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Facility Assessment of Quality of Care for Essential Newborn Care and Neonatal Resuscitation

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Facility Assessment of Quality of Care for Essential Newborn Care and Neonatal Resuscitation in selected African Countries Dr. Joseph de Graft-Johnson, MCHIP/Save the ... – PowerPoint PPT presentation

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Title: Facility Assessment of Quality of Care for Essential Newborn Care and Neonatal Resuscitation


1
Facility Assessment of Quality of Care for
Essential Newborn Care and Neonatal Resuscitation
  • in selected African Countries

Dr. Joseph de Graft-Johnson, MCHIP/Save the
Children Newborn Team Leader
2
Acknowledgments
  • Ministries of Health and staff of the study
    facilities in Ethiopia, Madagascar, Rwanda, and
    United Republic of Tanzania
  • Data collection teams in each country
  • Research team for MCHIP Jim Ricca, Barbara
    Rawlins, Linda Bartlett, David Cantor, Patricia
    Gomez, Heather Rosen, Bob Bozsa
  • MCHIP\jhpiego headquarters and in-country staff,
    Tandem consulting (Madagascar)

2
3
Presentation outline
  • Summary of the newborn sample
  • Newborn care equipment supplies inventory
    findings
  • immediate newborn care findings
  • Neonatal resuscitation results
  • Conclusions

4
Summary of newborn care sample
  • Surveyed 177 facilities in 4 countries observed
    2500 deliveries and ANC consults, and
    interviewed 600 health workers

Sample Ethiopia Tanzania Rwanda Mada-gascar Total
Facilities 19 52 70 36 177
-Hospital 100 29 60 75 58
-Health Center/dispensary 0 71 40 25 42
           
Observations 318 880 604 671 2473
-Deliveries 192 489 293 348 1322
Newborn care 115 419 225 336 1095
-ANC consults 126 391 311 323 1151
           
Health workers interviewed 79 206 146 140 571
Newborn health 79 202 142 132 555
4
5
Inventory of supplies for immediate newborn care
(n177)
5
6
Inventory of supplies for management of newborn
complications
  • 54 of facilities had gentamycin and ampicillin
    with wide range by country (29-67)

6
7
Essential newborn care from policy to practice
(1) SDGs covers all elements of ENC, data missing
for Tanzania and Rwanda (2) births attended by
skilled attendants (3) facilities stocked with
cord ties, sterile scissors, towel/blanket (all
3) (4) personnel knowledgeable in immediate
newborn care (5) personnel received supervision
within last 3 months
7
8
Observation of immediate newborn care (n1095)
  • 24 of deliveries (range 17-40) received all
    essential newborn care elements ()

(1) Ethiopia cuts and ties/clamps cord,
protecting newborn from blade or scissors
9
Non-beneficial and un-indicated newborn care
practices
9
10
Health worker knowledge of immediate newborn care
and management of complication (n423)
(1) no data for Madagascar (2) n555, written
test for Ethiopia, simulation for Tanzania,
Rwanda, Madagascar
10
Values are mean score
11
Newborn resuscitation simulations
(1) Simulation drying, place on warm clean
surface, head in slightly extended position,
suction with bulb or catheter in mouth or nose
(all items) (2) Ventilation place correct size
mask covering chin, moth and nose, squeeze bag
with 2 fingers or hand appropriately, ventilate
at 40 breathes/min (all items) (3) Adjustment
is any proper adjustment check neck position,
check seal, repeat suction, squeeze harder
11
12
Management of Newborn Asphyxia
Item n Percent
Cases of resuscitation observed 148  
     
Type of treatment provided    
-Drying/wrapping 130 88
-Position for resuscitation 117 79
-Use of suction 62 42
-Use of bag and mask 69 47
-Ventilate with oxygen 15 10
     
Outcome of newborn    
-Alive 128 86
-Dead 17 11
12
13
Conclusions
  • Assumption that skilled birth attendance equal
    quality newborn care is obviously not true
  • There is need to improve the quality of newborn
    care for infants delivered at health facilities
  • A sizable percentage of health facilities have
    newborn resuscitation equipment but staff skills
    needs improvement
  • Countries are committed to make these
    improvements and all must play their part
  • to make it happen

14
  • Thank you!
  • wwww.mchip.net
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