Reductions in neonatal mortality in a mission hospital in Malawi

1
Reductions in neonatal mortality in a mission
hospital in Malawi

• Marco Linden (MD, DTM)

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Geography
Population 60,496,000 Population12,884,000 (111.
2 per sq km) (108.7 per sq km)
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Significance

• Millennium Development Goal No 4
• Reduce by two thirds the mortality rate among
  children under five

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Some Indicators
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Some Indicators
Sources WHO Statistical information System
(WHOSIS) Ministry of Health Malawi
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Nkhoma, some facts

• Mission hospital, 220 bed
• Deliveries 2,113 (2007)
• Rural population, catchment 60,850
• Referral centre for 12 clinics from 5 of these,
  patients receive free maternal and neonatal care

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Result

• Reduction of hospital neonatal mortality from
  3.8 to 1.6

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Intervention strategy (1)

• PDSA approach (Shewart, Deming cycle)
• In various areas simultaneously

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Intervention strategy (2)

• Reduction cross contamination
• Active case finding
• Protocol led treatment
• Delay reduction by empowerment
• Skills improvement
• Equipment

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Case finding
This neonatal sepsis protocol should be followed
if any of the following is present Temp over
37.5 or less than 36 axillary, respirations gt60
or lt20, grunting, or disseminated pustular
rash.
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Reduce delay
Nurse midwife assesses the patient immediately
and notifies clinician
Give 1st dose antibiotics Ampicilline 50mg/kg
50 x _____ _____mg Time______
Sign Gentamycin 5mg/kg 5 x _____ _____mg
Time______ Sign
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Protocol led treatment

• Plans Check (?) all that apply.
• Give antibiotics for 7-14 days if signs of
  sepsis
• ? If hypoglycaemia
• ? If respiratory distress,
• ? If Pain or
• ? If Convulsing

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Result - review
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Challenges / Sustainability

• Availability of basics, e.g. paper
• Stationary as important as antibiotics
• Enthusiasm of staff
• Repeated reinforcement necessary
• Dependency on individuals
• Ward in-charge to be fully involved

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Conclusion

• As shown, a breakthrough change is possible,
  despite limited resources.
• Sustainability, however, depends largely on a
  continued effort from those directly involved on
  the site of intervention.

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Thank You