Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

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

Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

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)

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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

Presentation outline

Summary of the newborn sample Newborn care equipment & supplies

inventory findings immediate newborn care findings Neonatal resuscitation results Conclusions

Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

Summary of newborn care sample

Surveyed 177 facilities in 4 countries; observed ~2500 deliveries and ANC consults, and interviewed ~600 health workers

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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

Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

Inventory of supplies for immediate newborn care (n=177)

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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

Inventory of supplies for management of newborn complications

54% of facilities had gentamycin and ampicillin with wide range by country (29-67%)

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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

Essential newborn care: from policy to practice

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(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

Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

Observation of immediate newborn care (n=1095)

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

Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

Non-beneficial and un-indicated newborn care practices

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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

Health worker knowledge of immediate newborn care and management of complication (n=423)

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* Values are mean score

(1) no data for Madagascar; (2) n=555, written test for Ethiopia, simulation for Tanzania, Rwanda, Madagascar

Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

Newborn resuscitation simulations

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(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

Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

Management of Newborn Asphyxia

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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%

Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

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

Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011

Thank you!

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