03) in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS) were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND) in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively). Of all deaths (maternal and IVEND) 84% to 96% were considered avoidable.ConclusionsThese findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEmONC services and to improve maternal and perinatal health.

Scope of neonatal care services in major Nigerian hospitals

Background: Neonatal survival bespeaks the quality of neonatal care services available and accessible to the population. Intensive care improves outcome of high-risk infants with serious illness. The tiered level of care is yet to be applied to newborn care in Nigeria. Classification of care is key to improving neonatal survival with enhanced referral of high-risk patients to higher-level centres.Objective: To ascertain the scope and classify available newborn services offered at major Nigerian hospitals.Methodology: A semi-structured validated questionnaire was administered to attendees during 2015 Pediatric Association of Nigeria conference. The information derived was used to categorize neonatal care services.Results: The respondents consisted of doctors 201 (84.8%) and nurses 36 (15.2%) in 54 health facilities from all geopolitical regions of Nigeria. Of the 54 facilities, 34 (63%) were located in state capitals and 47 (87%) in public hospitals. Half of the evaluated units belonged to Class I, 22 (40.7%) Class II, and 5 (9.3%) Class III levels of neonatal care. Majority (81.6%) of the doctors have been trained on neonatal resuscitation; with senior residents being the highest 49 (89%) and Medical officers (MO) the least 4 (40%) trained. Doctors with training in mechanical ventilation (MV) were 39.2%; Consultants (51.2%), MO’s the least 1(11.2%) trained (p=0.025). Monitoring is usually by pulse oximeters 54 (100%), multi parameter monitors 23 (42.6%) and rarely ABGs 6 (11%).Conclusion: Neonatal care in Nigeria is still developing. Most centres provide basic neonatal care services. Regionalization of care may be the solution to higher level neonatal care.Kewords: Neonatal Care; Scope

Evaluation of Antenatal to Neonatal Continuum Care Services Affecting Neonatal Health in a Tertiary Health-Care Setup.

Background:Maternal and child mortality and morbidity continue to be high despite existence of various national health programmes in India. Annually 41% of all Under 5 mortality is comprised of neonates, 3/4 of who die within the first week of life. Even though effective programmes are existing, optimum utilization is still a question. So the present study was planned to assess utilisation of maternal and neonatal health services and its influence on neonatal health.Objectives:1. To assess the utilization of MCH services before admission to SNCU. 2. To analyse the process of implementation of IMNCI before referral and during the admission. 3. To observe the impact on neonatal health and give necessary recommendations.Methodology:The information regarding utilization of MCH services was obtained by conducting in depth interviews with the responsible adults accompanying the sick neonate. The Pre-treatment and referral slips were verified and compared with that of the prescribed guidelines laid down by the IMNCI for young infants (0-2 months) at SNCU.Results and Discussion:Some of the important observations were mentioned here. 100% women had TT immunization whereas 72% had the full ANC, 58.7% had full course of IFA, 76% had utilized JSY benefits and 48.34% had their PNC. 84% neonates had required immunization, 59.01% were on exclusive breast feeding. 38.9% were paid home visits, only 42% had an idea about the danger signs of neonatal period. 23% sick babies were treated under IMNCI guideline. Among them 98% given initial treatment, only 34% given proper diagnosis/classification, 56% were given adequate advice.

Child health Care delivery system in Rewa District: A critical analysis

Background : In developing countries like India, a very high proportion of the population especially in rural areas of Madhya Pradesh does not have ready access to neonatal and child health care services. There is an urgent need for removal of obstacles to pediatric health to improve health indicators. Aims & Objectives: To assess the infrastructure and quality of child health care delivery system in Rewa district of Madhya Pradesh. Material & Method: A cross-sectional observation study carried out at tertiary care hospital. 84 Auxiliary nurse midwives (ANMs), 16 Medical officers posted at primary health centres (PHCs) and 10 medical officers in-charge of Community health centres (CHCs) were interviewed through a predesigned questionnaire over a period of one year to assess neonatal and child health care services at sub centre, PHCs and CHCs respectively. Results: 91.66% subcentres had male workers and 90.4% had ANMs. 53.5% subcentres are covering 5-10 villages and 20.2% were covering even more than 10 villages. 42.9% of studied subcentres did not have their buildings. 31.2% of studied PHCs did not have doctor. 81.2% PHCs are not having staff nurses, 43.7% of studied PHCs are not having their own buildings. Marked lack of specialists in CHCs was found affecting newborn care. Conclusion: Improvement in infrastructure and specialist facilities is needed to improve neonatal and child health care services as well as health indicators in Rewa district. Background : In developing countries like India, a very high proportion of the population especially in rural areas of Madhya Pradesh does not have ready access to neonatal and child health care services. There is an urgent need for removal of obstacles to pediatric health to improve health indicators. Aims & Objectives : To assess the infrastructure and quality of child health care delivery system in Rewa district of Madhya Pradesh. Material & Method: A cross-sectional observation study carried out at tertiary care hospital. 84 Auxiliary nurse midwives (ANMs), 16 Medical officers posted at primary health centres (PHCs) and 10 medical officers in-charge of Community health centres (CHCs) were interviewed through a predesigned questionnaire over a period of one year to assess neonatal and child health care services at sub centre, PHCs and CHCs respectively. Results : 91.66% subcentres had male workers and 90.4% had ANMs. 53.5% subcentres are covering 5-10 villages and 20.2% were covering even more than 10 villages. 42.9% of studied subcentres did not have their buildings. 31.2% of studied PHCs did not have doctor. 81.2% PHCs are not having staff nurses, 43.7% of studied PHCs are not having their own buildings. Marked lack of specialists in CHCs was found affecting newborn care. Conclusion : Improvement in infrastructure and specialist facilities is needed to improve neonatal and child health care services as well as health indicators in Rewa district. Normal 0 false false false EN-IN X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

Barriers in the Delivery of Emergency Obstetric and Neonatal Care in Post-Conflict Africa: Qualitative Case Studies of Burundi and Northern Uganda.

ObjectivesMaternal and neonatal mortality and morbidity rates are particularly grim in conflict, post-conflict and other crisis settings, a situation partly blamed on non-availability and/or poor quality of emergency obstetric and neonatal care (EmONC) services. The aim of this study was to explore the barriers to effective delivery of EmONC services in post-conflict Burundi and Northern Uganda, in order to provide policy makers and other relevant stakeholders context-relevant data on improving the delivery of these lifesaving services.MethodsThis was a qualitative comparative case study that used 42 face-to-face semi-structured in-depth interviews and 4 focus group discussions for data collection. Participants were 32 local health providers and 37 staff of NGOs working in the area of maternal health. Data was analysed using the framework approach.ResultsThe availability, quality and distribution of EmONC services were major challenges across the sites. The barriers in the delivery of quality EmONC services were categorised into two major themes; human resources-related challenges, and systemic and institutional failures. While some of the barriers were similar, others were unique to specific sites. The common barriers included shortage of qualified staff; lack of essential installations, supplies and medications; increasing workload, burn-out and turnover; and poor data collection and monitoring systems. Barriers unique to Northern Uganda were demoralised personnel and lack of recognition; poor referral system; inefficient drug supply system; staff absenteeism in rural areas; and poor coordination among key personnel. In Burundi, weak curriculum; poor harmonisation and coordination of training; and inefficient allocation of resources were the unique challenges. To improve the situation across the sites, efforts are ongoing to improve the training and recruitment of more staff; harmonise and strengthen the curriculum and training; increase the number of EmONC facilities; and improve staff supervision, monitoring and support.ConclusionsPost-conflict health systems face different challenges in the delivery of EmONC services and as such require context-specific interventions to improve the delivery of these services.

Assessing Community Based Improved Maternal Neonatal Child Survival (IMNCS) Program in Rural Bangladesh.

ObjectivesA community based approach before, during and after child birth has been proven effective address the burden of maternal, neonatal and child morbidity and mortality in the low and middle income countries. We aimed to examine the overall change in maternal and newborn health outcomes due the “Improved Maternal Newborn and Child Survival” (IMNCS) project, which was implemented by BRAC in rural communities of Bangladesh.MethodsThe intervention was implemented in four districts for duration of 5-years, while two districts served as comparison areas. The intervention was delivered by community health workers who were trained on essential maternal, neonatal and child health care services. A baseline survey was conducted in 2008 among 7, 200 women with pregnancy outcome in last year or having a currently alive child of 12–59 months. A follow-up survey was administered in 2012–13 among 4, 800 women of similar characteristics in the same villages.FindingsWe observed significant improvements in maternal and essential newborn care in intervention areas over time, especially in health care seeking behaviors. The proportion of births taking place at home declined in the intervention districts from 84.3% at baseline to 71.2% at end line (P<0.001). Proportion of deliveries with skilled attendant was higher in intervention districts (28%) compared to comparison districts (27.4%). The number of deliveries was almost doubled at public sector facility comparing with baseline (P<0.001). Significant improvement was also observed in healthy cord care practice, delayed bathing of the new-born and reduction of infant mortality in intervention districts compared to that of comparison districts.ConclusionsThis study demonstrates that community-based efforts offer encouraging evidence and value for combining maternal, neonatal and child health care package. This approach might be considered at larger scale in similar settings with limited resources.

Ascertaining Cause of Perinatal Deaths in A Tertiary Care Hospital

Perinatal mortality rate of Nepal is high indicating poor obstetrics and neonatal care services in the country. Identifying the causes of perinatal deaths would help in identifying the avoidable deaths so that timely interventions can be implemented in future. This study was conducted with the aim of finding out the perinatal mortality rate and its causes at our centre, Manipal Teaching hospital. This is a prospective observational type of study. Perinatal deaths after 28 weeks of gestation and weighing more than 1 kg and neonatal deaths within one week of birth were included. Maternal and neonatal characteristics were studied. Perinatal deaths were classified according to Aberdeen classification of perinatal deaths. Results indicated perinatal mortality rate of 37.6 per 1000 births with more than 60% stillbirths. Mechanical factors during intrapartum period (21.5%) and neonatal factors like prematurity, meconium aspiration and sepsis (22.4%) were major causes of the perinatal mortality. Almost 24% of the perinatal deaths were unexplained and these occurred in macerated stillbirths. Therefore, focus should be on providing quality antenatal care and strict intrapartum surveillance as well as neonatal care to bring down the perinatal deaths. Autopsy should be considered when cause of death is unexplained.